To Resheath Or Not To Resheath?
That is the question we get asked on a frequent basis!
Not only do Dental Nurses want to know who is responsible for the dismantling and disposal of sharps but also there is the question from Dentists regarding resheathing.
Can we do it? If not, why not? If so, who is responsible?
In 2003 the NICE guidelines clearly stated the following;
22.214.171.124 Needles must not be recapped, bent, broken, or disassembled before use or disposal.
This indeed meant that resheathing was banned from being completed and that no Dentist was allowed to perform resheathing under any circumstances.
The guidance was reviewed and updated in March 2012.
So why was this updated in March 2012?
In March 2012 the NICE guidelines were reviewed due to the Dental industry needing a little more flexibility due to endodontic treatments etc. Therefore the following revised guidelines now apply.
126.96.36.199 Sharps should not be passed directly from hand to hand, and handling should be kept to a minimum.
188.8.131.52 Used standard needles:
- Must not be bent or broken before disposal.
- Must not be recapped.
In dentistry, if recapping or disassembly is unavoidable, a risk assessment must be undertaken, and appropriate safety devices should be used.
184.108.40.206 Used sharps must be discarded immediately by the person generating the sharps waste into a sharps container conforming to current standards.
220.127.116.11 Sharps containers:
- Must be located in a safe position that avoids spillage, is at a height that allows the safe disposal of sharps, is away from public access areas and is out of the reach of children
- Must not be used for any other purpose than the disposal of sharps
- Must not be filled above the fill line
- Must be disposed of when the fill line is reached
- Should be temporarily closed when not in use
- Should be disposed of every three months even if not full, by the licensed route in accordance with local policy
18.104.22.168 Use sharps safety devices if a risk assessment has indicated that they will provide safer systems of working for healthcare workers, carers, and patients.
22.214.171.124 Train and assess all users in the correct use and disposal of sharps and sharps safety devices.
So what does this mean?
In our terms, this means that the sharps must be disposed of by the Dentist, Hygienist or Therapist.
This must be done in a safe way using a safety device, and the user should be trained on how to do this.
NICE Guidelines click here >
What are your legal obligations as healthcare employers and employees?
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 state:
All employers are required under existing health and safety law to ensure that risks from sharps injuries are adequately assessed and appropriate control measures are in place. The Sharps Regulations builds on the existing law and provide specific detail on requirements that must be taken by healthcare employers and their contractors.
Where it is not reasonably practicable to avoid the use of medical sharps, the Sharps Regulations require employers to:
Use safer sharps (incorporating protection mechanisms) – Regulation 5 (1)(B)
The employer must substitute traditional unprotected medical sharps with a ‘safer sharp’ where it reasonably practicable to do so. The term ‘safer sharp’ means medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury. For example, a range of syringes and needles are now available with a shield or cover that slides or pivots to cover the needle after use.
The following factors should be considered:
- The device must not compromise patient care
- The reliability of the device
- The caregiver should be able to maintain appropriate control over the procedure
- Other safety hazards or sources of blood exposure that the use of the device may introduce
- Ease of use (taking into account the existing clinical practices commonly in use by the relevant health professionals – but not assuming custom and practice is safest)
- Is the safety mechanism design suitable for the application?
The following are relevant:
- If the activation of the safety mechanism is straightforward, it is more likely to be used
- If the safety mechanism is integral to the device – (ie not a separate accessory) it cannot be lost or misplaced
- For many uses, a single-handed or automatic activation will be preferable
- An audible, tactile, or visual signal that the safety mechanism has correctly activated is helpful to the user; and the safety mechanism is not effective if it is easily reversible
‘Safer sharps’ do not necessarily remove all risks associated with the use of sharps.
Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 click here >
Safety Sharp Devices
To help you comply with government legislation, there are many manufacturers that supply these on the market and it is your preference which one suits your needs.
Many safety sharp devices offer complete protection for employees and patients along with having the feel of a normal syringe device so there should not be any interruption to your practice routine when introducing a safety system.
CQC State in "Dental Mythbuster 7: Use of Safer Sharps":
- Employers ensure that risks from sharps injuries are adequately assessed and appropriate control measures are in place.
- There is a written practice policy/protocol in place, including a risk assessment explaining why they continue to use traditional local anaesthetic reusable syringes (see below points)
- The employer should ensure that sharps are only used where they are required.
- The employer must substitute traditional, unprotected medical sharps with a ‘safer sharp’ where it reasonably practicable to do so.
"Dental Mythbuster 7: Use of Safer Sharps" click here >
What do Isopharm recommend?
Be safe and risk assess anything that can cause harm to you, your staff or your patients.