How to Start a Needle Disposal Program
 

    1001 Fannin, Suite 4000, Houston, Texas 77002   

713.980.3120 or 800.643.1643

 

Guidelines for Establishing a Collection and Disposal Program

 

This year alone, nearly 9 million syringe users will administer 2 – 3 billion injections outside traditional health care facilities.  Two-thirds of these “at-home” injectors are people with diabetes and patients receiving home health treatment (i.e. allergies, infertility, multiple sclerosis, even veterinary care).  Many of these self injectors are unaware of safe disposal methods available to them and simply throw their used needles in the trash or flush them down the toilet, posing a risk of injury or potential infection from diseases such as Hepatitis B or C and HIV to anyone that encounters them. 

 

With the growing practice of home health care and a predicted 165% increase in Americans diagnosed with diabetes over the next 50 years, this problem will only get worse if it is not addressed.  Solutions are available that meet both individual and community needs.  Below are six types of disposal programs that currently exist in the United States.

 

Drop-off collection sites:  Some communities offer residents collections sites that accept used needles – many times for free.  These collections sites may be at local hospitals, doctors’ offices, health clinics, pharmacies, health departments, community organizations, police and fire departments and medical waste facilities. 

 

Household hazardous waste services:  Most communities have a disposal site already set up that accepts household hazardous waste items such as used oil, batteries, paint, etc. 

 

Residential special waste pickup services: Some communities offer residents a special waste pickup service.  When a resident has a full sharps container, these programs may ask residents to call for a pick up or offer residents a regular scheduled pickup.  

 

Syringe Exchange Programs: Some communities offer programs that allow individuals to exchange used needles for new needles.  To find out if your community offers a syringe exchange program call North American Syringe Exchange Network at (253) 272-4857 or online at www.nasen.org.

 

Mail-back programs:  Individuals buy this program complete with sharps container and mail-back packaging.  The individual fills the sharp container with used needles and mails it back in the shipping package that is provided by the manufacturer.  

 

Home needle destruction devices:  Several manufacturers offer products for sale that destroy needles at home by burning, melting or severing the needle – making it ok to throw the syringe in the garbage.  Prices vary depending on the product.

 

 

The primary goal in implementing a safe community collection and disposal program is to minimize worker and public exposure to used sharps (syringes, needles and lancets) and to reduce the potential for injury or infection from accidental needle sticks. 

 

Steps in Establishing a Community-based Sharps Collection and Disposal Program

 

Recognizing that local needs, resources and circumstances will vary, a safe sharps collection and disposal program should consider the following principles:

 

·         Accessible.  Safe sharps collection and disposal options should be easily accessible to all members of the community and conveniently available in terms of location, days and hours to ensure maximum utilization.

 

·         Inclusive.  Solutions should address the needs of all individuals in the community who use sharps.

 

·         Affordable.  Programs should be within reach of individuals at all income levels, including through reimbursement or subsidy when necessary.

·         Confidential.  Options should be available for Individuals who wish to dispose of sharps privately.

 

·         Distinct.  Disposal programs should consider directing sharps into a waste stream separate from the standard public waste stream.

 

·         Safe.  Programs should assure the safe collection and disposal of used sharps and comply with any pertinent federal, state or local requirements.

 

·         Well-publicized.  Information on disposal programs should be readily available through physicians, diabetes educators, nurses, pharmacists, substance abuse counselors, veterinarians and other health professionals who come into contact with those who use sharps.

 

·         Supported by the community.  To be effective, solutions should have broad-based community support.

 

Following are suggested steps for establishing a community sharps collection and disposal program.  It is important to note that there is no single solution that will fit every situation, so flexibility is important.

 

Step One:  Lay the Foundation

 

Ø      Check the CDC Safe Community Disposal website for updated information on state needle disposal regulations www.cdc.gov/needledisposal.

