Healthcare Waste Management Training

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Philippa Bradley
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1 WHO Regional Office for Europe Healthcare Waste Management Training Module 5 Sharps: Handling & Mitigation Measures

2 Content Introduction Needle Stick accidents: Tanzania Mitigation measures Safer design Collection containers Training PPE Vaccination Disposal Recording sharps incidents Summary

3 Introduction Sharps accidents are the number one of all reported accidents in the healthcare sector (16% in the US) In a two year period in the UK, 477 cases of sharps accidents contaminated with HIV, HBV, HCV were recorded 12 workers became infected cases of needle accidents are reported in the US every year. There were 66 documented cases of occupationally acquired HIV in Europe in In 1990, HBV cases caused by sharps in the US led to deaths

infected 600.000 800.000 cases of needle accidents are reported in the US every year.

4 Main Challenge= Sharps Accidents Example Tanzania: By the trainees, a baseline study on sharps accident was carried out: 197 people from 7 DH participated in the study 52 persons reported to had one or more accidents during the last 6 month In total 90 accidents were reported Per 100 staff per year it can be expected: >50 persons will have one or more injury About 90 accidents to be expected About 56% of the accidents are generated by non-injection items. About 40% off all accidents are happening during waste management, cleaning, laundry. Percentage of number of accidents within 6 month 16% 6% 3% 1% 0% 1% >5 73%

expected: >50 persons will have one or more injury About 90 accidents to be expected About 56% of the accidents are generated by non-injection items.

5 Sharps injuries Potential infection The main issue with sharps injuries is the potential risk of infection The risk of infection is dependant on many factors: The prevalence of infection in patients, The frequency and type of exposure, The transmission rate of the infection (what disease etc), The susceptibility of the host. Prevention is better than a cure!!!

infection in patients, The frequency and type of exposure, The transmission rate of the

6 Mitigation measures Universal measures: Precautionary Principle: treat all blood/bodily fluids as potentially infectious (conduct a risk assessment if required) Must be observed in all situations where there is contact with potentially infectious materials Mitigation measures: (a) Elimination (b) Safe Place options (c) Safe Person options

required) Must be observed in all situations where there is contact with potentially

7 Avoid injections (where possible) Use safer sharps designs Use sharps containers Train staff in sharps safety (include no recapping policy etc) PPE (gloves etc) Vaccination Mitigation measures II

8 Safer sharps design Needle-less System: a device that does not use needles for the collection or withdrawal of body fluids, or for the administration of medication or fluids Sharps with Engineered Sharps Injury Protection: a non-needle sharp or a needle device used for withdrawing body fluids via a vein or artery, or for administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident Blunt Tip Blood Drawing Needle:a device for sucking fluids into a syringe infusion tubes can be injected with pharmaceutical solutions without the use of needles

artery, or for administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure

9 Safer sharps design (examples) Hypodermic syringes with Self-Sheathing safety feature Hypodermic syringes with an Add On safety feature Hypodermic syringes with Retractable Technology safety feature

10 Safer sharps design (examples) II Disposable scalpels with safety features:

11 General requirements: Must safely contain contaminated sharps: At the point of use; During temporary storage; During handling and transport to the point of treatment and final disposal. Must be: Sharps disposal containers Closable, Puncture-resistant, Leakproof on the sides and bottom, and Appropriately labeled or color coded

12 Sharps disposal containers II Types of container: Safety boxes made of cardboard Will be supplied folded, Usually volume of 5 litres, Collection of complete syringes, infusion sets, scalpels etc. Mainly used in case of incineration and during immunization campaigns

litres, Collection of complete syringes, infusion sets, scalpels

13 Sharps disposal containers III Types of container: Safety boxes made of plastic Different capacities available, Two different types: Collection of complete syringes, infusion sets, scalpels etc. Separation of sharp items with needle removal features Reduction of volume

types: Collection of complete syringes, infusion sets, scalpels etc.

14 Sharps collection containers IV Disposal of a Luer - Lock & blood extraction systems:

15 Sharps collection containers V Disposal of a Luer - Slip systems:

16 Sharps collection containers VI Disposal of a butterfly:

17 Sharps collection containers VII Types of container: Improvised containers

18 Sharps collection containers: Correct use IV Do not overfill! UNSAFE SAFE The container must be closed prior transport!!!

19 Needle cutter: Needle removal devices Separate the needle from a syringe or the plastic hub of a needle by means of a simple mechanical action, Collection of needles in a secure container within the device.

20 Disposal Disposal methods should: Ensure that needles can not be re-used, Be selected in consideration of economical and environmental aspects. Treatment as infectious waste: Incineration, Autoclaving. Disposal option for rural areas: Sharp pit

21 Disposal Requirements Hatch should be easy to open, should hermitically close the tank and should be lockable. Tank should be water tight and impermeable. 2 m 0,9 m 0,3 m Final sealing 2nd sealing 0,3 m Capacity planning (for 5years): 3rd sealing V = 50l * number of beds 1 m Groundwater

22 Training Target groups: Medical staff, Transport & cleaning staff, Disposal companies. Contents: Risks, Safe handling, PPE, Labelling Transport Disposal.

23 Re-capping! Past studies of needle stick injuries have shown that approximately 10% to 25% occurred when recapping a used needle Introduce & enforce a strict no recapping policy!!!

24 Personal Protective Equipment (PPE) Past studies of needle stick injuries have shown that wearing gloves can reduce the chance of being infected by a needlestick injury by up to 50% When using sharps, ensure everyone wears them

25 Vaccination Should be made available, free of charge to all employees at risk of exposure unless: Employee already vaccinated Testing reveals immunity The vaccination must be performed by a licensed healthcare professional! Keep Records of the vaccination program

26 Let the injury bleed freely, do not press, squeeze or suck the injured part. Wash the wound with soap and water. Alert the supervisor and take injured person to a doctor for further treatment. Report the incident via the accident reporting system. If possible, identify the source patient. Ensure that the patients blood (with permission) & the injured persons are tested for: HIV HBV/HCV In case of

27 Recording sharp incidents All incidents involving sharps must be reported and the details recorded The HWO should investigate all incidents to see if any lessons can be learned which could reduce the chance of the same incident occurring again All the reports should collated annually & passed to the HWM for review

28 Summary Sharps pose a high risk of infection. When dealing with sharps remember the precautionary principle. Recapping is a major cause of sharps injuries so should be prohibited. All incidents and accidents should be reported & investigated. Remember: Prevention is better than a cure!

OSHA s Revised Bloodborne Pathogens Standard. Outreach and Education Effort 2001

OSHA s Revised Bloodborne Pathogens Standard Outreach and Education Effort 2001 Bloodborne Pathogens Standard 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens Published December 1991 Effective