Disposing of Hypodermics: Stuck with a Needle Problem

2001-07-31
What happens when a hypodermic needle gets tossed into a household wastebasket? More often than people think, it ends up sticking the sanitation worker who picks up the trash.

American Medical News
OPINION - Editorial. July 30, 2001.
A used hypodermic needle at a hospital or medical practice is certain -- at least, federal regulations say so -- to be dropped into a specially designed sharps container, then handled with care as infectious medical waste. The same needle at home is nearly as certain to end up in the household's regular trash.

So-called community disposal of sharps -- that is, throwing them out at other than medical facilities -- is what happens to an estimated three billion needles and lancets in this country every year. The AMA reports it has become "an important public health hazard," especially for sanitation workers at risk of sharps sticking out of trash. A 1989 survey of such workers suggests they have a 3% risk of being stuck annually.

No one knows how serious a health problem it might be for transmission of bloodborne pathogens. It is generally believed to be very low, but it has also not received much study. Yet even a benign needle stick can trigger mandated interventions, such as counseling and preventive treatment, costing thousands of dollars.

Conventional wisdom has been to tell patients to put sharps in a container, like a bleach bottle, for disposal. That's better than nothing, but experience shows that containers -- including biohazard boxes -- routinely burst open when compressed in garbage trucks. Recycling has compounded the problem. Truck contents are dumped onto a conveyor line where workers pick out recyclables. Their leather gloves are no match for needles as they come down the line.

The nation's 3.7 million insulin-using diabetics are the single greatest source of these sharps, although they also come from patients with a wide range of other conditions. Also a significant factor are injection users of illegal drugs, each of whom may inject as many as a thousand times a year. They are prompted by fear of arrest to dispose of needles any way they can, often in the nearest dumpster -- one of several powerful arguments in favor of clean needle exchanges. Despite the scale of the situation, regulations and laws are rare. The federal bloodborne pathogens standard covers workplaces, but not households.

What's needed most are safe, practical ways for individuals to dispose of this trash. Pick-ups, drop-offs and even mailing in the sharps are options to be explored. (It's not unheard of for individuals unsure of what to do to simply let used needles pile up in the basement).

At its recent Annual Meeting, the AMA House of Delegates received an in-depth report on the situation from the AMA Council on Scientific Affairs. The delegates instructed the Association to further study and support action to solve this problem. Even earlier this year, the AMA co-sponsored a conference to examine the issue, which brought together representatives from government, industry, public health and other organizations.

The AMA didn't call on physicians to start taking in their patients' used sharps, but is seeking greater awareness of the situation. On the doctor-patient level, it's worthwhile to encourage use of what local solutions there are, as well as to point out special hazards. Hotel workers are known to have been stuck, for example, with needles left by travelers in waste baskets.

Some communities provide models for action. A public-private sector initiative in San Francisco has sharps collection points in Walgreens drug stores, and the program is underwritten by the waste disposal industry -- sanitation worker needle sticks dropped dramatically. Rhode Island, New York State, Wisconsin and Minneapolis also have model programs. Other states and communities should follow their example. Meanwhile the needles keep coming -- 20,000 into the trash just in the time that it took to read this editorial.