 

Ø      Check with local officials and community leaders to see if there are existing disposal guidelines or programs currently available in your community: 

·         Local (city or county) public health officials

·         Local waste management departments

·         Local hospitals, clinics, doctors’ offices and pharmacies

·         Local police and fire departments

·         Local diabetes educators through local hospitals

·         Community nonprofit organizations (Chapters from ADA, AADE)

 

The Coalition website, www.safeneedledisposal.org, has contact information and hot line numbers for state health departments, as well as other helpful information and links to pertinent sites.

 

Ø      Contact the Coalition for Safe Community Needle Disposal, at 800-643-1643 to see if they are aware of others in your community who interested in establishing a sharps collection and disposal program. 

 

Step Two:  Build a Team

 

Ø      Contact other interested parties to see what progress they have made and explore ways to collaborate on the project (e.g. public health officials, diabetes educators, HIV/HVC departments, waste officials, health industry [local chapters of AMA, AADE, ADA, ANA etc.], individuals)

 

Ø      Identify a group leader and core team members.

 

Step Three:  Clearly Define Your Needs and Priorities

 

Some factors that will help determine your needs and priorities are:

 

Step Four:  Assess Your Options

 

Ø      Examine available collection and disposal solutions to determine which best meets your community’s needs. 

 

Ø      Possible solutions may include:

 

Community sharps collection and disposal sites.  Used sharps are brought to a central collection site, either loose or placed in containers.  At the site, sharps are received by facility personnel for removal to a storage area or placed by the individual into a sharps collection kiosk or other receptacle for future disposal.  Collection or disposal sites may include:

 

Availability:  Currently hundreds of collection or disposal programs exist across the country, active states include Wisconsin, Rhode Island, Florida, California, Massachusetts, New York, Washington and 11 other states all have at least one existing program.

 

Costs: The individual cost can range from $0 to $10 which may or may not include a sharps container, but the community costs for implementation varies greatly depending on disposal costs and funding availabilities which include (grants, property-based taxes, waste tipping fees at landfills or transfer stations, donations, or city/county contributions). 

 

The Houston Airport implemented 63 containers for about $2,000 in IAH restrooms and maintains the program for $225 - $270 per year. This program was implemented after custodial workers noticed an increase of used needles in bathroom garbage.

Contact: Thomas Bartlett, 281-230-3017, tombartlett@cityofhouston.net

 

The implementation costs for the Eureka Program of RI was $135,000 for all 39 sites which includes 50 kiosks, marketing campaign (posters, graphics, and brochures) sharps containers and disposal.  The cost to maintain the program is approximately $750 per site per year.  Funding was provided by Foundations, the state of Rhode Island, Stericycle, Rhode Island Resource Recovery and Diabetes Foundation of Rhode Island.

Contact:  Cherie Kearns, Exec. Director, 401-725-7800 CherieK@dfri.org

 

Riverview Hospital in Wisconsin Rapids, Wisconsin offers a Sharp Smart Drop-off program to its community of approximately 25,000 people.  Located in the main entrance of the hospital, individuals can drop off sharps disposed in household containers 24-hours a day.  Funding for the project is provided by the Riverview Hospital Foundation.  The implementation cost was $1600 for the cabinet that holds the 17-gallon sharps containers (individuals deposit their own container in a larger sharps container).   The cost to maintain the program is approximately $2500 per year, which includes the hauling by Stericyle and the 17-gallon containers.

Melody Dearth – Director Environmental Services, 715-421-7443 deamel@rhahealthcare.org

 

 

Household Hazardous Waste Drop-off Sites.  Used sharps are brought to a central collection site, either loose or placed in containers. Most communities have a disposal site or pick-up date already set up that accepts household hazardous waste items such as used oil, batteries, paint, etc.  Contact your local waste department to see if your community household hazardous waste site accepts used needles.

 

City of San Bernardino. When the city of San Bernardino’s hospital stopped accepting used sharps from community members, sanitation workers began to notice an increase in needle sightings - despite a city ordinance that prohibits disposing of used sharps in household trash. The city implemented a sharps disposal program in 1998 that allows sharps users to drop off sharps containers at the city’s existing household hazardous waste (HHW) collection facilities without charge. The program has been successful, largely due to the fact that it is convenient and free. The California Integrated Waste Management Board funded the program for the first 2 years at an annual cost of $5,900. The city of San Bernardino now funds it at an annual cost of $6,000.

