[Pharmwaste] FW: Med Take Backs, Needlesticks, and Other Risks

[Tenace, Laurie]

Please note that this email did not originate with me - Laurie





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From: Jaramillo, Jeanie [mailto:Jeanie.Jaramillo at ttuhsc.edu]
Sent: Sunday, April 29, 2012 10:21 PM
To: pharmwaste-bounces at lists.dep.state.fl.us
Subject: Med Take Backs, Needlesticks, and Other Risks

Hello All,

This list serve in an invaluable tool for all of us to communicate our experiences.  As the director of a med take back program, I wanted to share information with the group regarding needlesticks.  First, for our program, we require a 1.5 hour training session for all volunteers.  In this session, we go through our mission & goals, event layout and flow, and safety precautions and risks.  We inform the volunteers that there are risks to assisting with our community take back programs and that these risks include potential needlesticks, car vs. pedestrian injury, and assault.  We also have all volunteers sign liability waivers acknowleging that they are aware of the risks up to and including death (reviewed by our university's legal dept with all the added legal terminology).  People laugh, but I was extremely greatful that we go to these extremes when at our 18th Medication Cleanout on April 21st we had our first volunteer suffer a needlestick.

I understand that some of your programs/state or local regulations prohibit the collection of sharps, but these items can appear regardless.  Although we do not advertise to accept sharps, we do accept them and receive them at every event.  Our first survey question to participants is "Did you bring any needles, sharps, lancets today?"  If they answer yes and they do not have these items already contained within a soda bottle, coffee can, or other container; we hand them a sharps container and ask THEM to insert their sharps.  That being said, the circumstances regarding this incident are as follows: a particpant brought a box of medications to the event.  Contained in the top of the box was a plastic grocery bag with the handles tied together.  The volunteer, who was wearing gloves, grasped the bulk of the bag and received a needle stick.  The puncture site bled immediately and he removed the glove and washed his hands thoroughly with soap and water.  I inspected the bag further and noted that it contained about 30 3cc syringes; all with the plungers depressed - all were capped except the one that resulted in the stick.  There was no visible residue in the syringes, but since they were not contained in their packages, we assumed they were used.

At the following week's event on the 28th, one of volunteers found an exposed needle while visually inspecting a collection of medications that were dumped into a black plastic garbage bag.  We were able to carefully remove this syringe and place it in a sharps container without incident.

I share this info with you in the hopes that you all have policys/procedures in place for needlesticks or will take these measures if you do not.  Our university does have a procedure in place, but we still learned a lot from this incident.  If you don't have a policy in place yet, there are guidelines for post-exposure prophylaxis on the CDC website: http://www.mpaetc.org/downloads/PEP%20final%20(2006).pdf

Also, consider contracting with a local hospital or university team for the management of needle sticks.  Perhaps they would do this on an in-kind basis for events such as one day take backs or they might charge a one-time fee per event.  It is much better to have this lined up ahead of time because an ER visit will likely be much more costly (I've heard up to $1,100) as compared to a local lab with a contracted service (~$150).  Dependent on the circumstances, victims of needlestick may need to have labs drawn within 24 hours of a stick.

As for other risks, we warn volunteers of the car vs. pedestrian injury risk because we conduct curbside surveys at each event (our events are drive thru).  Often, a line of cars accumulates and we have multiple surveyors working....so we ask them to avoid walking in front of or between vehicles if possible and if it becomes necessary, to be sure to make eye contact with driver(s) before walking in front of their car(s).  We also have surveyors wear neon safety vests to increase visibility.  We warn about the potential for our events to be targeted for theft by drug seekers and advise that should anyone be approached by someone with a gun, knife, etc. to turnover what they ask for.  Armed officers are on-site for all of our events - in most cases we have a marked patrol car & officer in the parking lot and another at the indoor, secure (no public) processing area for the processing of controls.

If any others of you can share "lessons learned" that may help the rest of us, it's appreciated.

Jeanie Jaramillo, PharmD
Managing Director, Texas Panhandle Poison Center Director, Medication Cleanout Assistant Professor, Texas Tech UHSC School of Pharmacy
1501 S. Coulter St.
Amarillo, TX 79106
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