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Safe Community Needle Disposal

Rhode IslandRhode Island Public Health Laws and Regulations: Impact on the Safe Disposal of Used Syringes by Individuals in the Community

Content Verified on: February 15, 2003


Summary

Regulatory Environment

  • Sharps used at home are exempt from Rhode Island’s medical waste regulations and may be disposed in the trash.
  • Approved community sharps collections sites, such as pharmacies or fire stations, that accept filled sharps containers from households, are also exempt from Rhode Island’s regulated medical waste law and rule (see the “Eureka” program).
  • Hospitals and other facilities that produce medical waste are regulated under Rhode Island’s medical waste disposal standards.

Identified Community-based Disposal Initiatives

• Eureka (formerly known as SharpSmart), A Program of the Diabetes Foundation of Rhode Island, Inc., has developed safe disposal guidance for individuals and established community syringe collection sites at pharmacies, fire stations, and the Diabetes Foundation of Rhode Island. Eureka has developed several models of “kiosks” that are available for placement in pharmacies and other locations. The program provides free sharps containers for users and gathers data on numbers of sharps containers collected and their impact on landfills.


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 Diabetes Foundation of Rhode Island, in conjunction with the Rhode Island Department of Health and other public and private sector organizations, has developed a community sharps collection program with guidance for individuals called “Sharp Smart: The Nation’s First Statewide Residential Needle Disposal ProgramLink to a non-CDC site (soon to be named “Eureka”). The guidance states:

…SharpSmart is a program that provides small household containers, called Sharps containers, to hold your needles and lancets, and collection receptacles located throughout Rhode Island for you to safely throw away your full Sharps containers…

If you want to make that that you are disposing of your Sharps the right way, follow these simple rules:

DO use a container that is puncture resistant and is not see-through

  • 1 gallon bleach or liquid detergent bottles
  • sealed and taped coffee can
  • Sharps container (preferred container)

DO keep containers in areas that are child and animal proof.

DON’T put Sharps in soda cans or bottles, juice bottles, glass containers, or milk cartons.

DON’T put Sharps containers in your recycling bin.

DON’T flush needles or lancets down the toilet. (Sharps that are flushed down the toilet may end up on our beaches and riverbanks.)

DON’T throw loose needles or lancets in the recycling bin, trash, or SharpSmart receptacle.

DON’T empty the Sharps container in the SharpSmart receptacle. Throw away the full container.

A list of sharps collection locations in Rhode Island is published on the SharpSmart web page (soon to be renamed “Eureka”).


Solid and Infectious Waste Policies

1. Regulated Medical Waste Law and Regulation

Summary
Establishes sharps definition – “Sharps” (hypodermic needles, syringes and other sharp items) are defined as a form of regulated medical waste.

Exempts residential sharps waste from the medical waste standards – Sharps waste from residences is exempt from both the definition of regulated medical waste, and from the Rhode Island medical waste regulations. Individuals may therefore dispose of sharps in the trash. (This is not recommended in Rhode Island: See the “Eureka” program.)

Establishes requirements for facilities that generate and handle infectious waste – The law and regulation establish standards for segregating, containing, treating, transporting, disposing, and tracking of regulated medical waste. Community sharps container collection programs are not specifically addressed by the rule, but must be approved by the Rhode Island Department of Health and Department of Environmental Management.

Law
Title 23 [Health and Safety], Chapter 23-19.12 [Generation – Transportation – Storage – Treatment - Management and Disposal of Regulated Medical Waste], Sections 23-19.12-1 through 23-19.12-19 [Ref 1]

Regulation
Regulation DEM-DAH.MW-01-92 [Rules and Regulations Governing the Generation, Transportation, Storage, Treatment, Management and Disposal of Regulated Medical Waste in Rhode Island – March 1992, As Amended: April 1994] [Ref 2]

Responsible Agencies
Department of Environmental Management
Rhode Island Department of Health


Bloodborne Pathogen Standards

Summary

Federal bloodborne pathogen rule applies – Rhode Island 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 I)
Area Office (Responsible for OSHA compliance in Rhode Island)


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 Rhode Island’s Laws and Regulations
Because sharps from residences are not regulated, community sharps collections sites, such as pharmacies or fire stations, are not covered by Rhode Island’s medical waste law and rule. This would encourage facilities to become approved sharps collection sites.

Rhode Island’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.