To publicize the program, the city offers a point-of-sale display to pharmacies and includes information about the program in the city newsletter. Linda Ceballos, 909 384-5549 ceballos_li@sbcity.org

 

Residential Special Waste Pick-up Service: 

Home users place used sharps in a special “sharps” container and much like a recycling container; it is set outside for pick-up by special waste handlers.  

 

Availability:  Typically smaller communities offer this service to its residents.  It’s not known how many of these currently exist in the United States.  

 

Cost:  The community costs for implementation varies greatly depending on disposal and transportation costs.  For example in some states there may be only one waste hauling company in the area – this causes the cost to rise tremendously.

 

Columbus, Georgia.  The city of Columbus, Georgia, took a personal approach to its sharps disposal program after experiencing problems with sanitation workers suffering needle-stick injuries from sharps discarded in household garbage. Residents can now collect their sharps in their own hard plastic container and call the city’s waste management agency when their sharps container is full. A waste supervisor is then dispatched to their home to take the container for safe disposal.   

By having waste collection supervisors, who are already in the field on their regular rounds, pick up sharps from residents, Columbus has provided a safe disposal option that costs the city virtually nothing. For more information, contact Contact Les Moore, 706-653-4161 Lesmoore@columbusga.org

 

Syringe exchange programs (SEPs).  Syringe exchange programs offer individuals sterile syringes and needles in exchange for used ones. SEPs are believed to be an effective public health practice for reducing the number of HIV and HVB and HVC transmissions among injecting drug users.

 

Availability:  There are 180 actual SEPS nationwide with 36 states and Washington DC, Puerto Rice and Indian Nations participating in SEPs.  During 1998, SEPs operated at 534 sites averaging five sites per program (median: nine; range: 1--31). Sites included 202 health van stops, 59 shooting galleries, 56 sidewalk tables, 51 cars, 43 storefronts/indoor sites, 30 SEP workers on foot, 23 health clinics, and 70 other sites. Delivery of syringes and other risk-reduction supplies to residences or meeting spots was reported by 55 (50%) SEPs, and 94 (85%) allowed participants to exchange syringes for persons other than themselves (secondary exchange).

 

Costs:  The combined operating budget of 105 SEPs in1998 was $8,567,662 (range: 0--$771,053; mean: $80,493; median: $38,000). A total of 51 SEPs in 15 states and Puerto Rico received public funding of $5,992,032.  About one half of all programs receive funding from state and local governments and the other half is funded through grants and donations.  The cost to the individual is always free.  Contact North American Syringe Exchange Network at 253-272-4857 or visit www.nasen.org

 

Sharps container mailback service.  Sharps containers packaged to meet U.S. Postal Service requirements are filled with used sharps and mailed to an approved facility for proper disposal.  These containers are available commercially.

 

Availability: There currently are at least eight companies nationwide that offer a sharps mail back solution to patients. 

 

The Sharps Compliance/BD/WM program is currently available nationwide through an 800 number and online.  It is available nationwide in pharmacy chains. This program is a mail back container that holds approximately 100 used syringes or 300 pen needles.  When the box is full it is shipped directly to an incineration plant in Texas where it is incinerated in a waste to energy plant.  Contact Sharps Compliance at 877-927-8363 or visit www.sharpsinc.com

 

The Voyager is a portable container that severs the hull of the needle into the container, leaving the plunger to be disposed in the garbage. It holds approximately 100 needle tips and is available on websites and through private and chain pharmacies nationwide (CVS and Rite Aid).  Contact 877-723-3633 or visit www.safemedical.com to find out more information.

