Establishments Order, 2013

L.N. 151 of 2013

PUBLIC HEALTH ACT

(CAP. 465)

Prevention of Sharp Injuries in Hospitals and Health Care

Establishments Order, 2013

IN exercise of the powers conferred by article 27 of the Public

Health Act, the Superintendent of Public Health has made the

following Order:-

The title of this order is the Prevention of Sharp Injuries in Citation.

Hospitals and Health Care Establishments Order, 2013.

In this Order, unless the context otherwise requires

Interpretation.

"employer" means any natural or legal person responsible for

managing, organising and providing healthcare and directly related

services or activities delivered by workers having an employment

relationship with a worker and includes contractors and sub-

contractors;

"hierarchy of measures" means the order of effectiveness of

measures taken to avoid, eliminate and reduce risks as defined in

article 6(2) of the Occupational Health and Safety Authority Act;

"preventive measures" means those measures taken to prevent

injury and, or transmission of infection in the provision of hospital

and healthcare directly related services and activities, including the

use of the safest equipment needed, based on the risk assessment and

safe methods of handling the disposal of medical sharps;

"sharps" means objects or instruments necessary for the exercise

of specific healthcare activities, which are able to cut, prick, cause

injury and, or infection;

"worker" includes any person employed by an employer

including trainees, students and apprentices in the hospital and

healthcare sector and directly related services and activities

irrespective of whether such employment is of a permanent or

temporary nature;

"workers’ representatives" and "workers health and safety

representatives" shall have the same meaning as prescribed in the

Occupational Health and Safety Authority Act and relative subsidiary Cap. 424.

legislation;

"workplace" includes any healthcare organisation or service in

both the public or the private sectors, and every other place where

health services and, or activities are undertaken and delivered, under

the managerial authority and supervision of the employer.

The scope of this Order is to aim at achieving the safest

possible working environment for health care workers by preventing

injuries caused by medical sharps, including needle-stick injuries,

protecting all workers at risk through the establishment of policies in

risk assessment, risk prevention, training, information, awareness

raising and monitoring and putting in place response and follow up

procedures.

The provisions of this Order shall apply to all workers in

the hospital and healthcare sector, and all who are under the

managerial authority and supervision of an employer.

Without prejudice to any obligations under any other law,

it shall be the duty of the employer

(a)

to ensure the safety and health of workers in every

aspect related to their work, including psycho-social factors and

work organisation;

(b) to develop an environment where workers and their

representatives are participating in the development of health

and safety policies and practices;

(c)

to ensure the provision of training on the prevention

of the risk of injuries and infections from medical sharps;

(d) to provide the necessary resources to minimise the

risk of occupationally acquired injuries or infections;

(e)

to promote a no blame culture focusing incident

reporting procedures on systemic factors rather than individual

mistakes.

Without prejudice to any obligations under any other law,

it shall be the duty of the worker

(a)

to take care, as far as possible, of his own safety and

health and that of other persons affected by his actions at work,

in accordance with their training and instructions given by his

employer;

(b) to undertake the training offered by his employer on

the prevention of the risk of injuries and infections from

medical sharps;

(c)

to make use of the resources supplied by the

employer to minimise the risk of occupationally acquired

injuries or infections.

It shall be the responsibility of the employers, workers and Responsible co-

workers’ representatives to work together to prevent and eliminate operation.

risks, protect workers’ health and safety, and create a safe working

environment, carry out consultation regarding the choice and use of

safe equipment, identifying how best to carry out training,

information and awareness-raising processes.

(1) Risk-assessment procedures shall be conducted by Risk

the employer in compliance with the requirements of the General assessment.

Provisions for Health and Safety at Work Places Regulations, and the

Protection of Workers from Risks related to Exposure to Biological S.L. 424.25.

Agents at Work Regulations, and without prejudice to the generality

of the foregoing they shall

(a)

include an exposure determination, taking into

account the importance of a well resourced and organised

working environment;

(b) take into account all situations where there is injury,

blood or other potentially infectious material;

(c)

take into account technology, organisation of work,

working conditions, level of qualifications, work related

psycho-social factors and the influence of factors related to the

working environment.

(2) The aim of the risk assessment shall be to identify how

exposure could be eliminated and to consider possible alternative

systems.

