{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Managing Sharps Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} effectively and safely manages the use, handling, storage, and disposal of sharps within its supported living services. This policy is in line with the latest Care Quality Commission (CQC) regulations, the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, and best practices to prevent injury, infection, and contamination.

Proper management of sharps is essential to protecting staff, service users, and visitors from the risks associated with needlestick injuries and exposure to bloodborne pathogens. This policy sets out clear guidance on procedures for handling sharps, staff training, risk assessments, and compliance monitoring to ensure a safe and efficient care environment.

2. Scope

This policy applies to all employees, agency workers, volunteers and other persons working under the supervision or direction of {{org_field_name}} who use, handle, dispose of, or may reasonably be exposed to sharps while carrying out their duties.

For the purposes of this policy, the responsibilities of {{org_field_name}} will be applied according to the nature of the activity and the degree of control exercised by the organisation.

Where staff employed by {{org_field_name}} use medical sharps as part of the care or treatment provided to a person, including where a healthcare task has been appropriately delegated to a care worker, {{org_field_name}} will ensure that:

• the activity has been appropriately risk assessed;
• the member of staff has received appropriate information, instruction and training;
• the member of staff has been assessed as competent to undertake the task safely where competency assessment is required;
• suitable equipment and safer sharps are used so far as is reasonably practicable;
• appropriate sharps disposal arrangements are available at or close to the point of use; and
• arrangements are in place for responding to and reporting any sharps injury or exposure incident.

Where an external healthcare professional uses sharps while visiting a person receiving support, the external healthcare professional remains responsible for following their employer’s arrangements for the safe use and disposal of those sharps. Staff must not routinely accept responsibility for disposing of sharps generated by an external healthcare professional unless responsibility has been expressly agreed and suitable arrangements are in place.

Where a person receiving support self-administers medication or independently carries out an activity that generates sharps waste, their care and risk assessment must, where {{org_field_name}} is involved in supporting that activity, consider the safe use, storage and disposal of sharps. The person’s independence must be supported while reasonably foreseeable risks to the person, staff and others are appropriately managed.

This policy includes:

• the prevention of avoidable sharps use;
• the selection and use of safer sharps;
• safe handling and disposal;
• the prevention of needle recapping;
• suitable sharps containers and waste arrangements;
• infection prevention and control precautions;
• risk assessment;
• staff information, instruction, training and competency;
• action following a sharps injury or exposure to blood or body fluids;
• incident recording, investigation and external reporting where legally required; and
• monitoring and review of sharps-related risks and control measures.

3. Legal and Regulatory Compliance

3.1 Legal and Regulatory Framework

{{org_field_name}} will manage risks associated with sharps in accordance with the legislation applicable to its activities, including:

• the Health and Safety at Work etc. Act 1974;
• the Management of Health and Safety at Work Regulations 1999;
• the Control of Substances Hazardous to Health Regulations 2002;
• the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, where those Regulations apply to the healthcare activity being undertaken;
• the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013;
• the Health and Social Care Act 2008;
• the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in particular Regulation 12, Safe Care and Treatment, Regulation 17, Good Governance, and Regulation 18, Staffing;
• the Care Quality Commission (Registration) Regulations 2009, including statutory notification requirements where applicable; and
• applicable environmental and waste legislation governing the classification, storage, transfer and disposal of healthcare and sharps waste.

{{org_field_name}} will also have regard to current CQC, Health and Safety Executive, Department of Health and Social Care, UK Health Security Agency and Environment Agency guidance relevant to sharps management and infection prevention and control.

3.2 Risk Management and Employer Responsibilities

{{org_field_name}} will assess the risks arising from the use, handling, storage and disposal of sharps and from reasonably foreseeable accidental exposure to used sharps.

Risk assessments must:

• identify who may be harmed and how;
• consider whether use of a medical sharp can be avoided;
• where a medical sharp is required, consider whether a safer sharp can reasonably be used;
• consider risks arising from the use, handling, transport, storage and disposal of sharps;
• consider the risk of exposure to blood-borne viruses and other biological agents;
• consider appropriate infection prevention and control measures;
• consider whether hepatitis B vaccination or other occupational health measures are indicated following assessment of occupational exposure;
• identify appropriate arrangements for emergency response and access to medical advice following an exposure incident; and
• be reviewed when circumstances change, following a relevant incident, or where there is reason to believe that existing control measures are no longer effective.

