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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 hypodermic needles, disposable scalpels and blades, contaminated glass and certain plastics, and guidewires used in surgery. [1]
In addition to needles and blades, anything attached to them, such as syringes and injection devices, is also considered sharps waste.
Blades can include razors, scalpels, X-Acto knives, scissors, or any other items used for cutting in a medical or biological research setting, regardless of whether 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 are treated with the same concern as needles and blades, even if unbroken. If glass is contaminated, 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.
Injuries from sharps waste can pose a large public health concern, as used sharps may contain biohazardous material. It is possible for this waste to spread blood-borne pathogens if contaminated sharps penetrate the skin. 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 of sustaining injuries from sharps waste as well when hypodermic needles are improperly disposed of by injection drug users.
Hard plastic containers known as sharps containers are used to safely dispose of hypodermic needles and other sharp medical instruments, such as IV catheters and disposable scalpels. They are often sealable and self-locking, as well as rigid, which prevents waste from penetrating or damaging the sides of the container. In the United States, sharps containers are usually red and marked with the universal biohazard symbol for ease of recognition. Elsewhere, they are often yellow. Waste is loaded into the container until it reaches a certain height, which is usually around three-quarters of the way full. At that point, the container is emptied or disposed of.
Sharps containers may be single use, in which case they are disposed of along with the waste they contain, or reusable, in which case they are robotically emptied and sterilized before being returned for re-use. Airports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent diabetics. Medical facilities and laboratories are also equipped with sharps containers, as well as the equipment required to safely sterilize or dispose of them. 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 in the US 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.
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 of. 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. Strict hospital protocols and government regulations that instruct health care providers on how to manage sharps waste help ensure that the waste is handled as effectively and safely as possible.
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. Recent[ when? ] 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.[ citation needed ]
A report by the Canadian Mental Health Association found that supervised injection sites help reduce the amount of discarded needles on streets. [2]
With more than sixteen billion injections administered annually worldwide, [3] needles 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. [4]
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 separately from the syringe. There is debate around the use of these devices, as they involve an additional step in the handling of sharps waste.
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 waste make up the largest portion of sharps waste. However, injection use is much more prevalent in the developing world. 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. [5] The average person has been estimated to receive 1.5 injections per year. [5] 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. [6]
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).[ citation needed ]
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. [7] 40-65% of new HBV and HCV infections are due to percutaneous occupational exposure. [8]
Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The infection control techniques were essentially good hygiene habits, such as hand washing and the use of gloves and other barriers, the correct handling of hypodermic needles, scalpels, and aseptic techniques.
Biosafety is the prevention of large-scale loss of biological integrity, focusing both on ecology and human health. These prevention mechanisms include the conduction of regular reviews of biosafety in laboratory settings, as well as strict guidelines to follow. Biosafety is used to protect from harmful incidents. Many laboratories handling biohazards employ an ongoing risk management assessment and enforcement process for biosafety. Failures to follow such protocols can lead to increased risk of exposure to biohazards or pathogens. Human error and poor technique contribute to unnecessary exposure and compromise the best safeguards set into place for protection.
A syringe is a simple reciprocating pump consisting of a plunger that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside of the tube, allowing the syringe to take in and expel liquid or gas through a discharge orifice at the front (open) end of the tube. The open end of the syringe may be fitted with a hypodermic needle, a nozzle or tubing to direct the flow into and out of the barrel. Syringes are frequently used in clinical medicine to administer injections, infuse intravenous therapy into the bloodstream, apply compounds such as glue or lubricant, and draw/measure liquids. There are also prefilled syringes.
Chemical waste is any excess, unused, or unwanted chemical, especially those that cause damage to human health or the environment. Chemical waste may be classified as hazardous waste, non-hazardous waste, universal waste, or household hazardous waste. Hazardous waste is material that displays one or more of the following four characteristics: ignitability, corrosivity, reactivity, and toxicity. This information, along with chemical disposal requirements, is typically available on a chemical's Material Safety Data Sheet (MSDS). Radioactive waste requires special ways of handling and disposal due to its radioactive properties. Biohazardous waste, which may contain hazardous materials, is also handled differently.
