Skip to main content
#
Sharps Disposal Maryland
site map
contact

-Maryland Sharps Disposal
-Maryland Needle Disposal
-Maryland Biohazard

Disposal Services:
- Maryland
- Sharps Waste Disposal
- Biohazard Sharps Waste
- Medical Needle Waste
- Infectious Sharps Waste
- Hazardous Waste
- Pharmaceutical Waste
- Needle Waste Disposal

Waste Customers:
- Maryland
- Funeral Home Disposal
- Tattoo Waste Disposal
- Dentist Waste Disposal
- Doctor Sharps Disposal
- Healthcare Waste Removal

MD Service Areas:

- North Carolina
- South Carolina
- Virginia
- Georgia
- Florida

- No Contracts!
- No Stop Fees!
- No Hidden Fees!
- No Monthly Fees!
- No Problems!

Blog

Thursday, July 30 2015

Maryland Sharps Container Regulations

Who is Enforcing Sharps Container Regulations?
By Alice P. Jacobsohn
 

“Can someone help me better understand what motivates a reusable sharps container user to record the cycles left on a container?”

This question, posed by Cindy Meissen, New Market Development Manager, Rehrig Pacific Co., Atlanta, Ga., was asked because manufacturers of sharps containers are subject to the U.S. Food and Drug Administration’s (FDA) elaborate medical device requirements and want to know whether their containers are being managed properly by users, especially for reusable containers.

“If users are not required to follow manufacturer instructions, all of these requirements are like having a speed limit that no one is enforcing,” said Meissen.

“What’s happening is that some containers are being used differently than the FDA approval requirements,” said George Weishoff, Owner, MED-FLEX, Inc., Hainesport, N.J. “At MED-FLEX we work with the manufacturer to purchase a container that will work for our customers and is in compliance, but some companies purchase a sharps container with detailed manufacturer instructions and then manage the containers in a way that better matches their company and customer operations. In at least one situation, a manufacturer designed and sold a sharps container claiming FDA approval, but then changed their mind about that approval. Users of the container, who spent a lot of money on purchasing the containers, are still using them as a sharps container.”

So, what are the requirements for sharps containers, what are different agencies enforcing, and why should a healthcare facility and waste management company follow manufacturer instructions?

The process starts when a manufacturer decides to consider producing a sharps container. “The container must meet customer needs and performance requirements, which have to be documented from the very first thought,” stated Meissen. She added, “Before a manufacturer can start molding plastic, a quality system is established. This system includes developing design parameters with a document control system, design verification and validation, and extensive testing.”

Sharps containers are regulated by the FDA as a Class II general hospital medical device through the authority of the Federal Food, Drug, and Cosmetic Act. The requirements are called the 510(k) process in reference to the applicable section of the act. A sharps container manufacturer must receive an order, in the form of a letter, from the FDA clearing the device for commercial distribution. This includes showing that the device is substantially equivalent to another device already legally marketed in the U.S. and is at least as safe and effective as that device.

A manufacturer must follow design controls during device development and provide the FDA with design control documentation. These design controls include several stages of planning. In general, planning refers to design and development activities and defines the responsibility for implementation of the plan. For example, the plan must show the relationship between different groups or activities that have input in the process such as the role of a company’s engineering and marketing teams. As the development process proceeds, the plan must be reviewed, updated, and re-approved by a designated company employee.

Procedures must be established to make sure the device is designed for its intended use. The FDA’s “Current Good Manufacturing Practices” regulations are part of the design quality control process. These requirements were added in the 1990s to comply with the Safe Medical Devices Act passed by the U.S. Congress to address device failure concerns.

Before the first container is produced, final specifications, inspections and testing criteria must show that the device’s design and final product match. “All of the participants in the container’s design look at the results to make sure that their activities and concerns have been fully considered – engineering, marketing, sales – everyone,” said Meissen.

Once the design is finalized, the manufacturer validates the design by producing a low volume of the container ensuring that the device conforms to its intended use. The container must be tested using actual or simulated use conditions and risk analysis.

While not part of the regulatory requirements, the FDA has published a detailed list of questions product evaluators (healthcare facilities or waste disposal companies) should ask when selecting a sharps container that manufacturers should consider in the design process. These include puncture resistance, safety features, opening and closing mechanisms, potential for spillage, ease of use, safe transport, autoclaving capability, handling procedures, container color and warning labels, overfill protection, container access, mounting systems, and cost effectiveness.

“At the end of the design stage, we must maintain a design history file that includes all required documentation,” Meissen stated. This file is not a place to dump documents, but, instead, includes an index and identifies the location of all applicable documents.

Once the container is ready for production, labeling, tracking, cleaning, and reporting requirements must be followed. The FDA’s labeling requirements include information provided through markings on the device (fill line, warning labels), manufacturer instructions, advertising, and other promotional material. Samples of these labels are submitted to the FDA through the approval process.

For reusable sharps containers, the FDA wants to see a tracking mechanism to allow users to determine the number of cycles a container can undergo before failure. This may be as simple as numbering the containers. Some manufacturers offer bar coding or radio frequency identification systems. Note that this tracking is not the formal tracking regulations where FDA will notify certain device manufacturers (defibrillators, heart valves) that they must implement a life-cycle tracking system for their device. The regulations are tricky. The FDA insists that a manufacturer provide a means of tracking along with instructions, but the regulations do not require the manufacturer or the user to actually track the containers. Instead, approvals make note of the tracking system provided to users and may state that the user can decide on whether to purchase that manufacturer’s cleaning equipment and tracking software.

“In my experience, no one from the FDA point of view is monitoring the cycles,” said Andrea Arredondo, President, Earth Compliance Solutions, Virginia Beach, Va. She explained that when she worked for a manufacturing company, “The FDA asked how we would track the containers, but seemed willing to accept any method. When the FDA inspector came to our facility during an annual audit, we were asked about tracking, but mostly, the auditor wanted to know how the containers were being cleaned.”

The tricky part is that while the FDA does not enforce tracking by users, the agency requires that a manufacturer maintain a relationship with users for purposes of reporting container material failure, i.e. when a medical device may have caused or contributed to a serious injury or death such as a needle stick from a sharp puncturing a container’s sidewall. Both the manufacturer and the user must file a report with the FDA. The manufacturer is required to investigate the cause of the injury.

“The first question we would want to ask is how many cycles has the container undergone,” said Meissen. She added, “The manufacturer is held liable if someone is harmed, but if the container was used for too many cycles, the fault is not ours. Yet, we have no control over the user’s management system. If the user is operating the wrong cleaning equipment such as using chemicals for cleaning that the manufacturer did not test for or the wrong temperature, we have no way of knowing.”

The regulations are more complicated when reviewing the requirements of other federal agencies. According to a regulatory expert at the U.S. Occupational Safety and Health Administration (OSHA), “Our regulations require that a sharps container be leak-proof on the sides and bottom, puncture-resistant, not be overfilled, and be replaced routinely. The definition of routine is not in the regulations and we do not enforce FDA requirements. A healthcare facility subject to OSHA’s regulations must have an exposure control plan that should include sharps and sharps container management.”

This means that healthcare facilities can follow manufacturer instructions such as container tracking and cleaning systems as part of an exposure control plan, but OSHA does not require that they do. However, potential liability can force a healthcare facility or disposal company to use the tracking system. For example, if a nurse gets stuck with a needle protruding from a container and sues for damages, an attorney may look at whether the container was used more times than the manufacturer specified.

“We check our containers regularly to make sure that they are not cracked and that the lids fit,” said Weishoff. He added, “We really haven’t had a problem because the sharps containers we buy last for years, and I’m not going to deliver a container to a customer that isn’t right.”

Other OSHA regulations that apply include a provision that reusable containers cannot be opened, emptied, or cleaned manually. The definition of manual is controversial because the definition refers to preventing “employees from exposure to the risk of percutaneous injury,” but does not specify whether a cheap screw driver or an expensive electronic opening system is required. In its guidance to regional administrators, OSHA recommends the use of a fully-automated system for opening, emptying, and cleaning reusable containers. Operating equipment designed by the container manufacturer may ensure compliance, but is not required.

