Policy in the Disposal of Sharps - Term Paper Example

Policy in the Disposal of Sharps Customer Inserts His/Her Name Customer Inserts Grade Course Customer Inserts Tutor’s Name Insert Date Here (Day, Month, Year) Introduction In clinical practices, scientific research or study at the undergraduate level ensuring safe and healthy environment is a main prerequisite involving particular management and control. Especially improper use of sharps not only can cause physical injury but also can pose risk to health. Sharps are any projected or pointed objects with corners, or edges having capability to cause physical harm or injury if not properly implemented or used. Sharps particularly used in the clinic of doctor include hypodermic needles, syringes with or without attached needles, Pasteur pipettes, scalpel blades, blood collecting vials, needles attached with tubing, culture dishes, suture needles, slides, cover slips and other broken or unbroken glass or plastic ware that are used in the care of the patient or during their treatment process and generally are exposed to the infectious agents. (Khan et al., 2005) On account of their exposure to the infectious agents, they can cause serious illness and can pose risk to the health or environment if not properly stored or treated or disposed off. Sharps constitute around 1 per cent of the total waste from the health care activities across the world. Every year approximately 12,000 million injections are used and it has been found out that not all needles or syringes are taken care of and properly disposed thus increasing the risk of injury and infection. (Khan et al., 2005) Sharps can get easily contaminated with several kinds of micro-organisms posing risk from blood borne viruses e.g. Human immunodeficiency viruses (HIV), and Hepatitis B and C which had become quite common and there are many more micro-organisms present in the contaminated blood, faeces, sewerage, human or animal secretions. This is the reason why all the sharps unless it is not known where they have been manufactured are considered to be contaminated. (Infection Control Team, 2008) To this effect it becomes mandatory to create the policy in the clinical or education set up for their proper handling and disposal. Literary works in the various spheres of Sharp prevention and disposal There are many literary works describing the effect of sharps and the methods to adopt for the disposal of the same. According to study by S.A. Tamplina, D. Davidson, B. Powis and Z. O’Leary under the title Issues and options for the safe destruction and disposal of used injection materials, the various issues and risk to the health in case of direct exposure or contamination of environment - health risks that can be caused on account of the exposure to the sharps and the contaminated environment because of the same have been undertaken. The study conducted by the writers brings out various issues and options on the way syringes ought to be destroyed or disposed off by involving the use of the document analysis. They also suggested holistic methods for the proper use of sharps and their proper way of handling and disposal. (Tamplina, Davidson, Powis, & O’Leary, 2004) There are many other journals also and in Journal of Clinical Nursing, the paper Universal precautions: a survey of community nurses' experience and practice by Glynis Bennett and Ian Mansell aimed to find out experiences felt by nurses when exposed to the sharps in their work places and any precautionary measures being used by them. The study was conducted through the survey done with the help of the questionnaires. These results showed the fact that they have complied themselves to the universal standard of the precautions, though very small number of nurses complained that they had to work with the re-sheathed needles, inappropriate containers and gloves and also were finding difficulty while washing hands. (Bennet & Mansell, 2004) Preventive Measures of Sharps-Historical Perspective Accidents on account of the hypodermic needles and other instruments have always been the most risky proportion and considered as an occupational risk for the health care workers. Reports as old as ninety years illustrated several cases of injuries from these needles. According to Evans, almost earliest case of blastomycosis was cited in 1903 caused on account of the injury from sharp while it was being inflicted by a physician during autopsy on a patient having systemic blastomycosis. In-fact in the year 1933, Sigeris too presented a report about professor and his colleague who had to sustain both cuts and injuries while they were experimenting and succumbed to death on account of septicaemia. More than 25 of laboratory cases were reported having leptospirosis by Blumenberg in 1937. All of them were caused on account of the needle-stick injury or cuts from contaminated glass. As per reports by Collins and Kennedy, in the Journal of Applied Bacteriology in 1987, there were 22 different kinds of infectious cases reported on account of the injuries being caused from needle-stick and