Toxic waste is any unwanted material in all forms that can cause harm. Mostly generated by industry, consumer products like televisions, computers, and phones contain toxic chemicals that can pollute the air and contaminate soil and water. Disposing of such waste is a major public health issue.
An autoinjector is a medical device designed to deliver a dose of a particular drug. The injectors were initially designed to overcome the hesitation associated with self-administration of the needle-based drug delivery device.
A hypodermic needle, one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body or extract fluids from the body. Large-bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.
A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three blood-borne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).
Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.
An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.
Illegal dumping, also called fly dumping or fly tipping (UK), is the dumping of waste illegally instead of using an authorized method such as curbside collection or using an authorized rubbish dump. It is the illegal deposit of any waste onto land, including waste dumped or tipped on a site with no license to accept waste. The United States Environmental Protection Agency developed a “profile” of the typical illegal dumper. Characteristics of offenders include local residents, construction and landscaping contractors, waste removers, scrap yard operators, and automobile and tire repair shops.
A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Among healthcare workers and laboratory personnel worldwide, more than 25 blood-borne virus infections have been reported to have been caused by needlestick injuries. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.
A needle remover is a device used to physically remove a needle from a syringe. In developing countries, there is still a need for improvements in needle safety in hospital settings as most of the needle removal processes are done manually and under severe risk of hazard from needles puncturing skin risking infection. These countries cannot afford needles with individual safety devices attached, so needle-removers must be used to remove the needle from the syringe. This lowers possible pathogen spread by preventing the reuse of the syringes, reducing incidents of accidental needle-sticks, and facilitating syringe disposal.
Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.
Biomedical waste or hospital waste is any kind of waste containing infectious materials generated during the treatment of humans or animals as well as during research involving biologics. It may also include waste associated with the generation of biomedical waste that visually appears to be of medical or laboratory origin, as well research laboratory waste containing biomolecules or organisms that are mainly restricted from environmental release. As detailed below, discarded sharps are considered biomedical waste whether they are contaminated or not, due to the possibility of being contaminated with blood and their propensity to cause injury when not properly contained and disposed. Biomedical waste is a type of biowaste.
The safe handling of carcinogens is the handling of cancer causing substances in a safe and responsible manner. Carcinogens are defined as 'a substance or agent that can cause cells to become cancerous by altering their genetic structure so that they multiply continuously and become malignant'. The World Health Organization breaks down the three types of carcinogens that can cause cancer in humans. The first type of carcinogen is the physical type which can be ultraviolet and ionizing radiation. The second type of carcinogens is defined as asbestos, tobacco smoke, alcohol, aflatoxin, and arsenic. The third type of carcinogen is biological which highlights infections that can be caused from viruses, bacteria, or parasites. There are many risk factors when it comes to the human body and carcinogens, which is why it is so important that the proper approach is used when attempting to reduce expose to cancer causing carcinogens.
A safety syringe is a syringe with a built-in safety mechanism to reduce the risk of needlestick injuries to healthcare workers and others. The needle on a safety syringe can be detachable or permanently attached. On some models, a sheath is placed over the needle, whereas in others the needle retracts into the barrel. Safety needles serve the same functions as safety syringes, but the protective mechanism is a part of the needle rather than the syringe. Legislation requiring safety syringes or equivalents has been introduced in many nations since needlestick injuries and re-use prevention became the focus of governments and safety bodies.
Prevention of viral hemorrhagic fever is similar for the different viruses. There are a number of different viral hemorrhagic fevers including Ebola virus disease, Lassa fever, Rift valley fever, Marburg virus disease, Crimean-Congo haemorrhagic fever (CCHF) and yellow fever. Lassa, Ebola, Marburg and CCHF can be spread by direct contact with the body fluids of those infected. Thus the content here covers the prevention of Ebola.
Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment. Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover drugs after treating patients and discarding of expired drugs. Failure to properly dispose of drugs creates opportunities for others to take them inappropriately. Inappropriate disposal of drugs can also cause drug pollution.
Single-use medical devices include any medical equipment, instrument or apparatus having the ability to only be used once in a hospital or clinic and then disposed. The Food and Drug Administration defines this as any device entitled by its manufacturer that it is intended use is for one single patient and one procedure only. It is not reusable, therefore has a short lifespan, and is limited to one patient.
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