Rick Racksnis, Director of Field Operations, Pipeline and Hazardous Materials Safety Administration, U.S. Department of Transportation (DOT) said, “An offerer [(healthcare facility)] is responsible for the packaging and must follow the packaging requirements, including labeling, marking, puncture-resistance, shipping papers, and other specifications.” He added, “The DOT requires that a sharps container be FDA approved and our investigators are going to look for that approval, but will not check the tracking system because that’s not in our regulations.”

Like OSHA’s requirements, the results from the U.S. DOT’s regulations are mixed. For those healthcare facilities and waste company partners using a sharps container that is not FDA approved, a federal DOT inspection, will land them in hot water. The DOT also will check for a protocol or other documentation to make sure that a container is leak-proof and puncture-resistant. However, for reusable sharps containers, following a manufacturer’s tracking instructions may serve the purpose of the DOT’s container integrity regulations, but other evidence of compliance may also be acceptable.

A significant difference between the OSHA and DOT requirements are the reporting regulations. OSHA requires reporting when an injury happens. The DOT requires reporting if a sharp has punctured the container even if no personal injury occurred.

While there is a gap in enforcement regarding tracking and cleaning, FDA does level the playing field for manufacturers. Publicly-available enforcement actions of sharps containers have included three FDA warning letters to manufacturers for failure to comply with the 510(k) requirements and obtain an approval letter before marketing their container. These warning letters are detailed on company failures. In a 2006 letter, the FDA informed a company that the quality system regulations were not followed. Design changes were made and control procedures were not followed, documentation was incomplete, procedures did not ensure that manufacturer instructions were placed in the customer shipments, and procedures were not followed to ensure that the design matched production.

A second warning letter in 2008 identified that a healthcare facility had contracted with a manufacturer to design a sharps insert system for their containers and did not follow Current Good Manufacturing Practices, including failure to designate a management representative to monitor the design process or to create a complaint evaluation process, lack of procedures for conducting quality audits or for implementing corrective and preventive actions, failure to perform evaluation tests when the contract manufacturer delivered the product, and failure to document changes to the design. This warning letter was the result of an FDA finding of a number of needle stick injuries that the facility failed to investigate.

The third warning letter in 2008 also showed a failure to comply with good manufacturing practices, including lack of written quality procedures, failure to obtain approval for material-failure reporting procedures, no established auditing procedures, inaccurate container labels, and failure to maintain complaint files or to document the design process. In this situation, the company was a distributor with a contract arrangement with a manufacturer for a container that the distributor designed.

Most of OSHA’s enforcement actions have been for failure to develop and comply with exposure control plans and failure to update these plans and test them for effectiveness. Needle stick injuries continue to plague healthcare providers. However, published enforcement actions have not included material failure investigations for sharps containers.

The DOT’s actions were mostly for failure to use a sharps container and disposing of sharps directly into plastic red bags or cardboard boxes. Both the DOT and OSHA have found problems with container lids, mostly from failure to follow manufacturer procedures for closing the containers. Leaks have occurred from overfilling and from wheels not properly attached or using carts not designed for the containers.

With these inconsistent enforcement actions, a manufacturer may question whether to spend the money to seek FDA approval for a reusable sharps container. Disposal companies may wonder about spending funds on tracking systems. But, there may be other reasons to invest.

“We use the tracking system with a bar code provided by the manufacturer because it helps us understand our business,” said Steven Groenke, Chief Executive Officer, Curtis Bay Medical Waste Services, Baltimore, Md. He explained, “A sharps container in a patient’s room may be exchanged every 60 days, but in an operating room a container is pulled daily. We use a standard operating procedure to manage these containers and incorporate a logistical deployment process that includes the bar code. Our company owns and operates medical waste facilities from the New England states to Georgia, we need to ensure compliance with a consistent process.”

Groenke emphasized the relationship of his company to his customers. He said, “From an economic standpoint, the use of a reusable container saves money because of reduced weight from fewer containers.” For a single-use container, the container becomes part of the disposal weight, but with a reusable some of this weight is saved. “In addition,” said Groenke, “customers are looking at zero waste opportunities, they want sustainability, and tracking helps them to reach that goal.”

So it seems that the FDA regulates the quality of sharps containers by requiring manufacturers to produce a well-made product and advise users on how to maintain that quality through tracking, cleaning, and other management instructions. The agency fails to fully implement its regulations by not requiring users to follow the instructions or purchase compatible cleaning equipment and tracking tools. This leaves manufacturers with questions about compliance and responsibility. Other agencies have overlapping regulations for sharps containers, but do not fill in the gaps left by the FDA. Ultimately, users will follow manufacturer instructions and buy compatible cleaning equipment when they make good business sense, reduce potential liability, and support their environmental policies.

Alice P. Jacobsohn is a government relations leader and attorney with a focus on assisting industry in understanding regulatory requirements, participating in the legislative and regulatory process, and positioning themselves for growth. She can be reached at alicej5251@gmail.com This email address is being protected from spambots. You need JavaScript enabled to view it. .

Posted by: jamyr68@comcast.net Mike AT 08:26 am   |  Permalink   |  Email
Friday, June 12 2015

Handling sharps in Maryland. Need help in Maryland with Sharps or needle waste management? Cotact us today for the most compliant and afforble Maryland Sharps disposal.

Do-

• Immediately place used needles and other sharps in a sharps disposal container to reduce the risk of needle-sticks, cuts, or punctures from loose sharps.

 • Use an FDA-cleared sharps disposal container, if possible. If an FDA-cleared container isn’t available, some organizations and community guidelines recommend using a heavy-duty plastic household container (i.e. laundry detergent container) as an alternative.

• Make sure that if a household disposal container is used, it has the basic features of a good disposal container. (See box at right for more info.)

• Be prepared — carry a portable sharps disposal container for travel.

• Follow your community guidelines for getting rid of your sharps disposal container.

• Call your local trash or public health department (listed in the county and city government section of your phone book) to find out about sharps disposal programs in your area.

• Ask your health care provider, veterinarian, local hospital or pharmacist o where and how you can obtain an FDA-cleared sharps disposal container, o if they can dispose of your used needles and other sharps, or o if they know of safe disposal programs near you.

• Keep all needles and other sharps and sharps disposal containers out of reach of children and pets.

 

Don’t -

• Throw needles and other sharps into the trash.

• Flush needles and other sharps down the toilet.

• Put needles and other sharps in your recycling bin — they are not recyclable.

• Try to remove, bend, break, or recap needles used by another person. This can lead to accidental needle sticks, which may cause serious infections.

• Attempt to remove the needle without a needle clipper device because the needles could fall, fly off, or get lost and injure someone.

 

Posted by: jamyr68@comcast.net Mike AT 08:34 am   |  Permalink   |  Email
Wednesday, June 03 2015

Why Green Montgomery?

Making Montgomery County a safer, healthier, more sustainable place to live is good for all of us.

Montgomery County Maryland, not just a leader, but raising the bar for sustainability for everyone. Working in Maryland is always exciting, having a community that is always forward looking for environmental options and a better way to operate. Maryland Sharps Disposal is excited to be a part of and help in this endeavor. If you need Sharps or needle disposal in Maryland or Montgomery County, contact us today.

There’s a good reason for everyone to want a green Montgomery County. For some, it’s to preserve our natural beauty. For others, it’s to reduce our carbon footprint and live more sustainable. And for others, it’s about saving “green” money every day. Whatever your reason, you’ll find information and resources throughout this site to reach your green goals. Below is a quick summary of the site.

Explore. Find Inspiration. Be part of our Green Montgomery.

