The Three Laws: Sharps Safety
The Three Laws: Sharps Safety

In Isaac Asimov’s writings about science, he created “the three laws,” a set of rules designed by humans that robots must follow in that fictional society. Robots cannot harm human beings, they must obey humans (unless it conflicts with the first law), and they must protect themselves from harm (unless that conflicts with the first two laws).  With those in place, there should be no issues with the use of robots in society, but bending those laws provided interesting plots for many books and movies. There are three laws for sharps safety as well, but breaking those laws can be far more dangerous for healthcare workers.

It is not an exaggeration to call the safety guidelines about medical sharps “laws.” In the United States the Occupational Health and Safety Administration (OSHA) has created regulations about sharps which are found in the Bloodborne Pathogens standard. The safety rules from OSHA regarding needles and other sharps can be broken down into at least two sets of “three laws” for the sake of simplicity.

The first set of rules surrounds the actual use of sharps in healthcare. Needles cannot be recapped, bent, or sheared in any way (unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical procedure). The practice is dangerous, and it needs to be avoided whenever possible. Needles and sharps need to placed into sharps containers as soon as possible after use. The longer a used sharp remains in the open, the more a risk for an exposure increases. The third law about sharps discusses the need to report needlestick injuries and exposures to OSHA. The employer is required to maintain a sharps injury log for the recording of injuries from contaminated sharps. The information in the sharps injury log must be recorded and maintained in such manner to protect the confidentiality of the injured employee. The log has to contain information about the type and brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the needle stick incident occurred.

The second set of three laws are about the actual containers used for sharps disposal. OSHA requires that that these containers are puncture-resistant and leak-proof. The containers must be labeled as biohazard, and they must have a lid on them at all times. Sharps containers must be prevented from tipping as well. That can be done by using carts or “dishes” which support the container.  Containers must be placed as near to areas where needles and other sharps are used as possible. Make it convenient and easy for staff to use the containers where they are needed. A fourth “law” that is largely unwritten is that sharps containers should be closed and replaced once they become at least ¾ full. Overfilling a sharps container is dangerous and has led to many unknown source exposures. Train staff to always replace full sharps containers quickly.

Breaking the laws regarding sharps can bring fines, and OSHA will certainly investigate an organization if many needle stick exposures are reported. The consequences for an exposed employee, however, can be far worse than any monetary punishment. Exposures from known sources have the advantage of being abler to obtain the disease status of the source patient(s). However, if the patient carries a bloodborne pathogen, specific treatments (not all pleasant) will be needed. Exposures from unknown sources are worse. Prophylactic treatment must occur since there is no way to test a source. For example, if someone is stuck after placing a needle into a full container, they cannot know which patient is the source. The prophylactic drugs used in these exposure cases cause unpleasant side effects, and if that can be avoided, it should.

In science fiction, bending or breaking the laws can create interesting and engaging stories. In the real world of healthcare, breaking the laws about sharps safety has only awful consequences. The stories are never good, and even if they have a happy ending (the source patient is negative for disease, for example), the cost of the testing and the personal stress are better if avoided altogether. Follow the sharps safety laws, and all employee safety stories can have a happy ending.

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