[Sqg-program] Sharps collection in medical facilities, pharmacies, and HHW centers/events

[Gleason, Irene]

FYI
Sharp Solutions for a Sticky Problem
Growing problem associated with improper needle disposal highlights the =
need
for new, safer disposal methods
By Ben Hoffman, MD - chief medical officer for Waste Management Inc.
The Problem
More than three billion injections and other skin punctures using =
"sharps" --
the medical term for hypodermic needles, syringes, lancets and anything =
that
is used to cut or penetrate skin -- occur outside of healthcare settings
every year to treat numerous conditions, including: diabetes, hepatitis,
multiple sclerosis, infertility, migraines and allergies. Only a =
fraction of
these needles are disposed of properly and advances in healthcare and =
the
desire of patients to receive medical care in their home are causing a =
rise
in the legal use of self-injected drugs. This increase is expected to
multiply dramatically over the next decade, with the Center for Disease
Control projecting that more than seven percent of the U.S. population =
will
have diabetes by 2050.
This rise in self-care poses a potential threat to community members.
Janitors, housekeepers, waste workers and even neighborhood children are =
at
risk of injury and infection when needles are discarded improperly =
inside or
outside of the waste stream. As a result, communities are faced with the
growing need to provide a means for self-injectors to safely dispose of =
their
used needles and syringes.
Despite the growing problems associated with improper needle disposal --
transmittal of blood-borne pathogens, including HIV, the virus that =
causes
AIDS, as well as hepatitis B & C -- there are currently no federal
regulations for safe needle disposal. While some states and local =
governments
do have disposal guidelines, laws or regulations, they are often =
ineffective,
unclear or even conflicting, and are little more than a source of =
confusion
for self-injectors. (State-by-state regulations, as well as additional
regulatory links, are available for review online at
www.epa.gov/epaoswer/other/medical
<http://www.epa.gov/epaoswer/other/medical>.)
The mail back program is a comprehensive home or commercial setting =
solution
for collecting, transporting and disposing of needles and syringes by
collecting used sharps in puncture- and leak-resistant containers and
treating them at a dedicated sharps destruction facility.
At the federal level, the transportation of hazardous materials, which
include medical waste, is regulated by the U.S. Department of =
Transportation
(DOT) (Regulations available at hazmat.dot.gov/rules.htm
<http://hazmat.dot.gov/rules.htm>). According to the U.S. DOT, there are =
a
number of requirements for the packing and transporting of infectious
substances and regulated medical waste. The requirements, however, apply =
only
to commercial activity -- healthcare facilities, waste haulers, =
treatment and
disposal companies -- not self-injectors.
The U.S. Postal Service (USPS) also outlines regulations for =
transporting
infectious materials in the Domestic Mail Manual. The USPS has adopted =
the
U.S. DOT rules for packaging and added tracking requirements =
(pe.usps.gov
<http://pe.usps.gov>). Again, these regulations where created to apply =
to
commercial facilities and not self-injectors.
EPA guidelines and the medical community recommend that self-injectors =
place
used needles in a bleach bottle and throw the sealed bottle in the =
trash.
However, this practice has become problematic. Plastic containers break =
open
as soon as they are compacted in a garbage truck, leaving needles loose =
and
increasing the likelihood for needle-stick injuries, and expanded =
recycling
of plastic containers puts sanitation workers at risk when these =
containers
get mixed in with recyclables. Another problem with putting used needles =
in
household plastic containers is that they are sought after by illicit
intravenous drug users who will reuse the needles and increase the =
spread of
blood-borne disease. Finally, needle disposal is a problem for people =
with
active lives who will not have a plastic container with them when they =
need
to self-inject while out, leaving them with no choice but to dispose of =
their
used needles by throwing them in the trash or flushing them down the =
toilet.
One Solution
A January 2001 meeting on the issue of safe community needle disposal at =
the
American Pharmaceutical Association in Washington D.C. was the beginning =
of a
national effort to develop a solution to this problem. Thirty attendees =
from
organizations with an interest in the issue identified public health
implications of unsafe sharps disposal and described current community
efforts to promote the safe disposal of needles as inadequate. The group
concluded that unsafe sharps disposal is widespread and that the =
populations
most at risk are environmental services employees in the solid waste and
wastewater sectors, hospitality employees and children. The group also
concluded that public attitudes about needle disposal need to change to
reflect the belief that placing needles in the trash is unacceptable. =
Above
all the group determined the need to create effective, inexpensive and =
widely
available methods for people to dispose of needles and sharps without =
putting
them in their communities? solid waste systems.
Mail back systems provide a simple, cost-effective and highly =
confidential
way of managing the collection and disposal of home-generated sharps =
waste.
The Coalition of Safe Community Needle Disposal, a non-profit =
organization
dedicated to finding a solution for this serious public health issue, =
came
out of this meeting. Recently, the organization issued a "Call to =
Action" for
their members to initiate new safe needle disposal practices in urban,
suburban and rural communities nationwide. The coalition will work to =
educate
individuals and policy makers about alternatives and options available =
to
communities to assure safe needle disposal. In addition, the coalition =
will