Green Projects

The what, whys and how-tos for everything from simple changes to a complete green make-over. Get started on a green project today! Learn More »

Incentives & Programs

Rebates, tax credits, discounts, freebies and information to help you do the green thing. Learn More »

My Community

Go local, get involved, get energized for what’s going on right in your neighborhood. Learn More »
Posted by: jamyr68@comcast.net Mike AT 08:15 am   |  Permalink   |  Email
Monday, June 01 2015

Choosing a Sharps container or Sharps disposal service in Maryland? Ask these 8 questions to help determine the types of sharps containers you need in your Maryland Healthcare practice.

For Maryland Sharps disposal, contact a permitted Maryland Sharps disposal company.

1.  What will you do with your sharps containers?

This may sound like a silly question. But start with the end in mind. Look ahead to the disposal service you’ll be using. Some companies and drugstores in Maryland sell sharps containers — without any disposal service. Filled sharps containers remain in homes, offices, and businesses — without a final destination in Maryland.

Maryland Businesses:

If you are a business or healthcare facility in Maryland, you can’t use just “any old plastic jug” for your sharps disposal. The Occupational Safety & Health Administration (OSHA) requires that you use specific engineering and work practice controls, which includes suitable sharps disposal containers, to protect employees from blood borne pathogens.

Additionally, the FDA requires that sharps containers be approved as class II medical devices. This approval process ensures that your containers have gone through a rigorous 510(k) approval. FDA-approved sharps containers must be properly labeled, closable, puncture-resistant, leak-proof on the sides and bottoms, and made using good manufacturing practices (GMP) that help ensure high quality products.

As a Maryland business, you may find that it’s more efficient to purchase your biohazard disposal service with your containers. Multisite facilities, hospitals, and other large facilities may also want to consider reusable sharps containers with sharps management services.

No matter what service you ultimately choose in Maryland, be sure to use sharps containers that will be accepted by the eventual disposal service. Keep in mind that, in order to ensure employee safety, some disposal service providers accept only their own containers or bins.

Maryland Individuals:

For individuals at home, an all-inclusive program, such as the consumer needle disposal program offered by Stericycle, may be ideal. These programs allow at-home patients to safely discard sharps in containers AND dispose of the containers themselves through an approved mail back system.

A mail-back system consists of an inner FDA-approved sharps container and special outer packaging stringently tested and approved by the US Postal Service for infectious substances (Hazard Class 6, Division 6.2). Among other requirements, the outer packaging must meet leak-proof, stacking, vibration, wet drop, cold drop, impact, puncture-resistant, temperature, absorbency, and watertight testing criteria.

 

2.  If you are a business, what type of facility do you have?

When it comes to sharps containers, needs vary widely. No matter where you work or live, you’ll want to buy sharps containers or bins that have lids designed to accommodate the largest sharps you use.

Some Maryland healthcare facilities, such as infusion clinics or surgical centers, generate vast numbers and sizes of sharps each day. For example, workers in diagnostic labs may need containers with wide openings, allowing fast, convenient disposal and daily pickups. In contrast, some practitioners may need only quart-size containers and monthly pickups.

You’ll also want containers that promote one-handed disposal and that prevent your hands from entering the sharps containers. This is especially true in pediatric and family practices where a rotating cylinder lid (called a “counterbalance lid”) is often recommended to keep tiny hands out of sharps containers.

For other businesses, such as body art studios, mail back programs may be necessary. Typical disposal service routes may not coordinate with nighttime business hours.

An experienced product specialist can offer you consultative guidance to help you properly identify the containers that will meet your needs.

3.  What are you putting into your sharps containers?

This may sound a bit like asking, “Who’s buried in Grant’s tomb?” But the reality is that some sharps do not belong in sharps containers.

Chemotherapy needles, vials, bags, and tubing must be empty AND have less than 3% of the former weight remaining to be considered “RCRA-empty.” RCRA (pronounced WRECK-rah or RICK-rah) refers to an Environmental Protection Agency (EPA) designation for RCRA-hazardous wastes. Most RCRA-empty items containing trace chemo are more appropriately placed in “trace” chemotherapy containers (either trace chemo biohazard bags for non-sharps items or trace chemo biohazard sharps containers for sharps items, as appropriate).

Containers with more than 3% of the original weight of chemotherapy waste still remaining, sometimes called “bulk” chemo waste, and are not trace chemo waste. Many are actually RCRA-hazardous waste. These wastes are required to be disposed in RCRA-hazardous waste containers. Other types of pharmaceuticals may also be deemed RCRA-hazardous waste.

Keeping all pharmaceuticals out of sharps containers and other bio hazardous waste bins is a best practice and the law in some states. Special pharmaceutical waste containers are available for non-RCRA-hazardous pharmaceutical waste.

Similarly, nonsharp biohazards or “soft” medical waste belongs in a red bag for disposal — not a sharps container. Conversely, don’t put loose sharps into other containers, such as red bags for disposal.

4.  What other laws or regulations apply to you in Maryland?

The Occupational Safety and Health Administration (OSHA) requires annual blood borne pathogens (BBP) training for employees who may be exposed to blood borne pathogens.

Your state may have more specific, and often complex, requirements for waste disposal or training.

Some states, such as California and Massachusetts, have regulations for home needle disposal. Furthermore, state laws for consumers are continuing to evolve and change. 

A competent sharps disposal service can help answer questions you may have about your state regulations.

5.  How quickly will you accumulate Maryland sharps waste?

Are you a new Maryland practitioner, starting your career? You may need a scalable program of containers and services. If you’re an existing office, how often do you change your containers?

The answers to these questions, along with your state or facility guidelines, will help determine how many and what size containers you may need.

6.  How many sharps use areas do you have?

If you are a business or healthcare facility, systematically identify each exam room and other specific areas of your facility where sharps will be used. This will allow you easy access when discarding sharps.

You’ll need storage space for unused sharps containers, so you can readily replace full containers.  You’ll also need a secure place to store your used, filled sharps containers.

7.  How else will you help ensure safe access to your sharps containers?

Place your sharps containers within arms reach and label them with obvious biohazard warnings. Containers should be located away from wall switches, clear of impact zones, and free of any obstacles. The container opening and fill status line should be clearly visible prior to use.

If you are using wall containers, mount them at 52"-56" for fill-line viewing and safe access. Your containers should be recognizable below eye level of your team members who will be using them. Be sure to work with your staff to identify issues and concerns they may have as part of your blood borne pathogens program.

8.  Do you need fixed or mobile sharps containers?

Often, securely mounted sharps containers provide the most safety, provided they are used, removed, and transported correctly. However, mobile sharps containers may be appropriate for some situations, such as mobile blood donation centers. Be sure to keep containers closed when not in use

Posted by: jamyr682comcast.net Mike AT 07:51 am   |  Permalink   |  Email
Monday, April 20 2015

Maryland Sharps Disposal in the Operating Room:
Current Clinical Practices and Costs

 

In Maryland and other States the evolving medical environment, fiscal constraints on medical practice is becoming the norm. The new days of austerity have revived interest in the economics of medical practice. Economic measures, however, should not impinge on the quality of patient care. Maryland waste disposal, in particular, is an area without any direct patient benefit but which carries both short- and long-term ecological costs. Much of how we dispose of waste is dictated in the United States by the Joint Commission for the Accreditation of Hospital Organization, Occupational Safety and Health Administration, state regulations, and individual hospital protocols. ln an attempt to elucidate the waste in waste management, we examined the use of standard operating room sharp boxes.

Full sharp boxes from three different Maryland operating sites were randomly saved. Boxes were weighed and opened, and contents were separated into appropriate sharps: loose needles, scalpels, syringes with uncapped needles, and other. Weight and volume assessments were performed on the non-sharps. True sharp values were derived from non-sharps data. Less than 50% of the contents were appropriate for sharps disposal, with empty glass vials constituting the greatest percentage by weight of non-sharps material. We believe that encouraging the appropriate use of sharps boxes is a potential source for savings. Implications: Sharp boxes were randomly saved from university operating rooms and analyzed for content. The full boxes contained 14% appropriate sharps by weight and ~50% appropriate sharps by volume. The largest fraction of non-sharps weight was found to be glass.