Where the results of the risk assessment carried out in Elimination,

terms of regulation 9 reveal a risk of injuries by medical sharps and, prevention

protection.

or infection, workers’ exposure shall be eliminated by implementing

the following measures

(a)

the specification and implementation of safe

procedures for the use and disposal of sharp medical

instruments and contaminated waste; such procedures shall be

regularly reassessed and shall form an integral part of the

measures for the information and training of workers referred to

in this Order;

(b) the elimination of the unnecessary use of sharps by

implementing changes in practice and on the basis of the results

of the risk assessment, providing medical devices incorporating

safety-engineered protection mechanisms;

(c)

the banning of the practice of recapping with

immediate effect;

(d) the placing of effective disposal procedures and

clearly marked and technically safe containers for the handling

of disposable sharps and injection equipment as close as

possible to the assessed areas where sharps are being used or to

be found;

(e)

the prevention of the risk of infections by

implementing safe systems of work, by

(i) developing a coherent overall prevention

policy, which covers technology, organisation of work,

working conditions, work related psycho-social factors and

the influence of factors related to the working

environment;

(ii) providing the necessary training;

(iii) conducting health surveillance procedures, as

provided by the Protection of Workers from Risks related

to Exposure to Biological Agents at Work Regulations; and

(f)

the use of personal protective equipment.

(1) If the assessment referred to in regulation 9 reveals

that there is a risk to the safety and health of workers due to their

exposure to biological agents for which effective vaccines exist, then

it shall be the duty of the employer to offer vaccination to the

(2) Vaccination and, if necessary, re-vaccination shall be

carried out in accordance with the schedules and recommendations

established by the Superintendent of Public Health

Provided that workers shall be informed of the benefits and

drawbacks of both vaccination and non-vaccination and that the

vaccination is offered free of charge to all workers.

As regards sharps it shall be the duty of the employer,

without prejudice to any other obligation under any other law, to take

the appropriate measures to

(a)

highlight the different risks;

(b)

give guidance on existing legislation;

(c)

promote good practices regarding the prevention

and recording of incidents and, or accidents;

(d) raise awareness by developing activities and

promotional materials in partnership with representative trade

unions and, or workers’ representatives;

(e)

provide

information

on

support

programmes

available.

(1) In addition to those measures established under the Training.

Occupational Health and Safety Authority Act and its subsidiary Cap. 424.

legislation, employers shall provide the necessary training on a

regular basis taking into account results of monitoring, modernisation

and improvements including

(a)

the correct use of medical devices incorporating

sharps protection mechanisms;

(b)

induction programmes for all new and temporary

staff;

(c)

the risk associated with blood and body fluid

exposures;

(d) preventive measures including standard precautions,

safe systems of work, the correct use and disposal procedures,

the importance of immunisation, according to the procedures at

the workplace;

(e)

the reporting, response and monitoring procedures

and their importance; and

(f)

measures to be taken in case of injuries.

(2) Employers shall ensure that workers are released in order

to attend the training provided.

(1) The employer shall set up a procedure whereby all Reporting.

sharp injuries can be reported. This shall be done in consultation with

the workers’ health and safety representatives.

(2) It shall be the responsibility of workers to immediately

report any accident or incident involving sharps to the employer or to

any other person so delegated by him.

Upon receipt of a report of an injury, the employer shall

(a)

immediately take the necessary steps for the care of

the injured worker, including the provision of post-exposure

prophylaxis and the necessary medical tests where indicated for

medical reasons, and the appropriate health surveillance in

accordance with the Protection of Workers from Risks related to

Exposure to Biological Agents at Work Regulations;

(b) investigate the causes and circumstances leading to

the injury and record the accident or incident, taking, where

appropriate, the necessary action; workers shall provide the

relevant information at the appropriate time to complete the

details of the accident or incident;

(c)

consider the need for counselling of workers, where

appropriate, and guarantee medical treatment;

(d) maintain the confidentiality of the injured worker

and the diagnosis and treatment resulting from the injury.

It shall be the duty of all employers to ensure compliance

with the provisions of this Order.

Without prejudice to the provisions of any other law, any

breach of these regulations shall be deemed to be a breach of the

Public Health Act and shall be subject to the penalties contained in

the said Act.

€0.54