Sharps waste

Sharps – like needles, syringes, lancets and other devices used at home to treat diabetes, arthritis, cancer, and other diseases – should be immediately disposed-of after use

Sharps waste is a form of biomedical waste composed of used sharps, which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are:

Qualifying materials

In addition to syringes and injection devices, anything attached to them will also be considered sharps waste. Examples of such attachments could be a tube or Vacutainer. The entire complex is treated as one unit of sharps waste, even though the attached item cannot puncture or lacerate the skin.

The category of blades can include razors, scalpels, X-Acto knife, scissors, or any other medical items used for cutting in the medical setting.

Both needles and blades are always treated and handled with the highest concern as sharps waste. This is regardless of if they have been contaminated with biohazardous material. While glass and plastic are considered sharps waste, their handling methods can vary.

Glass and plastic items, which have been contaminated with a biohazardous material, will be treated with the same concern as needles and blades, even if unbroken. If not contaminated, broken glass and plastic is still a sharp waste, but does not pose the same public health risk. Therefore, broken glass and plastic that has not been contaminated is not handled as delicately. Some common medical items of this category are test tubes, microscope slides, culture dishes, pipettes, and vials.

It should be noted that individual facilities have detailed definitions of specific materials that qualify. The treatment of a particular material as sharps waste may vary from one facility to the next.

Dangers involved

As a biohazardous material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of blood-borne diseases, such as Hepatitis B (HBV), Hepatitis C (HCV), and HIV. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste.

The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur. Contraction of disease through such an injury will inhibit health care workers from providing their services. This is a cost incurred by society in the promotion of public health. As trained professionals, their services are not easily replaced.

The general public can be at direct risk to injuries from sharps waste as well. If these hazardous materials are not separated from standard waste, individuals can unknowingly come in contact with them. In addition, if sharps waste is not disposed, and removed from the environment, then it can be subject to reuse and misuse, both intentional and unintentional. This is especially applicable in the areas of hypodermic needles and blades. The spread of disease through sharps waste is preventable through proper management and disposal.

Management and disposal

A sharps container is specially designed for safe disposal of sharps waste.

Extreme care must be taken in the management and disposal of sharps waste. The main goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an autoclave. A less common approach is to incinerate them; typically only chemotherapy sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.

From the moment sharps waste is produced, it is to be handled as little as possible. Health care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. If the sharps waste incorporates an additional part, such as a syringe, tube, or handle, the whole unit is disposed together. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict hospital protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose effectively.

Self-locking and sealable sharps containers are made of plastic so that the sharps waste can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use sharps containers of various sizes are sold throughout the world. They are now commonplace in clinics and hospitals. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.

Recent legislation in France has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.

Disposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the United States, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often medical waste, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the U.S. mail in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.

Injection technologies

With more than sixteen billion injections administered annually worldwide,[1] they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have recently been developed. Most of these are related to safety mechanisms on the actual injection device. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the Needlestick Safety and Prevention Act was passed, along with the 2001 Bloodborne Pathogens Standard. Both of these legislative actions make increase safety technology requirements.[2]

Medical injections result in contaminated sharps waste consisting of a syringe/needle complex. The main concern in the handling of this form of waste is the risk of needlestick injuries. The World Health Organization estimates that annually over two million such injuries occur worldwide. These injuries puncture the skin and have a high probability for the transmission of bloodborne pathogens. Safety features that have been incorporated into new injection technologies focus on the prevention of accidental needlesticks. Safety syringes help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device, or AD syringe. These injection devices automatically disable after removal from the patient. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused.

The most effective AD syringes for sharps waste management retract the needle into the syringe after one use. With the needle no longer exposed after injection, it is much safer to handle and dispose.

Covering the needle right after the injection is another approach taken for safe management of sharps. Injection devices are sold which can be recapped in very simple fashions. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Being able to cap the needle in this hands free way decreases needle sticks. However, the added action of capping the needle increases the time before it is placed in disposal containers.

Another technology in sharps waste management relating to injections is the needle remover. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste. Current legislation encourages the disposal of the whole injection device without this added step. The legislation requires the use of safety features such as hinged caps or preferably AD syringes.

In the developing world

Sharps waste is of great concern in developing and transitional regions of the world. The advances in sharps waste management made in developed countries have not been seen in these regions. Striking social and economical differences make implementing the same protocols and technologies unrealistic. In addition factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste. These factors make sharps disposal a pressing issue when addressing public health in these regions. As with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes.[3] Symptoms of fever, upper respiratory infections, colds, ear infections, skin infections, diarrhea, and fatigue are all commonly treated with injections. The average person has been estimated to receive up to 8.5 injections per year.[4] Newly developed injection technologies, such as AD syringes and one handed capping mechanisms, are rarely used to provide these injections. These technologies add unaffordable costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions [5]

The infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste (particularly injection devices) in the environment. This can lead to accidental needle sticks, reuse, or misuse. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).

Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually.[6] For each year, these infections are modeled to cost society over 270,000 lives between 2000 and 2030. Additionally, it has been shown that most exposures to disease among health care workers in developing regions are attributable to sharps waste injuries. 40-65% of new HBV and HCV are due to percutaneous occupational exposure.[7] The ratio of educated health care professionals to population disease prevalence is already a reason for concern in the developing world. The loss of these individuals is very damaging to public health interest in these regions.The majority of death, disability, and disease in these regions can not be attributed to deficient sharps waste management. However, their effective and practical management promotes public health and reduces disease spread. Remedying the current situation has been modeled to show an opportunity provide substantial social benefit at a relatively low cost. In addition this situation poses the opportunity to provide this considerable social benefit within a short time frame. For the most rapid improvements protocols and technologies must be developed specific for these regions. These must be designed in line current available resources and infrastructure. If tailored for these regions the sharps waste management methods rapid acceptance is more likely.

References

  1. ↑ WHO World Health Organization (2004). Proposed agenda to evaluate the risks and benefits associated with using needle-removing devices. Switzerland.
  2. ↑ Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003). Chapter 31: Occupational Exposure to Bloodborne Pathogens: Epidemiology and Prevention. Prevention and Control of Nosocomial Infections (4th Ed). Lippincott, Williams, and Wilkins.
  3. ↑ Simonsen, L. Kane, A. Lloyd, J. Zaffran, M. Kane, M (1999). Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization, 77(10).
  4. ↑ "Simonsen"
  5. ↑ Needle Remover Harner, C. (2004, October). Needle Remover Device Design Transfer Package. Retrieved September 7, 2005.
  6. ↑ Dziekan G, Chisolm D, Johns B, Rovira J, Hutin Y (2003). The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization, 81(4)
  7. ↑ Pruss-Ustun A, Rapiti E, Hutin Y (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization, (WHO Environmental Burden of Disease Series, No. 3).

Further reading

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