Staff must receive the information, instruction, training, supervision, equipment and support necessary to carry out their duties safely.

4. Safe Use and Handling of Sharps

4.1 Identification of Sharps Sharps include but are not limited to:

• Needles used for injections, vaccinations, or blood tests.
• Syringes that come with fixed or detachable needles.
• Lancets used for blood glucose testing.
• Scalpels and other cutting instruments used in medical procedures.
• Broken glass that may cause injury if not disposed of correctly.
• Razor blades used for grooming or medical purposes.

4.2 Safe Handling Procedures

The use of medical sharps must be avoided so far as is reasonably practicable. Where a medical sharp is necessary, a safer sharp incorporating a mechanism designed to prevent or minimise accidental injury must be used so far as is reasonably practicable.

Before using a sharp, staff must be familiar with the equipment, the person’s care plan and risk assessment, and any applicable safe system of work or delegated healthcare instructions.

Only staff who have received appropriate training and, where required, have been assessed as competent may undertake a task involving the use of medical sharps.

Needles must not be recapped after use. Recapping is permitted only in the exceptional circumstance where a suitable and sufficient risk assessment has identified that recapping is required to control another risk and the risk of sharps injury is effectively controlled by the use of a suitable appliance, tool or other equipment. Manual two-handed recapping must not be used.

Sharps must:

• be handled as little as possible;
• not be passed unnecessarily from hand to hand;
• not be bent, broken or otherwise manipulated by hand after use;
• be disposed of immediately after use, or as soon as reasonably practicable, into the correct sharps container;
• be disposed of at the point of use wherever reasonably practicable; and
• never be left unattended or placed on surfaces where another person may accidentally come into contact with them.

Written instructions for the safe disposal of medical sharps and clearly marked, secure sharps containers must be available close to the areas where medical sharps are used where {{org_field_name}} is responsible for the healthcare activity.

Where a person self-administers medication or otherwise uses sharps independently, staff must follow the person’s agreed care plan and risk assessment and must not unnecessarily restrict the person’s independence.

5. Safe Storage and Disposal of Sharps

5.1 Sharps Containers and Storage

Sharps must be disposed of into an appropriate purpose-designed sharps container suitable for the type of waste being generated.

Sharps containers must:

• be of an appropriate specification for their intended use;
• be puncture-resistant and sufficiently leak-resistant for their contents;
• be clearly identifiable;
• be correctly assembled and labelled where required;
• be positioned safely and, when in use, as close as reasonably practicable to the point where sharps are generated;
• be positioned so that they do not create an additional risk of injury;
• be kept out of unauthorised access, including access by children or other people who may be at risk;
• have the temporary closure mechanism used when appropriate while the container is not actively in use; and
• be permanently closed and removed from use when the manufacturer’s marked fill line is reached.

Sharps containers must never be overfilled. Staff must never push, compress or force sharps further into a sharps container and must never place their hands inside a sharps container.

Where sharps containers are awaiting collection, they must be stored securely so that they are protected from unauthorised access, accidental damage, spillage or interference.

5.2 Disposal and Waste Management

Sharps must never be disposed of in general household waste, recycling bags or ordinary waste bins.

Sharps waste must be appropriately classified and segregated according to its contents, including whether the sharp is contaminated with medicines, infectious material, or cytotoxic or cytostatic medicines.

Where {{org_field_name}} generates or takes responsibility for healthcare sharps waste, suitable arrangements must be made for lawful collection, transfer and disposal through an appropriately authorised waste collection or disposal service.

Where a visiting healthcare professional generates sharps waste while providing healthcare to a person receiving support, the professional should dispose of that waste through their own organisation’s approved sharps disposal arrangements unless an alternative arrangement has been formally agreed.

Where a person generates sharps through self-administration, appropriate arrangements must be made for a dedicated sharps container and lawful collection or disposal. This may include arrangements through the relevant local authority, healthcare service, pharmacy or other authorised service, depending on local arrangements.

Staff must follow the applicable waste segregation system and must not assume that all sharps waste is disposed of through the same waste stream.

Waste transfer, collection and disposal documentation required by applicable waste legislation must be retained by {{org_field_name}} where the organisation is the waste producer or otherwise has responsibility for the waste.