sharps. These involved diphtheria, herpes, malaria, scrub typhus, syphilis, toxoplasmosis, hepatitis B virus (HBV), human immunodeficiency virus (HIV) and Ebola fever. But at that time, not much concern was shown on the injuries that were caused by sharps, its subsequent consequences and the suitable ways of its management and disposal. (NSW Health Department, 2008) With the increase of the danger of infectious diseases like HIV, HBV and hepatitis C (HCV), concern has been raised all over the world on the proper management of the same. Because of the increase in the cases of HIV, a complete new strategy was adopted by United States to reduce the risk of transmission of blood borne diseases in the medical and health care settings. Centers for Disease Control and Prevention (CDC), in America adopted some of the strategic moves to put more emphasis on application of the blood and body fluid precautions universally all over the world irrespective of the way they were infected. This strategy was revised throughout 1980’s, laying emphasis for the prevention of the transmission of blood-borne pathogens at the area of their work. With very little changes and modifications, Australia then adopted Universal Precautions highlighted by CDC. Recommendation was made for its proper care to avoid injuries from sharp instruments on account of the needles, scalpels or any other sharp instrument or device while in the process of handling, cleaning and disposal. Special instructions were given to the health care workers to avoid recapping the needles, bending or breaking it or removing them from the disposable syringe or otherwise changing or touching it by hand. It was suggested to keep sharp items in puncture resistant containers to be disposed off. Precaution was taken to keep these containers as close to the work area and manufacturers too began to produce safety devices and systems which do not require needles. But, it was also noticed that the safety measures in case of performing venipuncture and other process had not reduced the risk of injuries from needle-sticks or danger of risk to health care workers from blood borne pathogens. Several studies have revealed the fact that the injuring occurring from the needle-sticks could be prevented if proper care has been taken and correct way is adopted for the disposal of sharps. (NSW Health Department, 2008) The New South Wales Health Department Infection Control Policy Circular 99/87 especially made it mandatory for the health care workers to provide proper and adequate resources for the disposal of sharps. Under their provision, each health care worker has the responsibility for its proper management and disposal. (NSW Health Department, 2008) Proper Management of Sharps: Safety of the health workers comes under provision of the Occupational Safety and Health Act 1984, the Poisons Act 1964, the Radiation Safety Act 1975. The Victorian Needle and Syringe Program is the most crucial public health program to decrease the impact of the spread of blood borne viruses HIV/AIDS and hepatitis B and C among the public health initiatives among drug users and wider community. It began its operations in 1987 with the main motive of giving Needle and Syringe program, providing community health and hospital and emergency unit services. For more information regarding the same, NSP providers can be contacted at the call Disposal Help-Line on 1800 552 355 for complete 24 hours and seven days a week. There are three kinds of NSP models- Primary, Enhanced Secondary and Secondary NSPs. These services ensure that the sterile needles and syringes are available for the drug users, besides they provide other relevant information as well as other services. They also make provision for the distribution of the sharp disposal containers, condoms, water based lubricants and alcohol swabs. Besides they also give services for the suitable disposal of used injecting equipments. Similarly, Enhanced Secondary NSPs are the programs funded by government for the community health services and for hospitals. Within these services, there are also different kinds of models like fixed site, mobile services, disposal hotline and outreach foot patrol. There are other agencies too associated with it and these are Anex (the Association for Prevention and Harm Reduction Programs) and VIVAIDS Victorian Drug User Groups etc. (Mental Health & Drugs Policy Unit, 2008) Safety Measures and Procedures All safety measures should be adopted for the proper handling of sharps and there are certain statutory requirements also for the same: Statutory Requirements It is a legal requirement for the authorities to ensure safe environment at the work place of the clinicians. Section 19 of the Occupational Health, Safety and Welfare Act is meant to protect the clinicians, researchers and students of medical concern to make the environment safe for their usual and day-to-day work. The National Code of Practice for the Control of Work-related Exposure to Hepatitis and HIV (blood-borne) Viruses also makes it easier to guide the management about several preventive