In the average hospital or medical office, proper sharps waste disposal is a top priority for management and staff alike. Correct disposal of biohazard materials — including used syringes — is a highly regulated procedure at both the state and federal level in an effort to make the work environment as safe as possible. From beginning to end, organizations must institute very specific parameters reduce injury risk for medical personnel, housekeeping staff, sanitation workers and waste haulers.
The proper disposal process begins with diligent management, planning, and training. According to the Occupational Safety and Health Administration (OSHA) Bloodborne pathogen standards, specific training of employees who handle and dispose of hypodermic needles is required by law.1 Additionally, the National Institute for Occupational Safety and Health (NIOSH) encourages hospitals to assemble a specific committee to evaluate needle safety as it relates to the disposal process.2 This group of employees develops prevention methodology to be implemented across the organization, as well as an Exposure Control Plan in the event of an injury.1 This plan must address methods of compliance, hepatitis B vaccination, hazard communication to employees, record keeping and methods to evaluate sharps injuries.1
Once training and other preventative measures are taken, there are still many engineering and work practice controls that are utilized during the actual disposal process. Engineering controls are measures that isolate the hazardous materials from the workplace, such as approved disposal containers.3 There are four major criteria for appropriate sharps containers: functionality, accessibility, visibility and accommodation.2
In terms of functionality, sharps containers must be durable, leak proof, sealable and puncture resistant. Regulations are also placed on specific closure mechanisms, size and shape, and mounting brackets. 2 Next, the containers must be easy to find and easy to operate. It must be accessible for one-handed disposal while at the same time secure enough to prevent children from reaching in. Additionally, the container must not be located in a heavily trafficked area where it could be knocked over, and installation height should accommodate 95 percent of the adult population.2 Lastly the container should be kept in a well-lit area of the room, be red or orange-red in color and properly display the biohazard symbol.2
Work practice controls are measures that reduce the likelihood of exposure by amending the manner in which a task is performed. These controls include prompt disposal of sharps waste and proper handling protocol.3 After syringes have been placed in the designated sharps container, they cannot simply be thrown out with the rest of the garbage. Medical waste must be disposed of in either a sterilizing autoclave or, less commonly, incinerated after having been stored for no more than seven days.1 Many large facilities have their own autoclaves, which drastically minimizes the number of people who come into contact with the sharps waste. However, smaller clinics without their own autoclave are required by federal regulations to retain professional services to properly dispose of hazardous wastes.
Typically smaller organizations will choose one of two options: Truck service or mail-back service – each with their own specific regulatory processes and additional costs to the clinic.Truck services have very specific EPA and OSHA guidelines that must be followed by all parties involved and employees must undergo extensive training to be able to transport sharps and medical waste to the destruction facility. Hospitals must first provide transporters with written assurance that they have complied with all labeling, packaging, and storage requirements and provide the EPA Administrator with the names of all waste transporters.4 Transporters must then inform the EPA Administrator of the exact number and type of vehicles used to transport the waste, as well as the way in which the waste was handled and segregated.4 Finally, owners of the disposal facilities must provide notice of disposal to the clinic, register with the EPA Administrator, and establish an educational training program for their employees who come into contact with the used syringes.4
Unsurprisingly, the mail-back disposal method is also complicated. Although this method is less costly than hiring a truck service, it still entails many federal regulations. The mail-back system enables small facilities to dispose of sharps waste through the U.S. Postal Service (USPS), but the packaging must meet strict guidelines. The USPS requires all sharps waste packaging meet federal Department of Transportation (DOT) standards.5 For instance, all containers must clearly display the USPS authorization number, the container ID number, the name of the manufacturer or distributor and the biohazard symbol. Most importantly, each container must include a four-part USPS manifest that identifies the mailer and destruction facility.5 Once the syringes arrive at a destruction facility a whole new set of trained employees must handle the materials before they are appropriately disposed of.
The primary goal in sharps waste management is to have the used needles handled as little as possible, with steps taken along the way to prevent injuries when contact is unavoidable. Hospitals, clinics, and waste management companies strive tirelessly to minimize employee injuries, but even when all federal and state regulations are followed to a tee it has been shown that as many as one third of all sharps injuries are still related to the disposal process.2
The only way to spare healthcare and waste management professionals from hypodermic needlestick injuries is to reduce the number of needles used in the medical facilities. According to the Bloodborne Pathogens Standard, the best practice is for employers to select safer injection devices.3 By using a device like the PharmaJet needle-free injector, hospitals and clinics can provide a safer environment for their employees and patients, while at the same time reducing their overall medical waste production.
- United States. Centers for Disease Control and Prevention. Safe Community Needle Disposal. Web.
- United States. Centers for Disease Control and Prevention. Selecting, Evaluating, and Using Sharps Disposal Containers. Web.
- United States. Occupational Safety and Health Administration. Department of Labor. Needlestick/Sharps Injuries. Web.
- United States. House of Representatives. GovTrack.us. 31 July 2013. Web.
- “Federal Regulation.” SafeNeedleDisposal.Org. Coalition for Safe Community Needle Disposal, Web.