In the present age of medical cost containment, clinicians must do more with fewer clinical dollars. This new practice constraint requires efforts to reduce costs in areas that have little to do directly with patient care. Medical waste management is one such area. Waste produced during clinical practice has an adverse impact on the environment.

Managers estimate that hospitals generate 3.2 million tons of waste annually, with half coming from operating rooms (ORs) (1).The generation of medical waste without consideration of its cost or disposal is an endemic problem with medical caregivers. Investigation of the impact of disposable versus reusable OR items has focused on economics (2), not waste-generating behavior. Because of its high economic and ecological cost, waste generation is an area that merits further examination.

 

Affordable Sharps Disposal Maryland - Contact Us Today

  • No Contracts
  • Maryland Sharps & Biohazard Disposal
  • Affordable & Friendly

 

The mantra of waste management has become “reduce, reuse, and recycle.” relating to proper handling of medical waste arises from several sources, including waste wash-ups on beaches, concern for the proper use of landfills, and fear of infection relating to inappropriate disposal of hospital waste (3, 4). Although all infectious waste is regulated by the Environmental Protection Agency and state and local law, it is infectious sharps waste with which the public is especially concerned (5, 6). Hospitals are limited in their ability to channel the stream of waste because of government regulations, restrictions on incinerators, and the decreasing numbers of landfills that will accept medical waste. Consequently, options for the disposal of sharps waste are decreasing.

Because of their high content of plastic and metal, sharps boxes are incinerated in relatively few places because of engineering issues relating to the smokestack scrubbers (7). Thus, full sharps boxes are routinely transported cross-country to authorized incinerators, then incinerated; the ash is landfilled. At the University of Pittsburgh Medical Center (UPMC), this is done at a cost of $0.55~$1.10 per kilogram. National estimates of waste cost disposal in 1990 dollars was estimated at $480,000,000 (1). Although Occupational Safety and Health Administration guidelines (8) clearly describe what is to be disposed of in sharps boxes, personnel are often unsure of these regulations.

As a result, sharps boxes could be used inappropriately as generic garbage receptacles. To determine whether sharps boxes are used appropriately, we studied what was actually placed into sharps boxes in a busy OR setting. We hypothesized that sharp boxes are used inappropriately in Maryland. We quantified the material placed into sharp boxes and then estimated the potential ecological and economic impact of their inappropriate use. Methods Conduct of the study was approved by the Environmental Health and Safety, Infection Control and Risk Management departments at UPMC. Twenty-seven two-gallon sharps disposal containers (Sharps-A-Gator; Devon Industries, Inc., Chatsworth, CA) were randomly saved before disposal from ORs at UPMC. None of the personnel using the sharps boxes were aware of the study. The full sharp boxes were weighed and emptied into a stainless steel basin. Each empty sharp box was weighed. Non-sharps (syringes, glass vials, paper products, etc.) were separated from the sharps (Table1) and placed in a previously weighed plastic waste disposal bag. The sharps were disposed of in a new sharps disposal container. The plastic bag, with its non-sharps contents, was then weighed. Weight of the sharps was calculated by subtracting the non-sharps weight plus empty box weight from the full box weight. After the initial 10 boxes were examined, the high content of glass was noted and subsequently evaluated.

 

The glass items were separated into a new plastic bag and weighed. Glass weight was studied for the remaining 16 of the original 27 total boxes after the initial 10 boxes showed a high percentage of glass weight. For volume assessment, volume displacement was used because of the irregular nature of the items being assessed. The excess air within the plastic bag Table 1. Appropriate Sharps as Defined for the Study Loose needles, capped or open Syringes with uncapped needles Suture needles IV needles, Surgical staples Surgical scalpel blades Table 2. Weight and Volume Assessment of Sharps Boxes containing the non-sharps were evacuated using a standard OR suction. This bag was placed in a second bag, and the excess air was evacuated. The bag with non-sharps was then placed in a box of known volume, and water was added until the full volume was reached. The volume of water added was subtracted from the known box volume to yield the volume of non-sharps. All measurements were made in triplicate and averaged. Descriptive statistics were determined for each sharps box.

 

Results

 

Our data indicate that the OR sharps containers held ~50% appropriate sharps by weight and volume (Table 2). The highest percentage of non-sharps by volume was found to be plastic needleless syringes. The highest percentage of non-sharps by weight was found to be empty glass vials (Tables 2 and 3). Discussion Disposal of sharps can cost hospitals hundreds of

thousands of dollars per year. The UMPC Environmental Services Division estimates that of all infectious waste, approximately 20% is from the sharps containers, which must be incinerated off site and then disposed of at landfills. Because the cost of sharps container disposal is based on weight, a reduction in sharps box misuse by 50% could save in excess of $200,000 per year at UPMC. Although some glass is “sharp,” it is primarily generated from drug vials; therefore, it is not considered infectious as defined by Occupational Safety and Health Administration or hospital infection control policies. Glass is inexpensive to dispose of and potentially recyclable. By placing glass-only disposal boxes in the OR, the high percentage of noninfectious, non-sharps weight could be significantly reduced in the sharps containers. In addition, personnel would have a safe, rational, and inexpensive option for the disposal of glass waste. The disposal of glass boxes is much less expensive than sharps waste disposal. Using sharps boxes as they are intended can be achieved with minimal alteration in personnel practice. Subsequent cost savings are realized not only through reduced disposal weight due to proper sharp and non-sharps disposal, but also the reduced need for empty boxes, reduced personnel handling costs; reduced transport costs to the incinerator and landfill site, and the result of ultimately less ash to be landfilled.

The concomitant increase in non-sharps waste is lo-fold less expensive to dispose of and at UPMC is incinerated at the institution, limiting out of pocket expenses for waste disposal. Concurrent with changes in OR disposal options, an educational program for OR personnel is to be implemented. This program will focus on appropriate sharps-related behavior as defined by federal and local regulations as well as clarification of “what goes where.” In conclusion, misuse of sharps containers has both significant ecological and economic impact. Through increased personnel awareness and education, appropriate disposal of sharps and no sharps can result in significant cost savings.

 

 

Article Written and provided by:
Peggy A. Seidman, MD*, and Brian M. Parker, MD

 

 

 

Posted by: jamyr68@comcast.net Mike AT 07:30 am   |  Permalink   |  Email
Saturday, March 14 2015

Reduce sharps disposal in Maryland and Needle Sticks, here is a great article on Maryland sharps and needle stick prevention.

Every day while caring for patients in Maryland, nurses are at risk to exposure to bloodborne pathogens potentially resulting in infections such as HIV or hepatitis B and C. These exposures to Marylanders, while preventable, are often accepted as being a part of the job. In the United States, needlestick injuries have begun to decrease from an estimated one million exposures per year in 1996 to 385,000 per year in 2000. This decline has resulted from the protections afforded by the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard. Reasons for the success in decreasing needlestick and sharps injuries may be attributed to the elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions.

The prevention of needlestick injuries in Maryland Healthcare has made slow progress over the past 20 years since the HIV epidemic drew attention to the deadly nature of health care work and to protection of health care worker health and safety. In Africa, where the AIDS virus originated and where the prevalence of the human immunodeficiency virus (HIV) among hospitalized patients is highest in the world, attention has been directed only recently at protecting health care workers. Nurses, especially those infected from a preventable exposure, have been at the forefront of advocacy for prevention.

This article includes a review about the hazard of exposure in Maryland to bloodborne pathogens and epidemiology of occupational infection. The author discusses how to apply standard methods of occupational health and industry hygiene using the hierarchy of controls framework to prevent exposure to blood, and discusses evidence-based prevention and efficacy of particular control measures. Legislative progress and implementation of enforceable policy to protect health care workers is outlined.