6. Prevention of Sharps Injuries

6.1 Information, Training and Competency

Employees who are exposed to a risk of injury from medical sharps must receive information and training appropriate to their role and to the work they carry out.

Information provided to relevant staff must include:

• the risks associated with injuries involving medical sharps;
• the legal requirements relating to protection from sharps injuries, including relevant employer and employee responsibilities;
• good practice for preventing sharps injuries;
• information relevant to vaccination against blood-borne diseases, including the benefits and potential consequences of vaccination and non-vaccination where occupational exposure creates such a risk; and
• the support available from {{org_field_name}} following a sharps injury.

Training must include, where relevant to the person’s duties:

• safe use and disposal of medical sharps;
• correct use of safer sharps;
• the actions to take following a sharps injury or exposure to blood or body fluids;
• incident reporting procedures;
• the medical, occupational health, health surveillance and follow-up arrangements that may apply following an exposure incident;
• infection prevention and control precautions; and
• the safe use of any personal protective equipment required following risk assessment.

Training and competency must be provided before a member of staff undertakes an activity involving sharps independently.

Where a healthcare task involving sharps has been delegated to a care worker, the worker must receive task-specific training and must have their competency assessed in accordance with the delegation arrangements before undertaking the task without appropriate supervision.

Training needs and competency must be reviewed at appropriate intervals and following any relevant incident, change in equipment, change in procedure, identified deficiency in practice or other indication that further training or assessment is required.

6.2 Hierarchy of Controls, Safer Sharps and PPE

{{org_field_name}} will apply the hierarchy of controls when managing sharps risks.

Medical sharps must be avoided where their use is not necessary. Where their use cannot reasonably be avoided, safer sharps must be used so far as is reasonably practicable.

The suitability of safer sharps must be considered as part of risk assessment and procurement arrangements. Staff must be appropriately trained in the activation and safe disposal of any safety mechanism incorporated into the device.

Personal protective equipment must be selected on the basis of risk assessment and the nature of the activity. PPE must not be regarded as a substitute for avoiding unnecessary sharps use, using safer sharps, safe working practices or immediate disposal.

Appropriate disposable gloves must be worn where there is a risk of contact with blood or body fluids. Additional PPE, such as an apron, protective clothing or eye and face protection, must be used where the risk assessment identifies a risk of contamination or splashing.

The effectiveness of sharps safety measures must be reviewed at suitable intervals and following incidents, changes in practice or the availability of relevant safer equipment.

7. Responding to a Sharps Injury or Exposure Incident

7.1 Immediate First Aid

Where a person suffers a sharps injury from a sharp that is, or may be, contaminated with blood or another potentially infectious body fluid, the following action must be taken immediately:

• encourage the wound to bleed gently, preferably while holding it under running water;
• wash the wound using running water and plenty of soap;
• do not scrub the wound;
• do not suck the wound;
• dry the wound and cover it with a waterproof plaster or dressing;
• where there has been a splash to the eyes or other mucous membranes, irrigate the affected area promptly with appropriate clean water or saline; and
• seek urgent medical advice in accordance with the organisation’s exposure procedure.

The incident must be reported to {{org_field_name}} as soon as practicable.

7.2 Medical Advice, Treatment and Support

Where a member of staff has suffered an injury from a medical sharp that exposed, or may have exposed, them to a biological agent, {{org_field_name}} must take immediate steps to ensure that the employee receives medical advice.

Any treatment advised by a registered medical practitioner, including post-exposure prophylaxis where clinically indicated, must be made available to the employee.

The need for relevant testing, hepatitis B vaccination or booster arrangements, post-exposure prophylaxis, follow-up testing and occupational health review must be determined by an appropriately qualified healthcare professional.

The policy must not assume that post-exposure prophylaxis is available or appropriate for every blood-borne virus. Clinical assessment and treatment must be based on the nature of the exposure and current clinical guidance.

{{org_field_name}} must consider whether counselling or other psychological support should be offered to an employee following a sharps injury.

Confidentiality relating to the injured employee and the source person’s health information must be maintained in accordance with applicable information governance and data protection requirements.

7.3 Recording, Investigation and Preventative Action

Every work-related injury involving a medical sharp that is notified to {{org_field_name}} must be recorded.

