PSI National Dialogue on Medical Sharps “Data” Workgroup

© Product Stewardship Institute, Inc.September 2008

PSI National Dialogue on Medical Sharps

“Data” WorkgroupSacramento, CA

September 23-24, 2008


Workgroup ParticipantsPSI: Scott Cassel, Sierra Fletcher (Facilitators)Angela Laramie, MA DPHMichael Mongillo, PathacuraLisa Pompeii, University of TexasJenny Schumann, Coalition for Safe Community Needle DisposalKarl Schumann and Bob Singley, BDDavid Trindell, Hoffman-La Roche

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Workgroup Process• Assignments from Meeting #1• 3 workgroup calls

– Refined purpose– Developed workplan– Conducted research between calls– Helped develop presentation

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Purpose of this Workgroup

Reach consensus on the nature & scope of the problem.

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Priority QuestionsNature & Scope of the Problem

• Incidence of needle-sticks (Where? Who? How many?)

• Costs/impacts of needle-sticks • Who is affected (public v. private

waste haulers; other sectors?)

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Incidence of Needle-stick Injuries (outside healthcare)

• Data for on-the-job needle-sticks:– Workers might not report the incident to

employers, leading to under-reporting of such events

– Companies/agencies might not collect this data– Companies/agencies might not be willing to share

these data, if collected• Data on needle-sticks among the public are

not available.6


2004

NIOSH

Waste Workers and Bloodborne Pathogen Exposure: Executive Summary of Existing Literature

• NY city – needle sightings in 2001 – 1 in every 4,156 truck shifts (Lawitts, 2002)

• NY city – Needle-sticks in 2001 – 1 in 34,000 truck shifts (Lawitts, 2002)

• San Francisco – 2001 – 6 needle-stick injuries (Drda, 2002)

2006

California Department of Health Services

Transforming Medical Waste Disposal Practices to Protect Public Health: Worker Health and Safety and the Implementation of Large-Scale, Off-site Steam Autoclaves

• April 2002 - December 2003 - 8 (12.5%) needle-stick injuries recorded by employer (out of a total of 64 injuries)

http://www.cdph.ca.gov/programs/ohsep/Documents/medicalwaste.pdf

Injuries Among Waste Haulers 7


1990

American Journal of Public Health

Turnberg, WL et al

Survey of Occupational Exposure of Waste Industry Workers to Infectious Waste in Washington State

• 438 (47%) of 940 surveys returned

• 144 (33%) reported experiencing contact with blood in the year prior t o the survey

• 28 (6%) of 438 of workers experienced a needlestick injury in the year prior to the survey

1998

American Journal of Industrial Medicine

Ivens, UI et al

Injuries among Domestic Waste Collectors

• 667 employees; 114 injuries

• 1 (0.9%) injury was reported from a needle-stick

Injuries Among Waste Haulers 8


Costs/impactsViability of disease outside the body

• According to the CDC:– HIV: less than a day– Hepatitis C: least 16 hours, but no longer than 4

days– Hepatitis B: at least 7 days

www.CDC.gov/hiv

www.CDC.gov/hepatitis

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Cost/impactsDisease transmission (healthcare setting)The risk of transmission of disease after a needle-stick

is as follows, if from a known, positive source:– HIV is 0.3%– Hepatitis C -- 1.8% (range 0% - 7%)– Hepatitis B -- (for an unvaccinated individual)

1% to 31%, depending on infection status of the source

CDC- MMWR 50(RR11); 1-42 www.cdc.gov/mmwr10


Cost/impacts of a Needle-stick

• Studies available for needle sticks within healthcare setting (more known factors)

• Direct costs range from a few hundred dollars to several thousand per incident– May include prophylaxis, cost of lost work hours,

personnel treating employee, etc.• Indirect costs may be 4-8 times greater than direct

costs, in general (psychological, etc.)

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PSI Medical Sharps Dialogue Meeting

Who is impacted: waste haulers

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• Waste industry has been focal point, no data on others impacted• Employees: 27% public, 72% private (both privately owned & publicly traded)• Facilities: 48% public, 52% private

Size of the U.S. Solid Waste Industry, Beck (2001)

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Priority Questions Medical Sharps Use/Disposal

• How many sharps are used in community setting?

• How are they disposed of now?

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# of Sharps Sold through Retail Outlets (annual, U.S.)

• Injection:– Insulin Syringes = 1,425,000,000 units– Pen Needles = 786,000,000 units– About 15-17% of the above sold via mail

pharmacies– Growing 11-12% annually

• 900 million lancets

14Becton, Dickinson and Co.


Self-injected pharmaceuticals and sharps use

• Developing a table of self-injected pharmaceuticals on the market– Over 25 manufacturers identified– Almost 50 different pharmaceuticals– Treating 14 different categories of

illnesses/conditions– Used with various injection devices

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Current sharps disposal practices

• Small-scale studies over past 10+ years• Range of responses

– Most sharps disposed of in trash (sometimes in container)– Generally small percentages take used sharps to various

locations (medical facility, pharmacy, HHW) or mail-back– Flushing not commonly cited

• California survey (2007)– Disposal to trash (often in container) is most commonly

referenced by respondents

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What can we conclude?

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• Needle-sticks are not commonly reported in the waste industry• Risk of disease transmission is low• We still do not know where and how often needle-sticks are occurring



What can we conclude?

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However,

• The costs of a needle-stick can be significant (direct and indirect), and treatment is always recommended

• Of the large number of sharps used annually today for self-injection, most are going into the municipal solid waste stream



Key Question

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Do we need more research?

If so, what and why?


Possible Next Steps for Workgroup1. Continue to collect information on self-

injected pharmaceuticals, devices used, etc.2. Conduct new study: To what extent could use

of safety-engineered devices reduce the risk of needle-sticks in the community?

3. Conduct new study: What is the incidence of needle-sticks in other occupations (besides waste-haulers) and the general public?

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