Citation: Wilburn, S., (September 30, 2004). "Needlestick and Sharps Injury Prevention". Online Journal of Issues in Nursing. Vol. 9 No. 3, Manuscript 4. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.aspx

Key words: bloodborne pathogens, HIV, needlestick, nurse safety, occupational health and safety, occupational injury and illness, safety device/sharps, universal precautions, work practice controls


...2.5% of HIV cases among health care workers and 40% of hepatitis B and C cases among health care workers worldwide are the result of occupational exposure.

 

Every year, hundreds of thousands of health care workers are exposed to deadly viruses such as hepatitis and the Human Immunodeficiency Virus (HIV) as a result of needlestick and sharps injuries. These preventable injuries expose workers to over 20 different bloodborne pathogens and result in an estimated 1,000 infections per year, the most common being hepatitis B, hepatitis C and HIV (International Health Care Worker Safety Center, 1998). In November 2002, the World Health Report published data demonstrating that 2.5 % of HIV cases among health care workers and 40% of hepatitis B and C cases among health care workers worldwide are the result of occupational exposure. A WHO report describing the global burden of disease from sharps injuries to health-care workers detailed the data from the previous year’s World Health Report.

Needlestick Injuries and Exposure to Bloodborne Pathogens: Scope of the Problem

In developing countries, where the prevalence of HIV-infected patients is the highest in the world, the number of needlestick injuries is also highest. African health care workers suffer on average two to four needlestick injuries per year and over half of the hospitalized patients in South Africa are HIV positive. In some regions of Africa and Asia close to half of all hepatitis B and C infections among health care workers are attributable to contaminated sharps. In some areas of the Eastern Mediterranean region over two-thirds of hepatitis B and C infections in health care workers are attributable to contaminated sharps. Over two-thirds of all hepatitis B in Central and South American are the result of occupational exposure.

 

 

Table 1. Risk of Transmission of Bloodborne Infection

Occupational Exposure

Risk of Transmission

HIV

0.3% (or a 1 in 300 chance of infection)

Hepatitis B Virus (HBV)

2-40%

Hepatitis C Virus (HCB)

2.7-10%

Factors surrounding the circumstances of a needlestick injury when combined can increase the risk of HIV infection to a 1 in 20 (or 5%) risk. These factors include: a deep injury, visible blood on the device, high viral titer status of the patient such as in newly infected patients or those in a terminal state, and the device being used to access an artery or vein. Post-exposure prophylaxis (PEP) with zidovidine (AZT), in a case control trial, demonstrated a reduction in the risk of transmission by 80%. The use of the newer antiretroviral drugs for PEP is likely to be even more effective for prevention because these drugs are much more effective for treatment.

While the risk of HIV infection is very low, the risk of infection with hepatitis, especially hepatitis B among unimmunized workers is very high. According to the WHO, in some areas of the world, over 80% of health care workers have NOT been immunized against hepatitis B despite its 95% efficacy rate. As a result of the 1991 U.S. Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard (BPS), employers are required to provide hepatitis B immunization to health care workers. As a result of this standard the number of infections and deaths from hepatitis B among health care workers in the United States has dropped significantly from thousands of infections per year to less than twenty.


The Centers for Disease Prevention and Control (CDC) estimates 385, 000 needlesticks and other sharps injuries per year among hospital workers in the United States.

 

There is no immunization for HIV or hepatitis C, and no recommended post-exposure prophylaxis for hepatitis C. The only solution is to prevent infection by preventing the exposure. Symptoms of HCV often do not emerge for 20-30 years after viral transmission occurs; thus the disease may be undiagnosed for 20 years or more. As many as 85% of those infected with HCV develop chronic liver infection and are at risk for cirrhosis and liver cancer, possibly requiring a liver transplant.

Post exposure prophylaxis (PEP) for reducing the chance of HIV infection should be started immediately (within 2 hours of the exposure to blood) and continue for a month to be most effective. PEP rapidly loses its effectiveness if delayed and some reports indicate that if delayed more than 72 hours it is not effective. Health care workers taking PEP need additional support from occupational health providers to manage the symptoms and side effects of the drugs.

The Centers for Disease Control and Prevention (CDC) estimates 385, 000 needlesticks and other sharps injuries per year among hospital workers in the United States. This has increased from 600,000 to 800,000 the number of injuries reported in 1999 by the CDC’s National Institute for Occupational Safety and Health.

Unreported needlestick and sharps injuries are a serious problem and prevent injured health care workers from receiving post-HIV exposure prophylaxis shown to be 80% effective against HIV infection. According to researchers, 40-70% of all needlestick injuries are unreported, thus the statistics are only estimates. Without documentation of the injury, the worker is unlikely to receive worker’s compensation benefits if later becoming infected with the human immunodeficiency virus (HIV) or hepatitis.

Causes of Needlestick Injuries

Nurses experience the majority of needlestick injuries in the world including half of the exposures that occur in the US, and 70% of exposures occurring in Canada. Other individuals at risk include frontline patient care providers such as physicians, phlebotomists, and support personnel (housekeepers and laboratory staff).

The United States National Surveillance System for Health Care workers (NaSH) identified six devices that are responsible for the majority of needlestick and other sharps related injuries. As depicted, these are hypodermic needles (32%), suture needles (19%), winged steel needles (butterfly) (12%), scalpel blades (7%), IV catheter stylets (6%), and phlebotomy needles (3%).

 

Figure 1. Devices Involved in Percutaneous Injuries

Devices Involved in Percutaneous Injuries

Percutaneous or needlestick injuries contaminated with blood or body fluids pose the highest risk and cause the most common exposures among health care workers. These blood-filled devices account for 59% of all NaSH reported injuries and 90% of the HIV seroconversions documented by the CDC.

The most common circumstances that cause injuries in NaSH hospitals involve hollow bore needles which are the most risky because the needle can be filled with blood. These needle injury situations which include: manipulating the needle in the patient (26%), disposal (23%), collision with worker or sharps (10%), during clean-up (10%), accessing IV line (6%), and recapping needles (6%).

 

Figure 2. Circumstances Associated with Hollow-Bore Needle Injuries
(CDC NaSH 6/95-12/01) Hollow-Bore Needle Injuries

Characteristics of devices that increase the risk of injury include:

- Devices with hollow-bore needles.
- Needle devices that need to be taken apart or manipulated by the health care worker such as blood-drawing devices that need to be detached after use.
- Syringes that retain an exposed needle after use.
- Needles that are attached to tubing such as butterflies that can be difficult to place in sharps disposal containers.


Work organization factors that contribute to injury and to prevention include: short staffing and a poor safety climate.

 

Work organization factors that contribute to injury and to prevention include: short staffing, and a poor safety climate. Clarke et al. demonstrated a relationship between short staffing and needlestick injuries. Nurses from units with low staffing and poor organizational climates reported twice as many needlestick injuries than nurses on well-staffed units. Thus, adequate staffing is not only safer for patients and prevents medical errors but it is also safer for nurses too.

Preventing Needlestick Injuries

Preventing needlestick injuries and resulting infections is possible and necessary to provide quality health care. While Clarke et al.demonstrated the relationship between short staffing and needlestick injuries, appropriate staffing is difficult to maintain when health care workers are unable to work due to work-related injuries and illness. Nursing shortages are exacerbated by uncontrolled occupational hazards and further made worse by the nurses’ fear of bringing a life-threatening illness home to their families. In 2000, 88% of nurses responding to a web based occupational health survey, indicated that the risk of occupational hazards determine whether they will continue to work in nursing and in what clinical area.

Needlestick Prevention and the Hierarchy of Controls

Prevention of needlestick injuries is possible by analyzing the hazards and applying control measures using a hierarchy of controls starting with the elimination of unnecessary sharps and injections to eliminate the hazard. Needleless IV systems, recommended by the Food and Drug Administration in 1992 remove an unnecessary sharp and reduce the risk of injury. Eliminating unnecessary injections by using oral instead of injectable medications eliminates the hazard.

