Sharps Safety Extends Beyond Hospital Walls

My son had a special friend in kindergarten whom neither of us will ever forget. Little D was the sweetest boy — so cute and full of life. He was the baby of the three children in his family, and named after his daddy, Big D.

The reason I will always remember Little D isn’t because the boys — at the ripe old age of 5 — got themselves locked out on the balcony at 4 a.m. during a sleepover. It is because Little D, at the end of kindergarten, was told that his momma wouldn’t make it to see him begin first grade.

Little D didn’t quite understand the ramifications of what he was told, what his life would become growing up without his mother’s special hugs and gentle teachings. He was confused, as was my boy, and we were all so very sad for Little D and his family.

His mother was a nurse for many years. She dedicated her life to helping others, but that dedication unfortunately ended up costing her life — and Little D his mother.

One fateful day, a slight mishap occurred and her life as she had known it was never the same. She contracted hepatitis from an accidental needlestick. Her liver was withering away and she suffered terribly. It was such a sad end to a beautiful person, one Little D needed in his life for a lot longer than five years.

Sharps safety in the healthcare setting is not new. Thankfully many organizations have worked diligently to lower risks and the number of accidents has steadily declined over the years. However, one aspect of these extensive educational programs is sometimes not conveyed. That aspect is patient-directed sharps safety education and programs.

Such lethal needlesticks as Little D’s mother experienced can very easily occur outside of a healthcare system. Frighteningly, any number of professionals and laymen alike are at risk for these — and the same repercussions can occur.

Data from the International Healthcare Worker Safety Center’s EPINet Multi-hospital Surveillance Network indicate that syringes cause the greatest number of sharps injuries. Moreover, according to the International Sharps Injury Prevention Society (ISIPS), annual rates of sharps-related infection in the healthcare arena alone weigh in at more than three dozen U.S. healthcare workers contracting human immunodeficiency virus (HIV); 2,000 healthcare workers becoming infected with the hepatitis C virus; and 400 contracting the hepatitis B virus. More than 20 additional types of infectious agents have been transmitted through needlesticks, including tuberculosis, syphilis, malaria, herpes, diphtheria, gonorrhea, typhus, and Rocky Mountain spotted fever.

Many patient groups handle a needle daily. To them, it is their lifeline. Diabetes is one such common disease that necessitates needle use. According to the American Diabetes Association, 20.8 million children and adults in the United States — or 7 percent of the population — have diabetes. That equals a lot of daily needlesticks. And while most do not have any transmissible bloodborne diseases, they still need to be aware of the utmost safety standards when handling these items. Sharps safety should be a part of a needle-user's everyday life. They need to protect themselves, and they need to protect others.

The education of a “domestic” sharps user should be molded to fit the demographic encircling the individual. For example, it is important to recognize that some states have passed legislation forbidding needle disposal in household trash. In fact, California Gov. Arnold Schwarzenegger signed SB 1305 “The Medical Waste Management Act,” making California the third state to forbid the placement of used needles in the household trash. The legislation was enacted because used needles can cause a public health hazard to anyone who comes in contact with them — primarily sanitation and waste removal workers.

The legislation, which becomes effective Sept. 1, 2008, will close a loophole in California’s Medical Waste Act by requiring home-generated sharps waste to be transported only in approved sharps containers and to be managed only at state-approved locations. California residents will no longer be allowed to dispose of used needles and other sharps waste in solid waste and recycling containers. The bill also encourages state agencies, local governments, and industry groups to work cooperatively to publicize sites that are authorized to accept sharps waste and to implement convenient mail-back programs that use containers approved by the U.S. Postal Service.

According to the press release announcing this new California law, it is currently estimated that between 8 and 9 million people are injecting medicine at home nationwide for the purpose of treating disease. “The majority of these needles end up discarded in the household trash and community waste bins,” which leaves waste removal personnel at dangerous risk of needlestick injury, the release said.

Pam Gill, RN, BSN, a HIV/HBV prevention specialist at Statesville, N.C.- based Iredell Memorial Hospital, points out that many patients simply cannot afford the proper materials to uphold sharps safety standards. “They reuse a lot of their supplies, including needles, to save money,” she warns. “So, in states where no provisions are officially made for disposal, educators should already know the local laws on needle disposal so that concrete suggestions may be made to the patients. For example, can they use containers such as bleach bottles? Should they be labeled? They definitely need to be secured (tape, etc.). Is there a drop program in your county or state?”

Gill says that biohazard labels are cheaper than official sharps containers. She suggests perhaps providing those to make it easier for the patient to label those containers. This could be an acceptable alternative in certain areas.