measures against HBV, HCV, and HIV in their work environment. (Government of South Australia, 2009) Measures to Reduce Risk: I work in a nursing home as an assistant researcher. In our nursing home, we have policy of disposal of sharps that we use but we don’t have any documentation of the same and as a result we have to face many discrepancies at our work place,. We have properly covered dustbins but there is no provision to provide protective gloves or equipments to protect workers exposing them to greater risk not only to their lives but also to the lives of other workers. The dustbins that I found are also comparatively less. There are gloves and equipments but only meant for doctors and staff posted at senior level whereas others are devoid of the same. Here are certain recommendations that I would like to suggest: Proper Documentation of the Policy to ensure safety Well-documented and adequately researched handling policy conducive to the work place should be applied. This policy should constitute the way any injury occurring from sharps is reported, treated, investigated and followed up and the way assessment of the risk towards hazards takes place. It also involves safe working procedures. Warning to the Other Staff Secondly employees like porters, veterinarians, domestic or commercial cleaners, council workers, electricians, plumbers and laundry staff or any other staff who so ever work demands exposure to the sharps should be made available with gloves that could reduce the risks of sudden accidents. The protected covers include Kelvor gloves, tongs or any other coated fabric enabling to attain suitable protection. Meanwhile they should also be made aware that no gloves are either sharp proof or puncture proof so they need to be cautious while performing their tasks. (Government of South Australia, 2009) Applying of the Control Measures to Reduce Risk Disposal of Used Syringes or sharps 1. There is every possibility that any used syringe can get easily contaminated and all the efforts should be made to dispose it by making a use of yellow receptacle. This receptacle should have a label on it that may include the words ‘Medical or Clinical Waste Incinerate’ and should show the universal biohazard symbol. Description of the contents like sharps, non-sharps, liquids etc. should also be given on them. 2. The intact syringes, needles and cut I.V. cannula lines should be as soon as possible disposed of into an adequate sharp container. 3. Efforts must be made to ensure that there are sufficient numbers of sharps’ containers or suitable yellow biohazard bins in those areas where syringes are being regularly used and disposed. For this purpose it is advised not to use plastic bags. 4. Before buying the sharp containers, it should be seen that these are puncture resistant, shatterproof, moisture-proof, and could be easily sealed. 5. All the containers should follow the Australian Standard (AS) 4031 Non-reusable containers to collect sharp items used for medical purposes. 6. There should always be made appropriate measures to use the adequate personal protective equipment (PPE). (Government of South Australia, 2009) 7. Always make sure that employees should never collect any rubbish or throw away substance with their bare hands. 8. Used sharp objects and general waste should be kept separated. 9. In any case, needles need not to be broken by hand, bent purposely, recapped or otherwise manipulated by hand. 10. In cases where the syringes need to be maintained and only the needle should be removed, the practitioners should make use of the denotching devices 11. Where the needles and scalpel blades are required to be resheathed or shielded, shielding or resheathing instruments should have to be used or precaution should be taken to place the sheath/cap on a horizontal flat surface and the needle or scalpel should be placed into the sheath/cap with the help of one hand. Up to the one third of the needle stick injuries take place while in the process of attempting to re-sheath. Efforts should be made to resheath the clean needles or if any action is unavoidable then assessment of the risk should be undertaken and written protocol should be made easily available. This whole process should be undertaken with the help of related Directorate and support from the Infection Prevention and Control Team (IPCT) and Health and Safety. (CHS OSH Committee, 2003) 12. Forceps or tongs should be made in use to pick up the needles that have been removed but not discarded. 13. All the efforts should be made to avoid placing hands in the sharps container or for removing any objects from the sharps container. 14. All patients should be deemed as potential inoculation risk and all the inventive prevention and control standards must be followed. Inexperienced staff should never be allowed to proceed with any procedure they might feel considered having exposed to high inoculation risk for e.g. HIV positive patient or patients affected with blood related viruses. (CHS OSH Committee, 2003) Disposal or proper use of Sharp Container The management of the sharp containers is very essential to retain safe environment and reduction of the risk to injury to any other accident or disease. 