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Safe Community Needle Disposal

MissouriMissouri's Public Health Laws and Regulations: Impact on the Safe Disposal of Used Syringes by Individuals in the Community

Content Verified on: March 9, 2003


Summary

Regulatory Environment

  • The Missouri Department of Natural Resources establishes regulations for the management of infectious waste.
  • Missouri law specifically exempts household-generated syringes from its infectious waste disposal regulations, provided they are properly packaged before disposal.

Identified Community-based Disposal Initiatives

  • No community-based disposal initiatives have been identified in Missouri.
  • The state has not developed written guidance on the safe disposal of household-generated syringes.

Introduction

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.”


Current Published Guidance for Individuals

The state of Missouri has not developed written guidance on the disposal of household generated syringes.


Solid and Infectious Waste Policies

1. Environmental Control Statute

Summary
Establishes rule making authority – The Department of Natural Resources has the authority to create a statewide solid waste management plan and to establish the rules that cover solid waste management systems. The statute requires each city and county, or combination thereof, to develop and implement rules for the collection, transportation, processing, and disposal of solid wastes. The rules that are generated should be in accordance with the regulations set forth by the Department of Natural Resources.

Establishes definition – Sharps (hypodermic needles and syringes) are classified as a form of infectious waste.

Establishes permit requirements – The statute requires all solid waste processing facilities and solid waste disposal areas to obtain a permit from the Department of Natural Resources.

Establishes treatment requirements – Prior to disposal, all solid wastes must be treated by a permitted infectious waste processing facility or by a hospital.

Establishes transportation requirements – Hospitals and small quantity generators are allowed to transport infectious waste to a hospital or infectious waste processing facility for treatment and may transport their infectious waste to a central collection point provided they utilize their employees and vehicles and comply with established requirements.

Law
Chapter 260 of the Missouri Revised Statutes [Ref 1]

Responsible Agency
Department of Natural Resources
Solid Waste Management

2. Infectious Waste Management Regulations

Summary
Establishes infectious waste requirements – The regulations establish rules for the storage, transport, treatment, and disposal of infectious waste.

Establishes packaging requirements – Sharps must be placed in rigid, leak-resistant, and puncture-resistant containers that are sealed and labeled with the universal biohazard symbol and labeled “Infectious Waste” or “Biohazard Waste” prior to disposal

Exempts household generated syringes - Persons who generate infectious waste at a single-family residence are exempt from the regulations, provided that sharps are placed in rigid, leak-resistant, and puncture resistant containers that are sealed prior to disposal.

Regulation
Chapter 7 of the Code of State Regulations Title 10 [Ref 2]

Responsible Agency
Department of Natural Resources
Solid Waste Management


Bloodborne Pathogen Standards

Summary
Federal bloodborne pathogen rule applies – Missouri has not established its own state plan for regulating bloodborne pathogens. Therefore, the federal Occupational Safety and Health Administration (OSHA) standards apply.

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
29 CFR Part 1910.1030 [Ref 3]

Responsible Agency
US Occupational Safety and Health Administration
Regional Office (Responsible for administrative activities in Region 7)
Area Office (Responsible for OSHA compliance in Kansas City District)
Area Office (Responsible for OSHA compliance in St. Louis District)


Selected Community Syringe Disposal Options

Container Collection Sites

Background

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 Missouri’s Laws and Regulations
Missouri law allows hospitals to accept infectious waste from small quantity generators (persons who generate 100 kilograms per month or less) for treatment provided the hospital obtains approval from the Department of Natural Resources as well as the Department of Health and Senior Services.

Missouri’s infectious waste regulations exempt pharmacies from the infectious waste processing facility permitting requirements provided that the only waste accepted are syringes presented in person by small quantity generators. Pharmacies under this exemption can hold no more than 10 kilograms of infectious waste on-site at any time and can process no more than 100 kg of infectious waste per month.

Syringes that are collected by hospitals or pharmacies must be managed in accordance with the infectious waste regulations.

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 Missouri’s Laws and Regulations
Missouri law allows sharps to be transported by the United States Postal Service for treatment provided that the generator complies with the federal requirements.

Sharps container collection programs are regulated under the U.S. Postal Service (USPS) when syringes are mailed [Ref 4]. 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 5].
  • 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 Missouri’s Laws and Regulations
According to Missouri law, syringes that are generated in the household must be placed in rigid, leak-resistant, and puncture resistant containers that are sealed prior to disposal in the trash.


How Might Missouri Ensure Safe Syringe Disposal by Individuals in the Community?

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 Missouri move toward the goal of “no syringes discarded in the trash or public locations.”


Current Identified Community Syringe Disposal Programs in Missouri Go to Top

No community syringe disposal programs were identified operating in Missouri. However, this does not mean that none operate in the state.


Responsible Agencies in Missouri

Links below will open in a new browser window.

Department of Natural Resources
Solid Waste Management
Link to a non-CDC site
PO Box 176
Jefferson City, MO 65102
Telephone: (800) 361-4827
Telephone: (573) 751-3443
Contact: Charlene Fitch

U.S. Occupational Health and Safety Administration Regional Office
City Center Square
1100 Main Street, Suite 800
Kansas City, MO 64105
Telephone: (816) 426-5861
Fax: (816) 426-2750

Kansas City Area Office
6200 Connecticut Avenue, Suite 100
Kansas City, MO 64120
Telephone: (816) 483-9531
Fax: (816) 483-9724
Toll Free (Missouri Residents Only): (800) 892-2674

St. Louis Area Office
911 Washington Avenue, Room 420
St. Louis, MO 63101
Telephone: (314) 425-4249
Fax: (314) 425-4289
Toll Free (Missouri Residents Only): (800) 392-7743


References

Links below will open in a new browser window.

1. Missouri Revised StatutesLink to a non-CDC site – Chapter 260 [Environmental Control]

2. Code of State Regulations (CSR)PDF IconLink to a non-CDC site – Title 10 [Department of Natural Resources], Division 80 [Solid Waste Management], Chapter 7 [Infectious Waste Management]

3. OSHA Bloodborne Pathogen StandardsLink to a non-CDC site – 29 CFR Part 1910.1030.

4. USPS Domestic Mail ManualLink to a non-CDC site [Click on “DMM Subject Index” then scroll to and click on “Sharps, CO23.85”]

5. Turnberg WL, Frost F. Survey of occupational exposure of waste industry workers to infectious waste in Washington State.Link to a non-CDC site American Journal of Public Health 1990;80(10):1262-1264.



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