Sharps waste is a form of biomedical waste composed of used "sharps", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are:
In addition to needles and blades, anything attached to them will also be considered sharps waste, such syringes and injection devices.
Blades can include razors, scalpels, X-Acto knife, scissors, or any other medical items used for cutting in the medical setting, regardless of if they have been contaminated with biohazardous material. While glass and sharp plastic are considered sharps waste, their handling methods can vary.
Glass items which have been contaminated with a biohazardous material will be treated with the same concern as needles and blades, even if unbroken. If glass is uncontaminated, it is still often treated as a sharp, because it can break during the disposal process. Contaminated plastic items which are not sharp can be disposed of in a biohazardous waste receptacle instead of a sharps container.
As a biohazardous material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of blood-borne diseases, such as hepatitis B (HBV), hepatitis C (HCV), and HIV. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste. The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur.
The general public can occasionally be at risk to injuries from sharps waste as well when improperly disposed of by injection drug users.
A sharps container is a hard plastic container that is used to safely dispose of hypodermic needles and other sharp medical instruments, such as an IV catheters and disposable scalpels. Sharps containers may be single use which are disposed of with the waste inside, or reusable which are robotically emptied and sterilized before being returned for re-use.
Needles are dropped into the container through an opening in the top. Needles should never be pushed or forced into the container, as damage to the container and/or needlestick injuries may result. Sharps containers should not be filled above the indicated line, usually two-thirds full.
In North America, sharps containers are often red, and elsewhere are often yellow.
Airports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent diabetics. People injecting drugs in their homes may substitute other hard-sided containers such as empty milk jugs for disposal of needles.
Extreme care must be taken in the management and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an autoclave. A less common approach is to incinerate them; typically only chemotherapy sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.
Health care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict hospital protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose of it effectively.
Self-locking and sealable sharps containers are made of plastic so that the sharps can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use sharps containers of various sizes are sold throughout the world. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.
NIOSH found through results from focus groups that accommodation, functionality, accessibility, and visibility are four areas of high importance to be able to ensure safe discarding of sharps. The studies found it was important to have containers that are easy to use with little need for training to be able to use. The containers should be visible in any areas that sharps are used and be placed in such degree that spillage and injury will not be likely to occur with use.
Recent legislation in France has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.
Disposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the United States, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often medical waste, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the U.S. mail in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.
With more than sixteen billion injections administered annually worldwide, they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have been developed, mostly related to safety mechanisms. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the Needlestick Safety and Prevention Act was passed, along with the 2001 Bloodborne Pathogens Standard.
Safety syringes help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device. These injection devices automatically disable after a single use. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused. Shielding the needle after the injection is another approach for safe management of sharps. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Another technology in sharps waste management relating to injections is the needle remover. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste.
In the developing world
Sharps waste is of great concern in developing and transitional regions of the world. Factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste, and the cost of newer disposal technology makes them unlikely to be used. As with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes. The average person has been estimated to receive up to 8.5 injections per year. Newly developed injection technologies are rarely used to provide these injections due to added costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions.
The infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not always available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste in the environment. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).
Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually. 40-65% of new HBV and HCV are due to percutaneous occupational exposure.
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