1. “Point-of-use sharps containers”, allows the disposal of sharps safely and in a more convenient way 2. Sharps containers should be made available in all the areas where there is more possibility for the use of the sharps. 3. Efforts should be made to see that the sharp container is placed near to the work area without having to walk to just dispose of the same. 4. Every one should avoid throwing sharp objects into the small sized sharp containers or into the containers, which are full. 5. These sharp containers should not be more than three-quarter full but if not found the same then there is a need to check that it should be closed in a very secured manner and removed for disposal and should also be replaced as soon as possible. 6. The sharp containers should be disposed after the approval of the waste management contractor. (CHS OSH Committee, 2003) Recommended Better Practice for the Disposal of Sharps Disposal of sharps by mail system is a unique approach of disposal system manufactured by the Sharps Compliance, Inc., for simplifying the management of the used needles, syringes and medical waste materials. This system has been claimed by the company as the most appropriate disposal solution for generating medical wastes in small quantities and most useful for the patients who are self-injectors. This mail system constitutes sharps container, a government approved return by mail system and consists of all instructions for its ultimate use. When the process is completed or at the time sharp container is full, the patient or generator of the medical waste would turn it back to its previous packing. This process Involves safety towards patients, their families, workers and caregivers. Removes used syringes out from the household trash systems and public landfills. It is environmentally conducive Conducive to the patient’s requirements Maintains the relationship with the patients. (Sharps Compliance Inc, 2009) The disposal procedures should follow the Australian Standards AS 4301: Non-reusable Containers for the Collection of Sharp Medical Items Used in Health Care Areas, and AS 4261: and Reusable Containers for the Collection of Sharp Items Used in Human and Animal Applications. (CHS OSH Committee, 2003) Certain recommendations for the Change in Work place Sharp Injury Controls Controls should be implied in the areas where practical for preventing disposal of Sharps on open sites. All the precautions should be made to avoid holding rubbish bags near the body or limbs, never place hands on the base of the rubbish bags, and be careful to recap, bend or cut discarded sharps. Managing the Skin Penetrating Injuries Sharp injuries could be a major risk to the health and if the person gets exposed to the body fluid or any like substances, it could pose considerable stress to the worker and his family. In case of injury with the sharp, bleeding should be allowed and that area should be washed with the running water and then covered. Recently in medical circle, importance is being given to the instant treatment in case of any injuries occurring due to the needle stick. This is on account of the fears occurring due to the transmission of HIV, HBV and hepatitis C (HCV). These diseases are mainly blood-borne pathogens currently posing occupational hazard to health care workers in Australia. Due to the concern regarding the gravest risk on account of the HIV, a new strategy was formed in the United States to reduce the risks in the transmission of the blood borne pathogens during the healthcare settings. The Center for Disease Control and Prevention (CDC) had put emphasis for the first time on applying blood and body fluid precautions universally to all the infected persons. (NSW Health Department, 2008) Equipments for personal protection Workers who have to get exposed to the potential sharp hazards should be supplied with items of PPE for e.g. tongs, gloves for e.g. turtle skin gloves, brand gloves etc. at all times while they are in the process of handling sharps. All personal protection equipments supplied to the workers to provide protection against sharps should be conducive to the relevant Australian Standards. For example, gloves should follow the AS/NZS 2161.1: 2000 –Occupational Protective Gloves - Selection, Use and Maintenance, and AS/NZS 2161.2: 1998 –Occupational Protective Gloves - General Requirements. (Stanwell Corporation Limited, 2007) Management of the Contractor Contractors should be provided information relating to the hazards identified or associated with their location and the contractor should acknowledge the fact that this information should be delivered in the best of his interest. Training to the Workers Workers considered to be at risk of exposure towards sharps should be given instruction about its safe handling and its disposal with relevant information on any blood borne diseases that can occur on account of it. Training will be imparted through the various Corporate