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Content Verified on: April 21, 2003
Regulatory Environment
Identified Community-based Disposal Initiatives
Disposing of contaminated medical waste, including needles, syringes, and other “sharps,” has become an important issue in public health policy. Waste generated in the health care system is highly regulated at the state and federal level. Hospitals and other health care facilities must follow special procedures for handling, transporting, and disposing of medical waste, including used needles that may contain blood. Facilities also have instituted strict safeguards to protect health care workers, housekeeping staff, sanitation workers, and waste haulers from needlesticks because of the risk of contracting HIV, hepatitis B and C, and other bloodborne infections. Less attention has been paid to safe disposal of used syringes that come from individuals living in the community. However, as many as 3 billion syringes are used each year outside health care facilities: It is estimated that between 0.9 and 1.68 billion insulin injections and up to 1 billion illegal drug injections occur each year in the United States. After being used and discarded, most of these syringes end up in the public solid waste system. This presents a risk of needlestick injury and infection, mostly to solid waste workers. A much smaller number are discarded in public areas, such as parks, presenting a risk to the public. This section of CDC’s Community Syringe Disposal, Laws and Regulations, and the Public Health web site looks at the public health dimensions of this problem. It describes this state’s solid and infectious waste laws and regulations as they relate to syringe disposal. It provides background information on several key disposal options currently used in the U.S. and describes the impact of this state’s laws and regulations on the way that individuals may use these options. It also includes brief descriptions of some safe disposal programs in the state and provides contact information for the state’s public health and environmental management agencies. This web site is designed primarily for individuals and communities who are working to build safe syringe disposal programs and improve public understanding of this important issue. We hope that the information and tools provided here will help communities move closer to the ultimate goal of “no syringes discarded in the trash or in public locations such as parks, buildings, or the streets.”
California has not published community syringe disposal guidance.
1. Medical Waste Law Summary Excludes medical waste generated from the household from regulation — Used syringes from households may be disposed in the trash. Local restrictions may apply. Recognizes community sharps container collection sites – The law recognizes community-based collection sites and contains special provisions for these sites:
Allows registered medical waste generators to accept used syringes from individuals – Medical waste generators registered with the Department of Health Services may accept home-generated used syringes. Certain requirements apply. Establishes approval and reporting requirements for medical waste mailback services – Medical waste mailback services must pay a fee and be approved by the Department of Health Services. These services must provide the Department with a list of all clients annually. Law Responsible Agency
Summary Sets requirements for collection sites when employees handle the sharps containers – Operators of sharps container collection sites in which employees physically accept and handle filled sharps containers from customers are required to meet the OSHA bloodborne pathogen standards. This involves developing a written Exposure Control Plan that identifies the frequency of exposure and the tasks and procedures in which exposure may occur. The Plan also must address methods of compliance, hepatitis B vaccination, hazard communication to employees, recordkeeping, and methods to evaluate exposure incidents. Sets requirements for collection sites when employees do not handle the sharps containers – Operators of sharps container collection sites in which customers place filled sharps containers into a collection container are not subject to the bloodborne pathogen standard. In this situation, employees must not handle the sharps containers. Those involved with removing the sharps containers from the collection container must meet the standard. Law Responsible Agency
• Read about California’s sharps container collection programs
Effect of California’s Laws and Regulations California’s bloodborne pathogen standard discourages programs in which employees handle filled sharps containers from customers, and encourages programs in which employees do not have to handle filled containers because customers place them directly into a collection container.
Effect of California’s Laws and Regulations Sharps container collection programs are also regulated under the U.S. Postal Service (USPS) when syringes are mailed [Ref 3]. The USPS regulations establish specific packaging, labeling, and tracking requirements for these syringes.
Effect of California’s Laws and Regulations
The state legislature and individual communities may wish to more actively encourage individuals to safely dispose of used syringes and make it easier for them to do so. Many options for state and local action exist. They range from gathering data, to developing community collection site programs and education efforts, to creating partnerships with interested groups, to considering amending laws and regulations. All will help California move toward the goal of “no syringes discarded in the trash or public locations.”
