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.”
The Kentucky
Department for Environmental Protection, Division of Waste Management has
created a document entitled Medical
Waste Management. This document provides guidance on how to safely dispose of sharps (syringes
and lancets).
The guidance provides the following recommendations:
A commercially available disposal system can be purchased through
your local pharmacy.
An alternative is a hard plastic container such as an empty laundry
detergent bottle.
Label the container to indicate that it contains sharps.
Communicate with your garbage collector that you will be setting
out sharps containers on a regular basis.
Summary Establishes rule-making authority – The law gives the Natural
Resources and Environmental Protection Cabinet the authority to create regulations
for
the managing of solid waste. The Cabinet has the power to determine which
entities are required to submit a solid waste management plan and to approve
these plans. The law also gives the Environmental Quality Commission the authority
to recommend, adopt or reject any rule or regulation pertaining to the disposal
of waste.
Establishes permit requirements – The
law requires all facilities that handle, transport, or dispose of solid waste
to obtain a permit from the Natural
Resources and Environmental Protection Cabinet.
Statute
Subchapters 1, 10, 40 and 43 of the Kentucky Revised Statutes Title XVIII,
Chapter 224 [Ref 1]
2. Solid Waste Administrative Regulations
Summary Establishes solid waste administrative procedures – This administrative
regulation establishes procedures for service of process, computation of time,
and filing documents.
Regulation
Chapter 1 of the Kentucky Administrative Regulation Title 400 [Ref
2]
3. Solid Waste Management Regulations
Summary Establishes waste management procedures – The regulations
establish general administrative procedures and provisions then apply to
waste management regulations.
Establishes requirements and standards for solid waste
facilities – Solid
waste facilities are required to register and obtain permit applications from
the Department of Environmental Protection. The regulations establish specific
siting, design, and operation requirements for solid waste landfills.
Establishes solid waste planning requirements – The
regulations establish requirements and procedures for submitting, processing,
and amending
solid waste management plans.
Regulation
Chapters 30, 47, 48, and 49, and 100 of the Kentucky Administrative Regulations
Title 401 [Ref 3]
Summary Adopts federal bloodborne pathogen rule – Kentucky’s bloodborne
pathogen rule was adopted by reference from the federal standard. The state
operates its own program under an U.S. Occupational Safety and Health Administration
(OSHA)-approved state plan.
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.
How This Option Works
An individual brings filled sharps containers to a collection site
such as a pharmacy, medical facility (for example, a hospital or
public health clinic), or non-medical facility (for example, a fire
station) for safe disposal. Other sites have sharps collection drop
boxes (a kiosk, mailbox-type receptacle, or other secured collection
bin). This is a viable option that can capture many of the syringes
generated in the community. Successful syringe container collection
programs feature:
minimal regulatory constraints placed on
collection sites;
easy access provided through numerous and
well-publicized collection locations; and
minimal costs to users through subsidized
costs of containers and disposal.
Even if a community does not have collection
site programs, an individual may be able to develop an informal
relationship with a local pharmacy or other facility that will accept
and safely dispose of filled syringe containers.
Advantages and Disadvantages
Sharps container collection programs have two key advantages:
Used syringes are kept out of the regular
solid waste stream, which reduces the risk of needlestick injuries
to waste and recycling workers (see Disposal
in the Trash for more information).
Syringes collected through these programs
are disposed of safely as medical waste. This involves special
disinfection to destroy germs and destruction or burial to ensure
that the needle points cannot injure anyone.
Facilities and individuals may perceive some
disadvantages:
Individuals may feel that bringing sharps
containers to a collection site is inconvenient and reduces their
privacy because it identifies them as a syringe user.
Collection sites may have to comply with
state bloodborne pathogen standards and medical waste disposal
requirements, and they must carefully maintain the collection
bins or kiosks.
Effect of Kentucky’s Laws and Regulations on
Container Collection Sites Community sharps container collection sites
are not specifically addressed in Kentucky’s Solid Waste Regulations.
Collection sites would be required to comply with all applicable
solid waste regulations set
forth in the state of Kentucky.
Collection site operators may also be subject to meeting bloodborne
pathogen standards, depending on how the sharps containers are collected
and handled.
Container Mailback
Programs
Background
How This Option Works
Sharps containers are distributed to customers and, when full, are
mailed back to a syringe disposal company for safe disposal. This
is a viable option that can capture some of the used syringes generated
in the community.
Advantages and Disadvantages
Syringe mailback programs have the same advantages
as syringe container collection sites:
Used syringes are kept out of the regular
solid waste stream, which reduces the risk of needlestick injuries
to waste and recycling workers (see Disposal
in the Trash for more information).
Syringes collected through these programs
are disposed of safely as medical waste. This involves special
disinfection to destroy germs and destruction or burial to ensure
that the needle points cannot injure anyone.
The cost of mailing the container to the disposal
company varies. The cost may be too high for some individuals, and
may be considered a disadvantage.
Effect of Kentucky’s Laws and Regulations on
Container Mailback Programs
Sharps container mailback programs are not addressed by Kentucky’s infectious
waste rule. However, sharps container collection programs are regulated under
the U.S. Postal Service (USPS) when syringes are mailed [Ref 5]. The USPS regulations
establish specific packaging, labeling, and tracking requirements for these
syringes.
Disposal in the Trash
Background
How This Option Works
Individuals place their used syringes in the household trash, either
loose or in a puncture-resistant container. Some individuals remove
the needle from the syringe and put it in a container using a special
device. The syringe and contained needle are then disposed of in
the household trash.
Advantages and Disadvantages
The main advantages of this option are convenience
and low cost.
This option has one important disadvantage
– it places people at risk of being stuck by a needle and
increases their chances of contracting a bloodborne infection:
Placing unprotected syringes into the
household trash puts waste collectors at risk [Ref
6].
Placing used needles in a puncture-resistant
container may help protect trash collectors from being stuck.
Even so, most containers disposed of in the trash shatter in the
garbage truck and release their contents. This places other waste
workers at risk.
Bottles or cans used as puncture-resistant
containers may be recycled by mistake. This puts waste recyclers
at risk.
Effect of Kentucky’s Laws and Regulations
on Disposal in the Trash
Kentucky regulations do not address syringes that are generated within the
home. Therefore, home users of syringes may dispose of their syringes in
the trash.
How
Might Kentucky Ensure Safe Syringe Disposal by Individuals in
the Community?
The state legislature and individual communities may wish
to 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 Kentucky move toward
the goal of “no syringes discarded in the trash or public locations.”
Current
Identified Community Syringe Disposal Programs in Kentucky
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Kentucky's Public Health Laws and Regulations:
Impact on the Safe Disposal of Used Syringes by Individuals in the
Community