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PSI National Dialogue on Medical Sharps “Data” Workgroup

PSI National Dialogue on Medical Sharps “Data” Workgroup. Sacramento, CA September 23-24, 2008. Workgroup Participants. PSI: Scott Cassel, Sierra Fletcher (Facilitators) Angela Laramie, MA DPH Michael Mongillo, Pathacura Lisa Pompeii, University of Texas

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PSI National Dialogue on Medical Sharps “Data” Workgroup

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  1. PSI National Dialogue on Medical Sharps“Data” Workgroup Sacramento, CA September 23-24, 2008

  2. Workgroup Participants PSI: Scott Cassel, Sierra Fletcher (Facilitators) Angela Laramie, MA DPH Michael Mongillo, Pathacura Lisa Pompeii, University of Texas Jenny Schumann, Coalition for Safe Community Needle Disposal Karl Schumann and Bob Singley, BD David Trindell, Hoffman-La Roche

  3. Workgroup Process • Assignments from Meeting #1 • 3 workgroup calls • Refined purpose • Developed workplan • Conducted research between calls • Helped develop presentation

  4. Purpose of this Workgroup Reach consensus on the nature & scope of the problem.

  5. Priority QuestionsNature & Scope of the Problem • Incidence of needle-sticks (Where? Who? How many?) • Costs/impacts of needle-sticks • Who is affected (public v. private waste haulers; other sectors?)

  6. Incidence of Needle-stick Injuries (outside healthcare) • Data for on-the-job needle-sticks: • Workers might not report the incident to employers, leading to under-reporting of such events • Companies/agencies might not collect this data • Companies/agencies might not be willing to share these data, if collected • Data on needle-sticks among the public are not available.

  7. Injuries Among Waste Haulers

  8. Injuries Among Waste Haulers

  9. Costs/impactsViability of disease outside the body • According to the CDC: • HIV: less than a day • Hepatitis C: least 16 hours, but no longer than 4 days • Hepatitis B: at least 7 days www.CDC.gov/hiv www.CDC.gov/hepatitis

  10. Cost/impactsDisease transmission (healthcare setting) The risk of transmission of disease after a needle-stick is as follows, if from a known, positive source: • HIV is 0.3% • Hepatitis C -- 1.8% (range 0% - 7%) • Hepatitis B -- (for an unvaccinated individual) 1% to 31%, depending on infection status of the source CDC- MMWR 50(RR11); 1-42 www.cdc.gov/mmwr

  11. Cost/impacts of a Needle-stick • Studies available for needle sticks within healthcare setting (more known factors) • Direct costs range from a few hundred dollars to several thousand per incident • May include prophylaxis, cost of lost work hours, personnel treating employee, etc. • Indirect costs may be 4-8 times greater than direct costs, in general (psychological, etc.)

  12. Who is impacted: waste haulers • Waste industry has been focal point, • no data on others impacted • Employees: 27% public, 72% private • (both privately owned & publicly traded) • Facilities: 48% public, 52% private • Size of the U.S. Solid Waste Industry, Beck (2001) 12

  13. Priority Questions Medical Sharps Use/Disposal • How many sharps are used in community setting? • How are they disposed of now?

  14. # of Sharps Sold through Retail Outlets (annual, U.S.) • Injection: • Insulin Syringes = 1,425,000,000  units • Pen Needles = 786,000,000  units • About 15-17% of the above sold via mail pharmacies • Growing 11-12% annually • 900 million lancets Becton, Dickinson and Co.

  15. Self-injected pharmaceuticals and sharps use • Developing a table of self-injected pharmaceuticals on the market • Over 25 manufacturers identified • Almost 50 different pharmaceuticals • Treating 14 different categories of illnesses/conditions • Used with various injection devices

  16. Current sharps disposal practices • Small-scale studies over past 10+ years • Range of responses • Most sharps disposed of in trash (sometimes in container) • Generally small percentages take used sharps to various locations (medical facility, pharmacy, HHW) or mail-back • Flushing not commonly cited • California survey (2007) • Disposal to trash (often in container) is most commonly referenced by respondents

  17. What can we conclude? • Needle-sticks are not commonly reported in the waste industry • Risk of disease transmission is low • We still do not know where and how often needle-sticks are occurring

  18. What can we conclude? • However, • The costs of a needle-stick can be significant (direct and indirect), and treatment is always recommended • Of the large number of sharps used annually today for self-injection, most are going into the municipal solid waste stream

  19. Key Question Do we need more research? If so, what and why?

  20. Possible Next Steps for Workgroup • Continue to collect information on self-injected pharmaceuticals, devices used, etc. • Conduct new study: To what extent could use of safety-engineered devices reduce the risk of needle-sticks in the community? • Conduct new study: What is the incidence of needle-sticks in other occupations (besides waste-haulers) and the general public?

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