Sharps disposal an important health concern
As rates of certain diseases continue to grow, safe disposal methods are becoming paramount.
Each year, about 8 million people in the United States use more than 3 billion needles, syringes and lancets to manage medical conditions, according to the Environmental Protection Agency.
Although regulations exist for the disposal of sharps in health care settings such as hospitals and nursing homes, no federal guidelines regulate the disposal of sharps used in residential settings.
The issue of proper sharps disposal applies to physicians across a wide range of specialties. Patients with allergies, cancer, hepatitis, infertility, multiple sclerosis, psoriasis, arthritis, diabetes, HIV/AIDS, migraines, osteoporosis and many other conditions may all be administering injections in the home or workplace.
Improper disposal of sharps puts a wide range of people such as sanitation workers, janitors, housekeepers and children at risk for injury or the transmittal of diseases such as HIV/AIDS, hepatitis, tetanus and syphilis, and in rare cases diseases such as tuberculosis, herpes or malaria.
“Right now, there is no good documentation about how many people [in waste management] have gotten stuck with a needle and developed HIV or hepatitis as a result,” said Kathy Gold, RN, MSN, CDE, from the Diabetes Research and Wellness Foundation, Washington, D.C. and American Association of Diabetes Educators liaison to the Coalition for Safe Community Needle Disposal.
The number of needle sticks in the waste industry is very difficult to track. Waste companies are required by law to report injuries in Occupational Safety and Health Administration 300 logs, but due to the nature of this business, many workers may not even be aware they have been stuck, Gold told Endocrine Today. Waste workers are lifting, tossing and hauling several bags at once. They may receive punctures, abrasions or pokes daily. Many of these needles are so fine, the worker may not feel the puncture through the household trash bag, therefore never reporting the stick.
What is recommended?
The lack of federal regulations for needle disposal means that much of the responsibility for proper disposal falls on patients using injection drugs.
Source: Rays Trash Service Inc.; Boone County, Ind.
“A lot of patients are saying that doctors are not telling them what to do with their lancets, needles or sharps,” said Rachel E. Weinrich, a health educator for the Indiana State Department of Health. Weinrich presented information about a local sharps disposal program that was developed by Sharon Adams of the Boone County Health Department and David Lamm of the Boone County Solid Waste Management District in Boone County, Ind., at the 2007 CDC Diabetes Translation Conference in Atlanta.
“One man I came across in my research had collected five years worth of sharps from his veterinary practice,” Weinrich said. “He was a veterinarian whose practice was unregulated and needed a means of safe and affordable disposal. He had five years worth of animal sharps in boxes in his basement and the Boone County sharps disposal program provided him a means to dispose of his sharps safely and affordably.”
This situation seems extreme, but may be common. Weinrich, who has diabetes, said that at one point she was administering four insulin injections a day, adding up to 1,460 syringes to dispose of per year — a number that does not include lancets.
Manish Bhandari, MD, a staff oncologist at Christ Hospital in Cincinnati, Ohio said that hematologists and oncologists may deal with a variety of patients administering injections at home, such as red or white cell stimulation injections or people using blood thinners.
“We ask our patients to use the safety guards or caps that come with injections. We tell them to put it in a sharp-proof container or even a shoebox, collect them, and then bring them back to the clinic,” Bhandari told Endocrine Today. “We do it without any charge because we already have a waste disposal contract.”
Bhandari said that many of the patients that require these types of injections may already be returning to the clinic for other reasons, and bringing sharps is included in the trip. However, not all injection drug users are regularly returning to see their physicians.
Furthermore, many hospitals and clinics no longer allow patients to bring used needles back, according to Gold. “Medical waste management is so expensive that very few places — doctors’ offices or clinics — will dispose of them,” she said. An exception is in New York where laws have been passed that force all nursing homes and hospitals to accept needles for disposal.
One diabetes educator told Endocrine Today that she advises people “to use a sturdy container such as an empty detergent bottle, bleach bottle or coffee can” and dispose of the filled container in the trash.
“This is an inexpensive option for clients who often have incredible expenses in diabetes medications, strips and supplies,” she said. “It may not be the best solution, but it recycles containers and is inexpensive to the person with diabetes.”
Weinrich discouraged the use of coffee cans however, because the less sturdy plastic lid may still allow needles to puncture. Gold said that there are very few options for people with limited financial resources, especially when the community does not provide a needle disposal program.
“If anything is used it has to be in a very heavy container, like you would put detergent in, but none of them are good options,” Gold said.
In fact, the Environmental Protection Agency’s recommendations no longer suggest residents throw their used needles in the garbage, but encourage disposal of their used needles through other means such as community drop-off programs, household hazardous waste facilities, sharps mail-back programs or at-home needle destruction devices.
“I would recommend that [diabetes educators] contact waste management or the health department and find out what the regulations are in their area,” Gold said.
The Coalition for Safe Community Needle Disposal has a list of states resources on its website SafeNeedleDisposal.org.
State and local programs
Many state and local public health agencies, waste management companies and other organizations have begun to promote safe disposal options and build awareness among the public about the risks of disposing of used syringes in the trash.
Public health agencies and groups that work with injection drug users have been trying to raise awareness about the legal barriers that injection drug users face in association with safe disposal of their syringes. Agencies are working to encourage drug users to participate in community syringe disposal programs and syringe exchange programs.
One example of a safe disposal program is the Sharps Program in Boone County, Ind. The Sharps Program is a result of the health department and the solid waste district working together to initiate a program to help remove needles from the trash using money from an already existing grant.
The program has a pick-up and drop-off site at its health department where injection drug users can pick up free sharps disposal containers as needed. After the container is used, participants can return to the department to drop it off and take home a new empty container.
This program, which is free to the public and anonymous, costs about $3,000 per year — the same amount of cost incurred by an employer associated with the test and follow-ups from one needlestick injury even if no infection occurs. It removes approximately 100,000 needles per year from the county’s waste.
The success of this program has led other counties in Indiana to begin looking into developing similar programs.
The cost and accessibility of sharps disposal programs are big issues. Although there are programs available outside of local communities, many of them include added fees that people may not be able to afford.
Waste Management, one of the county’s largest waste and environmental services companies, and BD have a program called Sharps Disposal by Mail System. The program allows customers to purchase sharps disposal containers, fill them and return them using prepaid postage. A one quart container that holds about 50 to 70 1-cc syringes with needles costs about $27.62. At a rate of four injections a day, this would equate to two containers a month, costing about $650 per year.
There are also devices available that can destroy or melt syringes. These devices require a large initial investment, but last longer.
Even free programs provided by the community sometimes require transportation to and from clinics or health departments. In Columbus, Ga., a door-to-door program has been developed: Residents call the waste management agency when containers are full and a worker comes to the resident’s home to pick up the container.
“There are over 400 biologics, drugs that will probably be given as injections, in the pipeline right now,” Gold said. “This problem is going to escalate dramatically within the next couple years because there are more and more injectables being developed.”
Gold said that the Coalition for Safe Community Needle Disposal has begun to work towards shifting the financial burden from the patient to the pharmaceutical companies. “If you produce a drug that requires an injection then you need to be providing disposal solutions. We don’t want to put the burden on the patient,” she said.
The resources available will vary from community to community, but it is important to make sure that patients who self-inject are aware of available methods for sharps disposal. – by Leah Lawrence
For more information:
- Weinrich R. Removing the needles from trash — a necessary effort. Presented at: 2007 CDC Diabetes Translation Conference; May 2, 2007; Atlanta.