Engineering controls are the second most effective measure in the hierarchy of controls. The 2000 U.S. Needlestick Safety and Prevention Act established the requirement for health care settings to use engineering controls known as safer needle devices. Safer needle devices have been shown to reduce 62 to 88% of all needlestick injuries. These devices blunt, sheath, or retract the needle immediately after use and are available in injection equipment (syringes), IV access devices, lancets, and phlebotomy needles.

Effective needlestick injury prevention measures include administrative and work practice controls such as educating workers about hazards, implementing universal precautions, eliminating needle recapping, and providing sharps containers for easy access that are within sight and arm’s reach. In a study involving three Virginia hospitals, Jagger found a 59% reduction in IV access needle injuries following an education program and implementation of universal precautions. There was an additional 84% reduction in injuries after implementation of a safety IV catheter. Management commitment to occupational health is important for prevention. Management commitment to safety can be demonstrated through allocation of necessary resources and delegation of authority to a needlestick prevention committee charged with monitoring the exposure control plan and the evaluation and selection of control measures including safer needle devices.

Desirable Characteristics of Safer Needle Device

Safety feature characteristics listed by NIOSH for evaluating and selecting needlestick injury prevention products include:

  • The device is needleless
  • The safety feature is an integral part of the device.
  • The device preferably works passively (requires no activation by the user). If user activation is necessary, the safety feature can be engaged with a single-handed technique and allows the worker’s hands to remain behind the exposed sharp.
  • The user can easily tell whether the safety feature is activated
  • The safety feature cannot be deactivated and remains protective through disposal.
  • The device performs reliably.
  • The device is easy to use and practical.
  • The device is safe and effective for patient care.

As the use of safer devices reduces the number of injuries in clinical areas, the operating room is also emerging as the site with an increasing proportion of total injuries. While solid core sharp injuries from suture needles and scalpels are less risky than injuries from blood-filled hollow bore needles, transmission of HIV and hepatitis has been documented as a result of these exposures. Blunt suture needles for suturing internal fascia can reduce the number of suture needle injuries. The work practice control called the "neutral zone" is a technique for passing instruments on a basin or tray instead of from hand to hand and serves as an effective method for reducing injuries in the surgical setting.


...the operating room is also emerging as the site with an increasing proportion of total injuries.

 

Many tools are available for assisting nurses’ involvement in product evaluation and selection, including the ANA Needlestick Safety and Prevention Guide available on-line at. The ANA guide describes a three-step process for device selection with includes screening devices, simulation exercises, and pilot testing prior to making the final decision.

Evidence-Based Prevention

The use of the data collected about the nature of the needlestick injuries and near misses help guide needlestick prevention at the unit or institutional level and help make recommendations for new practices and devices for prevention and reoccurrence of injuries. In 2004, the CDC published a web based resource: Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. The workbook describes the use of Root Cause Analysis, a process for identifying causal factors to use in needlestick prevention and suggests that the institution’s needlestick prevention committee ask key questions (What happened?, How did it happen?, Why did it happen?, What can be done to prevent it from happening in the future?) to get at the "root" of situations resulting in injuries, thus identifying areas for change. By identifying where and how injuries occur in specific settings, interventions can be easily recognized and prioritized. Reporting injuries and documenting all bloodborne exposures is essential for having the evidence to analyze for prevention.

Legislative Impact

A new era for prevention began in November 2000 when President Bill Clinton signed the Needlestick Safety and Prevention Act shifting the focus in exposure control from behavior to devices. The law became effective in April 2001 and amended the OSHA Bloodborne Pathogens Standard to require the use of engineering controls known as safer needle devices to prevent exposure to bloodborne pathogens and to require documentation of all needlestick injuries. Similar efforts are underway in Europe where on International Nurses Day, May 12, 2004, a call for action to European institutions and policy makers was publicized by the Standing Committee of Nurses of the European Union (PCN) and others. A major goal is the use of ‘Sharps Protection’ Technology. This announcement and previous reports of the first documented deaths in 2003 from occupationally-acquired HIV in the National Health Services in the United Kingdom (UK), add momentum to a drive for safer needle devices led by the Royal College of Nurses and the UK health care worker union, UNISON.


...the Needlestick Safety and Prevention Act...require[s] the use of...safer needle devices to prevent exposure to bloodborne pathogens and...documentation of all needlestick injuries.

 

The movement for achieving passage of the U.S. 2000 Needlestick Safety and Prevention Act was a step-by-step, state-by-state approach, gathering allies and momentum for success. Nurses were key to the success. Nurses across the country were involved in conversations with colleagues and elected officials about the need to protect health care workers. This not only raised awareness about the hazard of HIV and hepatitis in the workplace, but also raised general awareness about the hazards faced by health care workers and the impact on the nursing shortage. By the time the federal law was enacted, 17 states had passed legislation requiring safety devices.

The law includes groundbreaking language requiring the involvement of frontline health care workers in the evaluation, selection and implementation of safer needle devices. The American Nurses Association (ANA) assisted in the writing and lobbying of the legislation that provided frontline nurses the power to participate in selecting devices that would be most effective for their own safety and the safety of the patients.

On July 1, 2004, further advances were made when Medicare began to enforce compliance with the OSHA Bloodborne Pathogens Standard including the new provisions required by the Needlestick Safety and Prevention Act, in all public hospitals not previously covered by OSHA. Since federal OSHA has jurisdiction only in the private sector (not-for-profit or for-profit health care settings), and 23 states enforce OSHA standards in state, county and municipal health care settings through their own OSHA-approved state plans, public hospitals in non-state plan states, for the first time, fall under the requirements of the OSHA Bloodborne Pathogens Standard and are subject to the same fines. Table 2 lists the standard coverage and describes how the federal bloodborne pathogens standard applies to particular populations of workers in the private and public sector depending on the state where the individual works and the specific legislation or regulation. The bloodborne pathogens standard, first implemented by the federal Occupational Safety and Health Administration (OSHA) in 1992, is the regulation that protects health care workers and governs the responsibility of the employer to enforce guidelines and provide supplies, immunization and post-exposure follow-up. This standard only applied to private sector workplaces (for profit or not-for profit health care settings) when it was first published and implemented. In the following six months, protection was extended to public sector health care workers (e.g. state, county, or municipal employees) in states where federal OSHA has approved a state occupational health and safety program). The remaining workplaces were not governed by the OSHA BPS until 2004 when the Medicare Modernization Act (MMA) extended coverage to public hospitals in states without OSHA state plans.

 

Table 2. OSHA Bloodborne Pathogens Standard Coverage

Legislation/Regulation Effective Date

Settings Where Workers Are Covered

Federal OSHA
Original Bloodborne Pathogens Standard effective 1992 with amendments directed by the Needlestick Safety and Prevention Act effective April 2001.

Private sector health care settings (for-profit or not-for profit)

OSHA Approved State Plans
(23 States are approved by OSHA see Effective 6 months following the federal standard

In the 23 states with OSHA approved state plans, the state, county, and municipal public employees are protected under the Bloodborne Pathogens Standard.

Medicare
(Section 947.) Effective July 1, 2004

All public hospitals not previously covered by the above as a condition of participation in Medicare.

Since implementation of the 2000 Needlestick Safety and Prevention law in April 2001, OSHA has conducted hundreds of inspections of hospitals, clinics and nursing homes, to determine compliance and has cited 123 institutions for violations of the standard. The most common violations include absence or lack of engineering controls, annual review of the Exposure Control Plan, sharps injury controls, documentation of employee involvement in device evaluation and selection, annual review of medical devices, and post-exposure medical evaluation.