{{org_field_name}} must:

• investigate the circumstances and cause of the incident;
• identify whether existing risk controls were adequate and were being followed;
• determine whether safer equipment or changes to working practices are required;
• take any action necessary to prevent recurrence;
• update relevant risk assessments, care plans, procedures or training where required; and
• maintain an appropriate record of the incident and resulting actions.

Staff must provide sufficient information about the circumstances of the incident to enable {{org_field_name}} to investigate and discharge its legal responsibilities.

7.4 RIDDOR and CQC Notifications

The responsible manager must assess every relevant sharps incident to determine whether it is reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013.

A sharps incident must be reported under RIDDOR where the statutory reporting criteria are met. This includes, where applicable:

• a sharps injury involving blood or body fluid known to be infected with a blood-borne virus where this constitutes a reportable dangerous occurrence;
• a work-related sharps injury resulting in a reportable injury or the required period of incapacity; or
• a diagnosed disease attributable to occupational exposure to a biological agent.

A sharps injury is not automatically RIDDOR-reportable solely because a needlestick or sharps injury has occurred. The responsible manager must apply the current HSE reporting criteria to the circumstances of the incident.

Where an incident involves a person using the service, the registered person must also determine whether the incident meets a statutory notification requirement under the Care Quality Commission (Registration) Regulations 2009. Where the statutory threshold is met, the required notification must be submitted to CQC without delay in accordance with the applicable regulation.

Any safeguarding concern arising from a sharps incident must be managed in accordance with {{org_field_name}}’s safeguarding procedures and referred to external agencies where required.

8. Monitoring and Compliance

8.1 Compliance Monitoring and Quality Assurance

{{org_field_name}} will establish and operate systems to assess, monitor and improve the safety of sharps management and to identify, assess and mitigate risks to people receiving support, staff and others.

Monitoring will include, where relevant:

• review of sharps-related incidents, near misses and exposure events;
• confirmation that required incident investigations and preventative actions have been completed;
• review of relevant RIDDOR and CQC notifications;
• review of staff training and competency records;
• checks that appropriate sharps containers are available and used correctly;
• checks that sharps containers are not being overfilled and are securely stored;
• monitoring of compliance with waste segregation and disposal arrangements;
• review of person-specific risk assessments relating to self-administration or delegated healthcare tasks;
• review of the availability and effectiveness of safer sharps; and
• confirmation that actions arising from audits and incidents have been completed.

Any identified deficiency that could place a person at risk must be addressed within a timescale proportionate to the level of risk.

Records of monitoring, incidents, investigations and resulting actions must be accurate, complete, appropriately retained and available for regulatory review where required.

8.2 Staff and Management Responsibilities

All staff must:

• comply with this policy and relevant risk assessments and care plans;
• use equipment in accordance with their training;
• immediately report defective equipment or unsafe sharps arrangements;
• report sharps injuries and exposure incidents as soon as practicable;
• cooperate with incident investigations; and
• raise concerns where they believe sharps are being used, stored or disposed of unsafely.

Managers must ensure that:

• appropriate risk assessments are in place;
• staff receive the required information, training, supervision and competency assessment;
• suitable sharps equipment and disposal arrangements are available;
• incidents are recorded, investigated and acted upon;
• occupational health or urgent medical advice is available following an exposure incident;
• statutory external reporting is completed where required; and
• this policy and associated procedures remain effective and up to date.

9. Related Policies

• SL02 – Infection Prevention and Control Policy
• SL07 – Health and Safety Policy
• SL13 – Risk Assessment and Incident Reporting Policy
• SL19 – Staff Training and Competency Policy
• SL25 – Waste Management and Environmental Policy

10. Policy Review

This policy and the procedures used to manage sharps will be formally reviewed at least annually and at suitable intervals necessary to ensure that arrangements remain effective.

An earlier review must be undertaken where appropriate following:

• a sharps injury, exposure incident or significant near miss;
• identification of a deficiency in existing controls;
• a relevant change in legislation, regulatory requirements or authoritative national guidance;
• the introduction of new sharps equipment or safer-sharps technology;
• a significant change in the people supported or the healthcare activities undertaken by the service; or
• evidence from audit, investigation or risk assessment that the existing arrangements may no longer adequately control the risk.

Any required amendments must be communicated to relevant staff and associated training, risk assessments, care plans and procedures updated where necessary.

---

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.