Sharp Solutions for a Sticky Problem

• Apr 01, 2003

The Problem

More than three billion injections and other skin punctures using "sharps" -- the medical term for hypodermic needles, syringes, lancets and anything that is used to cut or penetrate skin -- occur outside of healthcare settings every year to treat numerous conditions, including: diabetes, hepatitis, multiple sclerosis, infertility, migraines and allergies. Only a fraction of these needles are disposed of properly and advances in healthcare and the desire of patients to receive medical care in their home are causing a rise in the legal use of self-injected drugs. This increase is expected to multiply dramatically over the next decade, with the Center for Disease Control projecting that more than seven percent of the U.S. population will have diabetes by 2050.

This rise in self-care poses a potential threat to community members. Janitors, housekeepers, waste workers and even neighborhood children are at risk of injury and infection when needles are discarded improperly inside or outside of the waste stream. As a result, communities are faced with the growing need to provide a means for self-injectors to safely dispose of their used needles and syringes.

Despite the growing problems associated with improper needle disposal -- transmittal of blood-borne pathogens, including HIV, the virus that causes AIDS, as well as hepatitis B & C -- there are currently no federal regulations for safe needle disposal. While some states and local governments do have disposal guidelines, laws or regulations, they are often ineffective, unclear or even conflicting, and are little more than a source of confusion for self-injectors. (State-by-state regulations, as well as additional regulatory links, are available for review online at www.epa.gov/epaoswer/other/medical.)

At the federal level, the transportation of hazardous materials, which include medical waste, is regulated by the U.S. Department of Transportation (DOT) (Regulations available at hazmat.dot.gov/rules.htm). According to the U.S. DOT, there are a number of requirements for the packing and transporting of infectious substances and regulated medical waste. The requirements, however, apply only to commercial activity -- healthcare facilities, waste haulers, treatment and disposal companies -- not self-injectors.

The U.S. Postal Service (USPS) also outlines regulations for transporting infectious materials in the Domestic Mail Manual. The USPS has adopted the U.S. DOT rules for packaging and added tracking requirements (pe.usps.gov). Again, these regulations where created to apply to commercial facilities and not self-injectors.

EPA guidelines and the medical community recommend that self-injectors place used needles in a bleach bottle and throw the sealed bottle in the trash. However, this practice has become problematic. Plastic containers break open as soon as they are compacted in a garbage truck, leaving needles loose and increasing the likelihood for needle-stick injuries, and expanded recycling of plastic containers puts sanitation workers at risk when these containers get mixed in with recyclables. Another problem with putting used needles in household plastic containers is that they are sought after by illicit intravenous drug users who will reuse the needles and increase the spread of blood-borne disease. Finally, needle disposal is a problem for people with active lives who will not have a plastic container with them when they need to self-inject while out, leaving them with no choice but to dispose of their used needles by throwing them in the trash or flushing them down the toilet.

A January 2001 meeting on the issue of safe community needle disposal at the American Pharmaceutical Association in Washington D.C. was the beginning of a national effort to develop a solution to this problem. Thirty attendees from organizations with an interest in the issue identified public health implications of unsafe sharps disposal and described current community efforts to promote the safe disposal of needles as inadequate. The group concluded that unsafe sharps disposal is widespread and that the populations most at risk are environmental services employees in the solid waste and wastewater sectors, hospitality employees and children. The group also concluded that public attitudes about needle disposal need to change to reflect the belief that placing needles in the trash is unacceptable. Above all the group determined the need to create effective, inexpensive and widely available methods for people to dispose of needles and sharps without putting them in their communities? solid waste systems.

The Coalition of Safe Community Needle Disposal, a non-profit organization dedicated to finding a solution for this serious public health issue, came out of this meeting. Recently, the organization issued a "Call to Action" for their members to initiate new safe needle disposal practices in urban, suburban and rural communities nationwide. The coalition will work to educate individuals and policy makers about alternatives and options available to communities to assure safe needle disposal. In addition, the coalition will use advocacy and education to support guidelines that may be used by federal, state and local officials to develop locally-tailored programs for safe community disposal of used sharps.