 

Costs: The costs can vary from $15 to $50 depending on the manufacturer.  Some containers will hold up to 300 needles others containers actually sever the needle tip into a container holding 100 of those.  For a diabetes patient, this program is approximately $100 per year.  For patients injecting less often it could be as little as $30 per year.

Some municipalities are recognizing the flexibility benefits of mail-back programs and beginning to offer them to their residents. Restaurant chains, department stores, stadiums and school districts are also beginning to use mail-back programs as a viable disposal option for their collected sharps. Mail-back programs can complement existing needle collection programs by offering mail back solutions for rural residents or homebound residents.

Alameda County, California is conducting a pilot program by distributing mail-back containers free of charge to medically underserved populations. The county’s large size and diverse demographics have presented problems in adopting more traditional methods of safe sharps disposal, such as drop-off sites or residential collection. By contracting with a vendor for mail-back service, Alameda hopes to reach a greater percentage of its self-injecting population – if residents have a mailbox, they have access to the service. For more information, contact the Alameda County Sharps Coalition at 800-606-6606 or www.stopwaste.org.

 At-Home Needle Disposal Products.  Numerous “at-home” disposal products offer a variety of ways to destroy used needles. See the Coalition website for a vender list of disposal solution currently available www.safeneedledisposal.org.

 

Availability:  The FDA has approved of some needle destruction devices.  These small at-home units burn the needle down to a small ball.  There also exists other devices that use chemicals to destroy needles; however, I don’t believe those have been approved yet by the FDA.  These devices may be available at chain and individual pharmacies nationwide, through a toll-free number or over the internet.

 

Also available are needle clipping devices.  It is a device that clips the needles off into a container, much like the Voyager.  Becton Dickinson, www.bd.com has the Safe Clip, which stores up to 1500 insulin tips.  When complete this container should be dispose of through a mail back option or a community needle collection site.

 

Also, there are more than 15 manufacturers of sharps containers that are available on the market to individuals. Many people deposit their used needles in these containers and then ask their doctors or local hospitals to accept their used containers.  This approach depends on the good-nature of hospitals and physicians.

 

Cost:  Needle-destruction devices vary from $89 - $180.  Most last between three and five years.  Needle clippers are as little as $5 and as much as $10.  Call 877-797-4277 for more information on the Disintegrator.

 

Sharps containers may cost as little as $1 to $25, however, finding a charitable physician or hospital to accept full sharps containers costs time only.

 

 

Step Five:  Select the Best Option

 

Ø      Match program options with your community’s needs and available resources to find the best fit.  (Until your program is in place and fully operational, continue to follow local regulations or EPA guidelines for sharps disposal.)

 

Step Six:  Implementation

 

Ø      Work with other members of your community and local/state officials to put the program in place.

 

Ø      Work with state and local officials, healthcare workers and community leaders to publicize the program and to encourage creation of more programs that will remove sharps from the public waste stream.

 

Ø      Consult the Coalition for additional guidance at 800-643-1643.

 

 

Step Seven:  Monitoring and Evaluation

Ø      Determine how you will evaluate your program.  Seek assistance from someone experienced in evaluation or contact the Coalition at 800-643-1643 for evaluation information.

 

Ø      Develop measurement criteria and evaluation milestones.  Examples of measurement criteria might include:

o        Are people participating in the program, i.e., how many used needles are being turned in or how many pounds of sharps have been collected?

o        Does the program fulfill the abovementioned principles for effective sharps disposal?

o        Is the community supporting the program?

o        Does the program serve the population for which you created it?

o        Could the program be expanded to serve additional groups?

 

Ø      Evaluate your program at pre-determined points based on your measurement criteria.

 

Ø      If necessary, make adjustments.

 

Ø      Contact the Coalition for Safe Community Needle Disposal to keep us apprised of the status of your program.

 

For more information, please contact the coalition at 713-980-3120 (800-643-1643) or visit our Web site at www.safeneedledisposal.org.

 

 

Typical Challenges Facing Safe Collection and Disposal Programs

 

Some or all of the following challenges may be encountered in working to establish an effective sharps collection and disposal program: