Sharps Safety Extends Beyond Hospital Walls

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Sharps Safety Extends Beyond Hospital Walls

By Schraag

11/27/2007

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.

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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.

http://www.infectioncontroltoday.com/articles/sharps-safety-extends.html

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