Selection, evaluation and use of sharps container (Serialization 2)

Public safety summary

What is the risk?
Workers in the health care field and related occupations are at risk of occupational exposure to blood-borne pathogens and other potential sources of infection, including AIDS, hepatitis B, and hepatitis C

How did these risks arise?
The main route of occupational exposure to blood-borne pathogens is accidental skin damage (through the skin). Medical personnel use sharp tools and equipment such as hypodermic syringes, suture needles, venous blood collection equipment, phlebotomy equipment, and scalpels. It is estimated that 800,000 needlepoint injuries occur in hospitals every year, and most of them occur to medical staff who directly treat patients. Caregivers and doctors who performed surgery accounted for most of the needle-point injuries.

Research on needle-point injuries in hospitals has shown that many accidents occur after sharp tools have been used and in the process of handling them. As many as one-third of needlepoint injuries are related to the treatment process. The following factors are most closely related to sharp weapon damage:
 Inadequate design and inappropriate placement of sharps boxes
 The sharps box is too full
 Use inappropriate sharps boxes during patient treatment

How can these risks be avoided?
The use of safer needle placement devices, staff education and training, other measures to prevent injury from sharp objects, and compliance with standard warnings to prevent exposure to blood-borne pathogens should all be part of the overall needlepoint injury prevention strategy. The overall prevention strategy includes the following important elements
 Engineering control (an example is the use of a safer needle placement device)
 Organizational control (example is to reduce unnecessary sharps and training to use sharps boxes)
 Monitor needle tip injuries and evaluate their frequency and condition

In the case of medical assistance, the usual use of a strong sharps case has proven to be effective in reducing needle tip injuries. As part of the overall needlestick prevention plan, this document proposes a framework for selecting sharps boxes and evaluating their effectiveness

The first part of this article proposes four main criteria for evaluating the performance of the sharps box.
1. Functionality: The container should maintain its functionality throughout the service life (for example, these containers should always be durable and closed, have leak-proof and perforation-proof effects on the bottom and sides, and can last until the final treatment)
2. Accessibility: The container should be usable for workers who use, hold or handle sharp equipment. If necessary, the convenient placement and portability of the container in the working environment should also be considered.
3. Visibility: To the staff who use the container, the full scale of the container, the appropriate warning label and the container color should be clearly visible.
4. Containment: The container should be adjustable to facilitate users and supporting equipment. The container should be environmentally friendly (for example, no heavy metals and composed of recyclable materials). Adjustability also includes easy storage, assembly and operation.

Attachment D contains a list of questions for evaluating container performance based on four performance criteria. This form will help product evaluation, equipment management agencies and healthcare personnel to select and evaluate sharps boxes.

The second part of this document clarifies the requirements of the Occupational Safety and Health Administration and the recommendations of the National Institute of Occupational Safety and Health and the Center for Disease Control and Prevention on the selection and use of sharps boxes. The Occupational Safety and Health Administration’s blood-borne pathogen standards have been reviewed to establish minimum design performance element standards. Recyclable and reusable sharps boxes are also recommended.

The National Institute of Occupational Safety and Health recommends selecting a single container or a combination of containers based on a specific risk analysis and should refer to the following elements
 Assess work environment risks (such as biological, physical, chemical and radiological containment needs)
 Evaluate the size and model of the weapon to be processed
 Evaluate the volume of sharp objects to be processed after each use
 Assess how often the sharps box is emptied and how often the bracket is repaired
 Comply with federal, state and local regulations
 Safety requirements
 Container transportation and movement needs
 Clinical and procedural changes and changes
 Changes and changes in laboratory equipment
 Cost considerations
 Continuous evaluation of medical device technology, including evolving device design and barrier materials

Appendix C clarifies the decision logic for selecting the sharps box by outlining the appropriate criteria and priorities. This decision logic can be used alone or in conjunction with the effectiveness evaluation questionnaire in Appendix D, thus framing the selection process of the sharps box.

A sharps box with multiple functions, easy to use, easy to see, easy to get, and can be safely manipulated by patients and visitors will reduce the risk of skin punctures. A single container cannot meet the processing capacity requirements of the entire equipment. Because of the diverse healthcare environments and processes, it is impossible to choose only one container.

Where can I get more information?
The citations and related reading lists at the end of this document provide some useful published literature and reports. If you have difficulty obtaining the equipment described in this document, please contact your local biochemical safety or waste equipment supplier or call the National Institute of Occupational Safety and Health




To be continued...