use advocacy and education to support guidelines that may be used by =
federal,
state and local officials to develop locally-tailored programs for safe
community disposal of used sharps.
Recently Waste Management, Becton, Dickinson and Co. and Sharps =
Compliance
teamed up to provide self-injectors with a safe, effective, discrete and
affordable solution option for safe needle disposal with the Sharps =
Disposal
By Mail System(tm). The mail back program is a comprehensive home- or
commercial setting solution for collecting, transporting and disposing =
of
needles and syringes by collecting used sharps in puncture- and
leak-resistant containers, like those used by health professionals, and
treating them at a dedicated sharps destruction facility. Once the =
container
is destroyed, documentation that the container was received and =
destroyed is
issued to the customer.
This system is currently available to Waste Management's residential and
commercial customers across the country. The same mail back program is =
also
available in more than 55,000 pharmacies nationwide and includes a =
national
education campaign promoting safe sharps disposal to communicate to the
public the potential hazards of improper needle disposal.
The Future
There are numerous advantages to using the mail back system; however the
primary benefit is that this solution option provides for sharps =
disposal in
a way that isolates and removes them from the general public, thus
eliminating the possibility of injury and infection from a needle-stick =
for
families and community members while providing the patient with a =
convenient
and confidential disposal method. A pre-paid postage package, approved =
for
shipment through the U.S. Postal Service, is provided in order to send =
full
containers to the destruction facility, where it is incinerated. =
Customers
receive certified proof of destruction once the container and its =
contents
are destroyed. In short, mail back systems provide a simple, =
cost-effective
and highly confidential way of managing the collection and disposal of
home-generated sharps waste.
Janitors, housekeepers, waste workers and even neighborhood children are =
at
risk of injury and infection when needles are discarded improperly =
inside or
outside of the waste stream.
Ensuring personal and public safety by properly disposing of used =
needles and
syringes is a national effort that is gaining momentum on all fronts. =
>From a
work-related compliance standpoint, this is a high priority for =
employers and
risk managers. Recently, Occupational Safety and Health Administration =
(OSHA)
published regulations stating that all work-related needle stick =
injuries and
cuts from sharps objects that are contaminated with another person's =
blood or
potentially infectious material must be recorded. They have defined
potentially infectious materials as blood-borne pathogens including =
human
bodily fluids, tissues and organs, as well as materials infected with =
HIV or
hepatitis B or C. If a person receives a work-related needle stick and =
is
later diagnosed with an infectious blood-borne disease, the log must =
reflect
this information as well. In addition, diabetes educators are working in
conjunction with doctors to provide a better disposal alternative for =
their
patients. On a national front, the Coalition for Safe Community Needle
Disposal is working with lawmakers and lobbyist to draft legislation to
prohibit disposal of used sharps in the waste system. There is also an
effort, on local and national levels, to gain the support of third party
payers in order to provide coverage for mail back programs.
As part of this growing national trend, and prompted by the large number =
of
improperly disposed of needles, members of several California =
organizations
have formed the Alameda County Sharps Coalition. Along with the national
coalition efforts, the Alameda County Sharps Coalition is working to =
develop
and implement a program on a local level that is user-friendly, ensures
worker safety, allows for the greatest amount of sharps diversion from =
the
landfills and is fiscally sound. The group has identified mail back =
disposal
as the best method for removing needles from the Bay Area and has begun =
to
seek funding to support new safe needle disposal practices.
The Alameda County Sharps Coalition is building on the experience of two
successful Sharps Compliance Inc./Waste Management Inc. pilot programs. =
In
California, mail back sharps disposal units were offered for sale to
consumers in local pharmacies and for purchase through Waste Management =
Inc.
While in Iowa, Waste Management and Sharps Compliance initiated a safe
disposal program for three communities with the goal of educating the
community about the health risks of improperly disposed of needles. The
program used a state grant to provide residents with mail back systems =
free
of charge. The primary focus of the program was to educate =
self-injectors
about safe needle disposal practices and to provide a model for safe,
effective handling of used sharps in the future.
Of those consumers participating in the pilot mail back program in
California, 40 percent have reordered new disposal units. The Alameda =
Sharps
Coalition believes that with results like these, the residents of =
Alameda
County will benefit not only by increased diversion of sharps from area
landfills, but also by improving the quality of life of the community as =
a
whole.
The need for new, safe disposal practices is clear. The mail back =
program
ensures the safety of your home as well as the safety of your community. =
It
allows self-injectors to do the right thing by keeping used needles out =
of
the public waste system. With more and more people making the =
responsible
choice for safe needle disposal, and national and state efforts to =
develop
legislation, safe disposal compliance programs, such as the mail back
solution, will help to keep our communities across the country safe from
injury and infection.

This article originally appeared in the April 2003 issue of =
Environmental
Protection, Vol. 14, No. 3, p. 50.