Gill offers a few more educational pointers to share with patients: Needles: “Patients who use needles need to be educated on the safe way (passively) to recap because there are patients reusing their needles. If at all possible, the user of the sharp needs to be the one to secure the sharp. This is not always possible so patients and their caregivers need to be educated on safety.”

Sharps containers: “Sharps containers should never be shaken down to get another needle in. These containers are puncture resistant, not puncture proof, and I have seen big needles come right through the side of a container.”

Disposal: “Most hospitals or other facilities must pay for needle disposal by the pound. So, drop sites are not always available. There is also a safety issue for the people in a hospital setting that are responsible for disposal of the containers. We have policies here for closure and the taping and transporting of our containers. This is due to lids on full containers not being properly secured and the box coming apart from the lid while being transported. Education of our staff on our policy, along with the familiarity of the sharps containers, helps keep our handlers safe.”

“Most patients are very willing to comply with measures required to safely use and dispose of sharps in their homes if they have the knowledge and the resources in which to do so,” Gill concludes.

Editor’s note: page 28, “Sharps Safety 101” is intended as a handout to enhance patient-directed sharps education. It is also available for download online at www.infectioncontroltoday.com.

Sharps Safety 101

You have been prescribed an injectable medication. Use the following tips to help keep you safe.

What are sharps?

Sharps include needles, syringes, razor blades, slides, scalpels, pipettes, broken plastic or glassware, and any other devices capable of cutting or piercing the skin.

Best Practices

Make sure all sharps, sharps containers and medications are kept far out of reach of children or animals at all times. Always use the universal precaution principle: “Assume that all contaminated sharps are infectious and treat them accordingly.”

When working with sharps

Dispose of sharps in an infectious waste sharps container. Infectious waste sharps containers should be placed as close to the point of use as possible. The farther away the box is the more chance there is for a mishap. Ensure the sharps container is the appropriate size for the devices being placing in them. Containers should have a visible opening, be placed below eye level, and should be wall-mounted, if possible. Ensure there is an unobstructed opening that allows devices to drop in easily. Inspect sharps containers weekly and discard when they become three-quarters full.

Sharps containers must be non-breakable, leak-proof, impervious to moisture, rigid, tightly lidded, and puncture resistant. They should be red or at least bright in color and should be marked with the universal biohazard symbol or some other obvious warning.

Other important factors include:

• Discard contaminated sharps immediately into a sharps container
• Never force a sharp into a container or attempt to retrieve a sharp from a container
• Never bend, break, shear or remove needles from syringes
• Do not recap needles or syringes (by hand or otherwise). More sharps injuries and needlesticks occur due to attempted recapping than any other action
• Only work with one uncapped needle at a time, keeping other sharps in view
• Do not place a needle cap in your mouth in order to remove the cap. Also, make sure needle caps are always out of reach of children
• Never leave sharps unattended

Source: Harvard University Sharps Safety Fact Sheet

What if I am injured by a sharp?

You should wash the site right away with soap and water. If the needle was infected by someone with a suspected infectious/transmissible bloodborne pathogen (i.e. HIV, hepatitis, etc.), contact your healthcare professional immediately for full directions on testing and administration of antiviral drugs. Time is critical in some cases. If your doctor is not immediately reachable, report to the nearest emergency room.

What if my container is full or I am traveling?

There are several household containers acceptable to act as a sharps container. Bleach bottles, for example, are hard, puncture-proof containers that can be securely closed. When in a pinch, such items are acceptable alternatives. When disposing of sharps in this type of container, make sure the container is closed tightly with tape wrapped securely around the lid.

Never, ever flush syringes or other sharps down the toilet and never discard them in the trash can. Some states have passed legislation forbidding needle disposal in household trash.

Types of Sharps Disposal Programs

Drop Box Collection Points

Sharps users can take their filled sharps container to appropriate collections sites, which may include doctors’ offices, hospitals, health clinics, pharmacies, health departments, community organizations, police and fire stations, and medical waste facilities. States where these programs are readily available include Wisconsin, Rhode Island, and Florida.

Check with your local waste provider to find out if needles are collected at your local sites.

Mail-back Programs

Home users place used sharps in a special sharps container and return it by mail to a collection site to be disposed of properly. The BD™ Sharps Disposal by Mail system is one such example. For more information call 1-888-232-2737 or visit

www.sharpsinc.com

.

Residential Special Waste Pick-up Service

Home users place used sharps in a special sharps container and much like a recycling container, it is set outside for pick-up by special waste handlers.

For a list of sharps disposal facilities in your area, check out: www.safeneedledisposal.org/dispcenters.php.

For additional questions, contact your local health department.