Induction programs to all new staff by notifying them. Monitoring There should be careful monitoring of every aspect of the handling and disposal of sharps according to the set standards and Blood Borne Exposure Injuries Policy. The infection prevention and control committee would act in the way of the Operational Forum where the sharps and other sharps concerning issues would be discussed. There should be surveillance of waste management practices and infection control and thus it is required to identify and address poor and improper waste management practices to reduce risks. (International Council of Nurses, 2009) AS/NZS 2161.1: 2000 Occupational Protective Gloves - Selection, Use and Maintenance (Standards Australia International Ltd, 2000) This document was first published as AS Z4-1952 and its second edition was published in 1963, revised and re designated as AS 2161-1978 and then again jointly revised and re-designated in part as AS/NZS 2161.1:2000. This standard recommends and is a guide to ensure safe environment for all workers in their work place. Appropriate selection should be undertaken while choosing the kind of gloves according to the work place and any envisaged difficulty that may arise from the same. Suitable practices should be followed according to the type of gloves and the safe and hygienic practices should be followed for the decontamination/cleaning, storage and reissue of gloves. These standards do not involve requirements necessary for the performing or testing of gloves as per specifications in the other sections of AS/NZS 2161 series, AS/NZS 2225, AS/NZS 4011 and AS/NZS 4179 as appropriate. (Standards Australia International Ltd, 2000) Conclusion In the medical practice, health of not only the patients but also workers is very important, therefore it is very important to make sure all the health procedures are maintained especially handling of the disposable system of sharps. Proper management of the disposal of sharps is of utmost important, as without it, there would be always risk of infectious diseases and injury and every management should comply with the Australian specifications. Reference List Bennett, G. & Mansell, I. 2004. Universal precautions: a survey of community nurses' experience and practice. Journal of Clinical Nursing, 3(4), 413-421. CHS OSH Committee. 2003. Procedures – sharps management and injury protocol. Retrieved on April 27, 2009 from W.W.W: http://www.chs.ecu.edu.au/org/osh/documents/procedures/Sharps.pdf Collins C. H. & Kennedy D.A. (1987) Microbiological hazards of occupational needle-stick and ‘sharps’ injuries.  Journal of Applied Bacteriology, (62): 385-402. Government of South Australia. 2009. Safeguard Safe Handling of Syringes or Sharps. Retrieved on April 27, 2009 from W.W.W: http://www.safework.sa.gov.au/uploaded_files/gs5i.pdf International Council of Nurses. 2009. Immunisation Safety: Safe Waste Disposal Practices Save Lives. Retrieved on April 27, 2009 from W.W.W: http://www.icn.ch/matters_waste.htm Khan M.H. et al. 2005. Sharp waste disposal practice among general practitioners. Gomal Journal of Medical Sciences, 3(1). Infection Control Team. 2008. Safe Disposal of Sharps and Management of Contamination Injuries Policy. Retrieved on April 27, 2009 from W.W.W: http://72.14.235.132/search?q=cache:uABh8iHioQwJ:delt.shef.ac.uk/connect/action/file/download%3Ffile_guid%3D1517+protocol+on+safe+disposal+of+sharps+in+medical+practice+after+procedures&cd=3&hl=en&ct=clnk&gl=in Mental Health & Drugs Policy Unit. 2008. Needle & Syringe Program (NSP) Retrieved on April 29, 2009 from W.W.W: http://www.health.vic.gov.au/drugservices/services/needle.htm NSW Health Department. 2008. Resource Packages: Safe Handling, Usage and Disposal of Sharp Objects. Retrieved on April 27, 2009 from W.W.W: http://www.sesiahs.health.nsw.gov.au/albionstcentre/infection/Resource%20Packages/safehandling.asp Sharps Compliance Inc. 2009. Simply Keeping it Safe. Retrieved on April 27, 2009 from W.W.W: http://www.sharpsinc.com/disposal_mail_product_page.htm Safe Handling, Disposal Reporting of Sharps and Blood Borne Exposure Injuries Policy. 2008. Retrieved on April 27, 2009 from W.W.W: http://www.nuh.nhs.uk/about/foi/policies_and_procedures/clinical_polices/clinical_governance_and_practice/CLCGP021_Sharps_Policy.pdf Stanwell Corporation Limited. 2007. Corporate Standard: Safe Handling and Disposals of Sharps HB#560731. Retrieved on April 27, 2009 from W.W.W: http://www.stanwell.com/Files/PolicyandProcedure/Safe_Handling_and_Disposal_of_Sharps_Corporate_Standard.pdf Standards Australia International Ltd. 2000. Occupational protective gloves. Retrieved on April 27, 2009 from W.W.W: http://shop.standards.co.nz/scope/ASNZS2161.1-2000.scope.scope.pdf Tamplina, S.A., Davidson, D. Powis, B. & o’Leary. 2004. Issues and options for the safe destruction and disposal of used injection materials. Waste Management, 25(6), 655-665. UCL Institute of Child Health. Sharps disposal. Retrieved on April 27, 2009 from W.W.W: http://www.ich.ucl.ac.uk/clinical_information/clinical_guidelines/cpg_guideline_00104 Read More