Recently Waste Management, Becton, Dickinson and Co. and Sharps Compliance teamed up to provide self-injectors with a safe, effective, discrete and affordable solution option for safe needle disposal with the Sharps Disposal By Mail System™. The mail back program is a comprehensive home- or commercial setting solution for collecting, transporting and disposing of needles and syringes by collecting used sharps in puncture- and leak-resistant containers, like those used by health professionals, and treating them at a dedicated sharps destruction facility. Once the container is destroyed, documentation that the container was received and destroyed is issued to the customer.

This system is currently available to Waste Management's residential and commercial customers across the country. The same mail back program is also available in more than 55,000 pharmacies nationwide and includes a national education campaign promoting safe sharps disposal to communicate to the public the potential hazards of improper needle disposal.

There are numerous advantages to using the mail back system; however the primary benefit is that this solution option provides for sharps disposal in a way that isolates and removes them from the general public, thus eliminating the possibility of injury and infection from a needle-stick for families and community members while providing the patient with a convenient and confidential disposal method. A pre-paid postage package, approved for shipment through the U.S. Postal Service, is provided in order to send full containers to the destruction facility, where it is incinerated. Customers receive certified proof of destruction once the container and its contents are destroyed. In short, mail back systems provide a simple, cost-effective and highly confidential way of managing the collection and disposal of home-generated sharps waste.

Ensuring personal and public safety by properly disposing of used needles and syringes is a national effort that is gaining momentum on all fronts. From a work-related compliance standpoint, this is a high priority for employers and risk managers. Recently, Occupational Safety and Health Administration (OSHA) published regulations stating that all work-related needle stick injuries and cuts from sharps objects that are contaminated with another person's blood or potentially infectious material must be recorded. They have defined potentially infectious materials as blood-borne pathogens including human bodily fluids, tissues and organs, as well as materials infected with HIV or hepatitis B or C. If a person receives a work-related needle stick and is later diagnosed with an infectious blood-borne disease, the log must reflect this information as well. In addition, diabetes educators are working in conjunction with doctors to provide a better disposal alternative for their patients. On a national front, the Coalition for Safe Community Needle Disposal is working with lawmakers and lobbyist to draft legislation to prohibit disposal of used sharps in the waste system. There is also an effort, on local and national levels, to gain the support of third party payers in order to provide coverage for mail back programs.

As part of this growing national trend, and prompted by the large number of improperly disposed of needles, members of several California organizations have formed the Alameda County Sharps Coalition. Along with the national coalition efforts, the Alameda County Sharps Coalition is working to develop and implement a program on a local level that is user-friendly, ensures worker safety, allows for the greatest amount of sharps diversion from the landfills and is fiscally sound. The group has identified mail back disposal as the best method for removing needles from the Bay Area and has begun to seek funding to support new safe needle disposal practices.

The Alameda County Sharps Coalition is building on the experience of two successful Sharps Compliance Inc./Waste Management Inc. pilot programs. In California, mail back sharps disposal units were offered for sale to consumers in local pharmacies and for purchase through Waste Management Inc. While in Iowa, Waste Management and Sharps Compliance initiated a safe disposal program for three communities with the goal of educating the community about the health risks of improperly disposed of needles. The program used a state grant to provide residents with mail back systems free of charge. The primary focus of the program was to educate self-injectors about safe needle disposal practices and to provide a model for safe, effective handling of used sharps in the future.

Of those consumers participating in the pilot mail back program in California, 40 percent have reordered new disposal units. The Alameda Sharps Coalition believes that with results like these, the residents of Alameda County will benefit not only by increased diversion of sharps from area landfills, but also by improving the quality of life of the community as a whole.

The need for new, safe disposal practices is clear. The mail back program ensures the safety of your home as well as the safety of your community. It allows self-injectors to do the right thing by keeping used needles out of the public waste system. With more and more people making the responsible choice for safe needle disposal, and national and state efforts to develop legislation, safe disposal compliance programs, such as the mail back solution, will help to keep our communities across the country safe from injury and infection.

This article originally appeared in the 04/01/2003 issue of Environmental Protection.