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 Rhode Island’s Laws and Regulations
Sharps container mailback programs are not addressed by Rhode Island’s medical waste rule. However, 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 Rhode Island’s Laws and Regulations
Sharps from residences may be legally disposed in the trash. However, this is not recommended in Rhode Island (see the “Eureka” program).

This may discourage individuals from seeking safer disposal options, such as returning filled sharps containers to a pharmacy or other sharps container collection site.


How Might Rhode Island 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 Rhode Island move toward the goal of “no syringes discarded in the trash or public locations.”


Current Identified Community Syringe Disposal Programs in Rhode Island Go to Top

Eureka, A Program of the Diabetes Foundation of Rhode Island, Inc.

(See report in Journal of the American Pharmaceutical Association entitled, “Eureka – Implementing safe community needle disposal in Rhode Island” [Ref 6])

The Eureka program was formerly known as SharpSmart. This program was established to encourage safe syringe disposal by Rhode Island residents and is sponsored by a diverse partnership consisting of the Diabetes Foundation of Rhode Island, Inc., Stericycle, Rhode Island Resource Recovery, the Champlin Foundations, Rhode Island Department of Health (DOH), and the Rhode Island Department of Environmental Management. Described as the first statewide needle disposal project to be launched in the United States, the program’s goal is “to achieve our common goal of providing a safe and healthy environment for all Rhode Islanders.”

The program encourages individuals to safely dispose of used syringes by providing free sharps containers to users and establishing community sharps collection sites. These sites are located at several police stations, fire departments, and pharmacies around the state and at the Diabetes Foundation. The free sharps containers are subsidized by the solid waste industry, a DOH contract, and the Becton Dickinson Corporation. At this time, Stericycle is providing free pick-up and destruction of syringes collected from the collection sites.

The program also educates the public about the program and the importance of safely disposing of sharps through a brochure entitled “SharpSmart: The Nation’s First Statewide Residential Needle Disposal ProgramLink to a non-CDC site

Data collection – Project partners are collecting data on the scope and impact of the program, such as information on the number of sharps containers collected and the impact on landfills and recycling centers.

For additional information about the program, contact –

Diabetes Foundation of Rhode Island, Inc.
209 Cottage Street
Pawtucket, RI 02860
Tel: (401) 725-7800
Fax: (401) 725-8833

Cherie Kearns, Diabetes Foundation
Tel: (401) 725-7800 / Home Office – (401) 765-7245
Email: cheriekear@aol.com / cheriek@dfrii.org


Responsible Agencies in Oregon

Links below will open in a new browser window.

Department of Environmental ManagementLink to a non-CDC site
Bureau of Environmental Protection
Office of Waste Management
235 Promenade Street
Providence, RI 02908-5767
Tel: (401) 222-6677
Fax: (401) 222-3162
Contact: Mark Dennen [Email: mdennen@dem.state.ri.us]
Tel: (401) 222-2797 ext. 7112


Rhode Island Department of HealthLink to a non-CDC site
Office of Environmental Health Risk Assessment
Room 208, Cannon Building
3 Capitol Hill
Providence, Rhode Island 02908
Telephone: (401) 222-3424
Contact: Linda Phillips [Email: lindap@doh.state.ri.us]
Tel: (401) 222-7765

Occupational Safety and Health AdministrationLink to a non-CDC site (OSHA)

OSHA Regional OfficeLink to a non-CDC site
Region I
JFK Federal Building
Room E-340
Boston, MA 02203
Tel: (617) 565-9860
• Responsible for administrative activities in Region I

OSHA Area Office
US Department of Labor – OSHA
380 Westminster Mall, Room 243
Providence, RI 02903
Tel: (401) 528-4669
• Responsible for OSHA compliance in Rhode Island


References

Links below will open in a new browser window.

1. Title 23 [Health and Safety], Chapter 23-19.12 [Generation – Transportation – Storage – Treatment - Management and Disposal of Regulated Medical Waste], Sections 23-19.12-1 through 23-19.12-19Link to a non-CDC site

2. Regulation DEM-DAH.MW-01-92 [Rules and Regulations Governing the Generation, Transportation, Storage, Treatment, Management and Disposal of Regulated Medical Waste in Rhode Island – March 1992, As Amended: April 1994PDF IconLink to a non-CDC site

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

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.

6. Caranci PF, Farmanian R, Goldman D, Kearns CM, LeBoeuf K, Nicholson R, Sands R, Scheraga M. Eureka – Implementing safe community needle disposal in Rhode Island. J Am Pharm Assoc. 2002;42(supp 2):S109-10.



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