Assuring compliance with the law. OSHA inspectors known as Compliance Safety and Health Officers (CoSHO) use the OSHA Compliance Directive entitled "Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens" as a guide during an inspection. The checklist in ANA’s Needlestick Prevention Guide can assist health care institutions to prepare for an inspection. OSHA requires evidence documented in the Exposure Control Plan on an annual basis, that the institution has evaluated the effectiveness of their current control measures, including safer needle devices, and has considered new, potentially more effective alternative devices. The CDC Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program along with the NIOSH Best Practices web site are valuable resources for assisting nurses and institutions in preventing needlestick injuries, and complying with the OSHA Bloodborne Pathogens Standard.

Working While Infected with HIV or Hepatitis


...there should be no discrimination against health care workers on the basis of real or perceived HIV status or hepatitis infection.

 

Just as the Code of Ethics for Nurses calls for nurses to provide care to patients without discrimination on the basis of diagnosis, there should be no discrimination against health care workers on the basis of real or perceived HIV status or hepatitis infection. The International Labor Organization (ILO) states that HIV infection is not a cause of termination of employment indicating that persons with HIV-related illnesses should be able to work for as long as medically fit. The ILO further states that screening for HIV/AIDS should not be required of job applicants or employed persons (ILO). CDC guidelines call for a case-by-case analysis of duty fitness and recommend restriction of HIV positive health care workers only from practicing in "invasive exposure prone procedures."

Nurses who are infected with HIV or hepatitis whether from occupational exposure or not, are able to work in the health care workplace as long as their health allows. There is no undue risk to patients from infected workers. Nurses are safe to practice in all areas with the exception of exposure-prone procedures performed in the surgical setting such as when scrubbing in to an abdominal surgery case as first surgical assistant.

Conclusion

Needlestick and sharps injuries continue to be a serious hazard exposing health care workers to deadly viruses and other bloodborne pathogens despite significant progress in policy, practice, and products. Over the past 20 years, progress has included the implementation of Universal Precautions, and has culminated with implementation of needleless systems and safer needle devices as required by the U.S. Needlestick Safety and Prevention Act of 2000. Preventable needlestick injuries, while still common in the United States, occurs most commonly in Africa and Southeast Asia. These are the settings where health care workers are at greatest risk for infection because of the prevalence of infections among the patients and where hepatitis B immunization is not the standard. More attention and resources are needed to extend protection to health care workers worldwide.

The risk of infection with HIV/AIDS has stimulated a focus on health care worker health and safety, and has galvanized efforts towards the prevention of occupational injury and illness to push the hierarchy of controls to the utmost level, eliminating the hazards. The elimination of unnecessary injections and unnecessary sharps is the first step to preventing infection with bloodborne pathogens. Other occupational hazards can be eliminated with similar attention to prevention by eliminating toxic chemical exposures causing occupational asthma and eliminating unsafe lifting causing disabling back injuries. Focusing policy on health care worker health and safety has the additional benefit of improving quality of patient care and reducing risks to patients who are cared for in and suffer from the same environmental contaminants. Protecting health care workers by providing appropriate staffing as well as demonstrating commitment to prevention through the implementation of a comprehensive health and safety program will improve worker safety and patient safety.

Author

Susan Q. Wilburn, MPH, RN
 

Susan Wilburn, MPH, RN, has worked on behalf of nurses and nursing for the past 15 years at the local, state, national, and international levels as a shop steward, union organizer, lobbyist, political activist, and labor educator. She is currently the occupational and environmental health specialist for the American Nurses Association (ANA) and the International Council of Nurses. Susan is co-chair of the nurses work group of Health Care Without Harm, project director of ANA’s RN No Harm project whose goal is to develop nurses as environmental health advocates, project director of the WHO/ICN Needlestick Prevention project, and holds an elected position on the Washington State Nurses Association policy and legislative council. Susan is a graduate of Kent State University School of Nursing and the University of Washington School of Public Health.

Under Susan’s leadership, the ANA, prioritized occupational health as one of the top five core issues for the organization, passed the 2000 U.S. Needlestick Safety and Prevention Act, and adopted a precautionary approach as a principle for occupational and environmental health policy.

Susan speaks and writes extensively on occupational and environmental health issues including a regular column in the American Journal of Nursing. She has written testimony and testified before Congress, the European Union, and the World Health Organization. She has spoken on the subject of environmental health, occupational health, latex allergy, needlestick injury prevention, and chemical hazards.

References

American Nurses Association. (2001a). Code of ethics for nurses with interpretive statements. Washington, DC: ANA Publications.

American Nurses Association. (2001b). NursingWorld health & safety survey. Retrieved August 20, 2004,

American Nurses Association. (2002). ANA’s needlestick prevention guide. Available at

Arbury, S., & Williams, D. (2004). OSHA’s bloodborne pathogen standard. Presentation at the American Nurses Association Capacity Building Workshop on Preventing Needlestick Injuries, April 22, 2004.

Canadian Center for Occupational Health and Safety (CCOHS). (2000). Needlestick injuries. Retrieved May 7, 2004 from

Cardo, D.M., Culver, D.H., Ciesielski, C.A., Srivastava, P.U., Marcus, R., Abiteboul, D., et al. (1997). A case-control study of HIV seroconversion in health care workers after percutaneous exposure. New England Journal of Medicine, 337(21), 1485-1490.

Centers for Disease Control and Prevention. (1997a). Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures. MMWR, 46, 25-9.

Centers for Disease Control and Prevention. (1997b). Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures – Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR, 46(2):21-25.

Centers for Disease Control and Prevention. (1998a). Guidelines for infection control in health care personnel. Infection Control and Hospital Epidemiology, 19(6).

Centers for Disease Control and Prevention. (1998b, October 16). Recommendations for prevention and control of hepatitis C virus (HCV). MMWR, 47(RR-19), 1-39.

Centers for Disease Control and Prevention. (2001). Updated U.S. Public Health Service guidelines for the management of occupational exposure to HBV, HCV, and HIV and recommendations for post-exposure prophylaxis. Retrieved May 7, 2004 from

Centers for Disease Control and Prevention. (2004). Workbook for designing, implementing, and evaluating a sharps injury prevention program. Retrieved May 7, 2004 from

Clarke, S.P, Sloane, D.M., & Aiken, L. (2002). Effects of hospital staffing and organizational climate on needlestick injuries to nurses. American Journal of Public Health, 92(7), 1115-1119.

Davis, M.S. (1999). Advanced precautions for today’s O.R.: The operating room professional’s handbook for the prevention of sharps injuries and bloodborne exposures. Atlanta: Sweinbinder Publications LLC.

Eucomed. (2004). European healthcare workers at risk! Retrieved May 13, 2004 from

Fisher, J. (1994). Strategies for integrating health care workers into the process of design, selection and use of control technology. In W. Charney & J. Schirmer (Eds.), Essentials of modern hospital safety, Volume 3. Boca Raton, FL: Lewis Publishers.

Food and Drug Administration (FDA). (1992). FDA safety alert: Needlestick and other risks from hypodermic needles on secondary I.V. administration sets – piggyback and intermittent I.V. Rockville, MD: FDA.

Gartner, K. (1992). Impact of a needleless intravenous system in a university hospital. American Journal of Infection Control, 20, 75-79.

Gershon, R.R., Karkashian, C.D., Grosch, J.W., Murphy, L.R., Escamilla-Cejudo, A., Flanagan, P.A., et al. (2000). Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. American Journal of Infection Control, 28, 211-21.

Haiduven, D.J., DeMaio, R.M., & Stevens, D.A. A five-year study of needlestick injuries: Significant reduction associated with communication, education, and convenient placement of sharps containers. Infection Control Hospital Epidemiology,13, 265-71.

International Health Care Worker Safety Center. (1998). Annual Number of Occupational Estimated Annual Number of U.S. Occupational Percutaneous Injuries and Mucocutaneous Exposures to Blood or Potentially Infective Biological Substances. Advances in Exposure Prevention, 4(1), 3.

International Labor Organization. (2001). An ILO code of practice on HIV/AIDS and the world of work. Geneva: International Labor Office Publications.

Jagger, J. (1996). Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Infection Control Hospital Epidemiology, 17(9), 573-575.