Identified sharps container collection site programs in California [Ref 5] San Francisco Community Syringe Collection Site Program An increasing number of communities throughout California are implementing programs to get home-generated sharps out of the solid waste stream. San Francisco has operated a disposal program for home-generated sharps since 1991. Through this program, residents are given free, 2.2-quart sharps containers from participating pharmacies, hospitals, and clinics. Individuals return the containers when full to these sites and they are picked up by a licensed medical waste hauler either on demand or on a fixed schedule. During the year 2000, 13,980 containers were distributed in San Francisco by 46 participating Walgreen's Pharmacies, 5 hospitals, and 2 clinics. The program disposes of an estimated 1.8 million needles per year. This resulted in a reported seven-fold reduction in needle sticks to garbage collectors in the year 2000 as compared to 1989 [Excerpt from McGurk by permission (Ref 5)]. Ventura County Solid Waste Management Department Syringe Collection Site Program In response to needle stick injuries to workers doing recyclable sorting and a request from the County Environmental Health Division, the County of Ventura Solid Waste Management Department started a home-generated sharps program with the theme of: How NOT to Get Stuck in Ventura County. Their program was initiated in October 1998 and containers are distributed and collected at 18 facilities; 12 county-operated public health or family care clinics, and 6 privately operated hospitals and clinics. The program has distributed 3,202 sharps containers since October 1998 and collected 2,353 full ones from its sites through March 2001 [Excerpt from McGurk by permission (Ref 5)]. The City of Rancho Cucamonga Syringe Collection Site Program The City of Rancho Cucamonga initiated a program that allows residents to bring their used syringes to its five fire stations on Saturdays from 10:00 a.m. to 2:00 p.m. Residents receive free sharps containers and bring them back for disposal when they are 2/3 full. The program costs approximately $6,200 annually for the new sharps containers and treatment and disposal. These program costs are shared between the three residential waste haulers that operate within the city. The Rancho Cucamonga Fire District contributes all on-site personnel costs, training, marketing, and collection. The City of Rancho Cucamonga's Waste Management Division oversees the contract with the waste haulers and the medical waste company and tracks the success of the program and monitors the budget. To date, the program has diverted over 2,000 pounds of sharps waste from the solid waste stream [Excerpt from McGurk by permission (Ref 5)]. Waste Management Inc./Sharps Compliance Inc. Syringe Mailback Program Waste Management Incorporated (WMI) is teaming with Sharps Compliance Inc. (SCI) to implement a syringe mail back program in three areas of the country. The WMI/SCI project is being initiated in Orange County, California; Denver, Colorado; and Orlando, Florida. WMI customers are sent literature regarding the mailback program and offered an 800 number to call for further information and to sign up for the service. The program has recently been implemented in Chino, San Bernardino, and some of the other Inland Empire localities that are serviced by WMI. Residents who order the service are sent a postage-paid sharps container that they mail back to SCI's Texas facility when full [Excerpt from McGurk by permission (Ref 5)]. City of San Bernardino Syringe Collection Site Program The City of San Bernardino instituted a home-generated sharps disposal program in 1999 using grant funds from the California Integrated Waste Management Board. The program works closely with 20 pharmacies, senior and assisted living facilities, veterinary hospitals, and diabetic centers. Clients who are not homebound go to the San Bernardino Public Services Department where a representative completes a service request that helps determine the size container that will be needed. The containers and drop off locations program then provides to the customer. Requests from homebound customers are received over the phone and a coordinator establishes a container delivery date with the customer. When the containers are full, the homebound patient calls the coordinator who contacts the contract hauling company to set a convenient pick up time with the customer. A new container is exchanged for the full one. The program uses several avenues for outreach such as health fairs, press releases, tag lines in water bills, senior center public service announcements and advertisements on paper bags from the pharmacies. During the year 2000 the program diverted a total of 67,000 sharps from the solid waste stream [Excerpt from McGurk by permission (Ref 5)]. Identified Syringe Exchange Programs in California [Ref 6] San Diego Needle Exchange Program Clean
Needles Now, Los Angeles San
Francisco Needle Exchange Sites AIDS Project Central Coast Santa Clara County HIV/AIDS Program
Links below will open in a new browser window. Medical Waste Issues Contact: Jack McGurk, Chief Bloodborne Pathogen Issues
Links below will open in a new browser window. 1. California
Medical Waste Law - California Health and Safety Code, Division 1 2. California
Bloodborne Pathogen Rule – California Code of Regulations, 3. USPS
Domestic Mail Manual 4. Turnberg WL, Frost F. Survey
of occupational exposure of waste industry workers to infectious waste
in Washington State. 5. McGurk, Jack, Chief, State of California, Department of Health Services, Division of Drinking Water & Environmental Management, Environmental Management Branch, 601 N. 7th St., Sacramento, CA 94234-7320, Tel: (916) 323-3023, Fax: (916) 323-9869, E-mail: JMcGurk@dhs.ca.gov. Spring 2001. 6. NASEN
(North American Syringe Exchange Network), Disclaimer The materials provided on this web site are for general information purposes only. They do not constitute legal or policy advice or opinion. Access to these materials, their transmission, or receipt is not privileged and does not create any relationship with the provider. CDC has attempted to make the information in this website accurate. However, CDC makes no guarantees about the accuracy, currency, or completeness of the information provided. We are not responsible for any errors or omissions, or for results obtained from the use of the information. If legal advice or other expert assistance is required, the services of a professional should be sought. This CDC Web site is no longer being reviewed or updated and thus is no longer kept current. This site remains to assist researchers or others needing historical content. |
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Privacy Policy | Accessibility
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California Public Health Laws and Regulations:
Impact on the Safe Disposal of Used Syringes by Individuals in the Community