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Better container design reduces sharps injuries
Injury during or after disposal still a risk
About one in 10 sharps injuries occur during or after disposal of devices. Those exposures can be prevented with improvements in sharps containers and disposal methods, safety experts say.
"There continue to be disposal-related injuries, so there's continued room for improvement," says Jane Perry, MA, associate director of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.
Injuries occur when containers are not emptied frequently enough and workers leave sharps on top of the containers or in work areas. Injuries during or after disposal also may occur when the safety mechanism isn't activated on the device, she says.
"If you have a high percentage of unactivated safety devices, the risk of a health care worker being injured while introducing a device into a box or disposing of it is greater," Perry says. "There are hospitals that regularly audit their sharps boxes to see the rate of activation."
Sharps container design also can address some of the risks involved with disposal. Fourteen Ascension Health hospitals adopted a new safety-designed sharps container and experienced an 81% decline in container-associated injuries. Overall disposal-related sharps injuries declined by 57%.1
The Ascension hospitals used a system produced and maintained by Daniels Sharpsmart of Chicago. The containers have a large opening, a sensitive tray that opens easily to accept the sharp, and a locking mechanism that doesn't allow sharps to be placed in the container when it is full.
"The door should be sensitive enough that it will tip the sharp straight in and close itself off when the sharps container is full," says Terry Grimmond, a Hamilton, New Zealand-based medical microbiologist and consultant with Daniels who helped design the containers.
Protruding, unactivated sharps create a risk of a needlestick from an unknown source, which requires extensive follow-up and post-exposure prophylaxis and creates anxiety for injured health care workers, says Kay Richter, RN, CIC, associate health nurse at St. Vincent Hospital in Indianapolis. "The exposure that occurs from an unknown needlestick is devastating," she says.
The Sharpsmart system also involves regular replacement of the boxes by the vendor, who sterilizes and compacts the contents so it can be disposed in regular waste. Previously, nurses were responsible for taking full sharps containers to the biohazard room.
This reduces a nursing task while also reducing the costly and environmentally sensitive biohazard waste stream from the hospitals, says Richter. Eleven Ascension hospitals using the system reduced their sharps waste by 28% with reusable containers. Other vendors offer a similar service.
Safer devices and better training are critical to reduce sharps injuries, notes Grimmond. But it's also important to "engineer out" the risks as much as possible, he says. "If you design a [disposal] container around health care worker behavior, it will reduce injuries," he says.
1. Grimmond T, Bylund S, Anglea C, et al. Sharps injury reduction using a sharps container with enhanced engineering: A 28 hospital nonrandomized intervention and cohort study. Am J Infect Control 2010; 38:799-805.