Mahoney, F.J., Stewart, K., Hu, H.X., Coleman, P., & Alter, M.J. (1997). Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Archives of Internal Medicine, 157, 2601-2605.

Medicare Prescription Drug Improvement and Modernization Act of 2003. Section 947. Retrieved 13 May 2004 from

National Institute for Occupational Safety and Health (NIOSH). (1999). NIOSH Alert: Preventing needlestick injuries in health care settings. DHHS (NIOSH) Publication No. 2000-108.

National Institute for Occupational Safety and Health (NIOSH). (2004). Safer medical device implementation in health care facilities: Sharing lessons learned. Retrieved September 6, 2004 from

Osborn, E.H.S., Papadakis, M.A., & Gerberding, J.L. (1999). Occupational exposures to body fluids among medical students: a seven-year longitudinal study. Annals of Internal Medicine, 130, 45-51.

Prüss-Üstün, A., Rapiti, E., & Hutin, Y. (2003). Sharps injuries: Global burden of disease from sharps injuries to health-care workers. Geneva, Switzerland: World Health Organization. Available at

Royal College of Nurses. (2003). Report of the 2003 Congress and Report of Council. Retrieved September 6, 2004 from

U.S. Department of Labor, Occupational Safety and Health Administration. (1991). Federal Register: Occupational exposure to bloodborne pathogens. Final rule. 29 CFR Part 1910.1030. Federal Register, 56, 235.

U.S. Department of Labor, Occupational Safety and Health Administration. (2001a). Federal register: Occupational exposure to bloodborne pathogens: Final rule. 29 CFR Part 1910.1030. Federal Register, 66, 5318-5325.

U.S. Department of Labor, Occupational Safety and Health Administration. (2001b). Enforcement procedures for the occupational exposure to bloodborne pathogens CPL 02-02-069 - CPL 2-2.69. Available:

Wilburn, S. (2004 in press). Preventing needlestick injuries. In Protecting the health and safety of health care workers. Washington, D.C.: American Nurses Publishing.

World Health Organization. (2002).The world health report 2002: Reducing risks, promoting healthy life. Geneva: WHO.

Yassi, A., McGill, M.L., & Khokhar, J.B. (1995). Efficacy and cost effectiveness of a needleless intravenous system. American Journal of Infection Control, 23, 57-64.


 
 
Posted by: securewaste@comcast.net AT 02:43 pm   |  Permalink   |  Email
Monday, March 02 2015

What are sharps Containers? How to dispose of sharps in Maryland? For information on Sharps containers and proper Sharps disposal in Maryland, review this information then contact Maryland Sharps Disposal.

A sharps container is a container that is filled with used medical needles (and other sharp medical instruments, such as an IV catheter). They fit into two main types:

-Single use which are disposed of with the waste inside

-Reusable which are robotically emptied and sterilized before being returned for re-use.

It is standard practice in developed and even underdeveloped countries for used needles to be placed immediately into a sharps container after a single use, with only a few exceptions to the general rule. Sharing needles is often the cause of AIDS (HIV) and other blood-borne infections spreading among intravenous drug users.

Needles are dropped into the container without touching the outside of the container. Needles should never be pushed or forced into the container, as damage to the container and/or needle stick injuries may result. In most countries around the world, recapping and de-notching needles is also no longer accepted practice.

Proper use of a sharps container includes pick up by or delivery to an approved "red bag" or medical waste treatment site. In addition to this pre-existing safety measure, all U.S. medical and educational staff are federally required to be tested on their knowledge of blood-borne pathogens.

 Common sharps containers (red plastic in the US, yellow plastic elsewhere) were first developed in 1979 when Frontier Plastics Ltd of South Wales in the UK recognized the need for a purpose designed container for the safe disposal of clinical sharps - developing the original Sharp-safe container which was first marketed in 1980.

The addition of Sharp-safe quickly expanded the realm of safe disposal within nontraditional areas such as Tattoo, piercing shops and the sorts. Shortly after this change a Canadian company (GICMD) quickly brought on their eco-friendly sharps disposal container which was compact and allowed an easy disposal of the hazardous materials with any collection service. This started a new trend in the industry allowing effective removal of waste.

During the last ten years, increased worldwide focus on safety and environmental impact has led to several positive government mandates being issued regarding engineered medical device standards and the reduction of clinical waste output from health facilities. This has resulted in a move toward reusable containers with built-in safety devices such as trays and locking devices. An example of this type is the Sharp-smart system, developed by Daniels Sharp-smart in 1986 and now used around the world.

Posted by: jamyr68@comcast.net Mike AT 07:32 am   |  Permalink   |  Email
Sunday, February 22 2015

Maryland Sharps Disposal And Sharps Needle Solutions

Sharps Compliance has launched a program designed to take medical waste out of the landfill and re-use it in the construction industry.

The Houston-based medical waste management company, which handles used syringes, needles, lancets and other medical waste from more than 9 million individuals and small companies around the country, has unveiled the GREEN Waste Conversion Process. The company will process the 100,000 pounds of medical waste collected each day at its plant in Carthage, Texas, into PELLA-DRX, a clean, raw material used in the manufacture of concrete.

“The world of medical waste has been a complex and expensive arena,” said David Tusa, Sharps’ executive vice president and CFO. “Green initiatives in this country are very important, and we set about trying to figure out how we could take part in that. What we really wanted to do was repurpose (medical waste), and so we’ve come up with something that’s very unique in the industry.”

According to Research and Markets, a recovering economy and aging population are combining to increase the demand for medical waste disposal. In addition, federal regulations are curtailing the use of incinerators to treat medical waste, forcing healthcare providers to either upgrade their incinerators or use commercial facilities such as landfills – both very expensive processes.

Sharps collects used medical materials from home health agencies, retail clinics, small businesses, private practices, individuals and the government – pretty much any generator of medical waste outside the hospital or large healthcare setting. The waste is shipped to Sharps via the U.S. Postal Service, and the company spends roughly $100,000 a year disposing of that waste in landfills.

“When you take medical waste to a landfill, it’s very, very, very expensive,” Tusa said.

“Sharps’ waste conversion process and the PELLA-DRX product are designed to address these medical waste concerns,” said Burton Kunik, the company’s CEO and chairman, who reportedly learned of the idea while attending a conference hosted by the Product Stewardship Institute. “Absolutely none of the medical waste we process will ever go to a landfill. Instead, it is repurposed into a raw material that becomes part of a new product. With our ground-breaking conversion process, medical waste throughout the world can now become a sustainable product managed in the most effective, environmentally thoughtful means possible.”

Company officials expect not only to eliminate their own waste disposal fees with this program, but also market the new material to cement manufacturers and other segments of the construction industry. They see this as a potential solution to a billion-dollar issue affecting healthcare providers of all sizes, from the single physician to the large network.

Tusa said the program may be adopted by hospitals and large healthcare providers as well.

Kunik said the program should appeal not only to healthcare providers looking to reduce waste disposal costs, but to everyone who wants to improve the environment. He pointed out that President Barack Obama has mandated that federal agencies cut their own contribution to global warming by 28 percent by 2020.

Posted by: localwastedisposal@comcast.net Mike AT 09:02 pm   |  Permalink   |  Email
Saturday, November 02 2013

Need a Maryland Sharps Disposal Company, check out this link Medical Waste Disposal Maryland

 

Posted by: Admin AT 10:35 pm   |  Permalink   |  Email
 

About Us:

Maryland Sharps Disposal, a Maryland company focusing on Safe, Compliant Sharps Waste Disposal and Sales

Contact Us:
Sharps Disposal Maryland
USA - North America
Rockville, Maryland 20850
877-633-7328
Maryland Sharps Disposal Company

Maryland - Sharps Waste Disposal - Needle Disposal - Biohazard Disposal - Medical Waste Disposal - Red Bag Waste Disposal - Biohazard Disposal - Medical Waste Management