Sharps injury reduction: a six-year, three-phase study comparing use of a small patient-room sharps disposal container with a larger engineered container

Abstract

Peer reviewed article 350-bed Sydney hospital noted excessive container-associated sharps injuries (CASI) using small sharps containers and compared the effect from 2004 to 2010 of using a larger container engineered to reduce CASI. In Phase 1 (Ph1), disposable 1.4L containers (BD Australia) were carried to/from patients' rooms. In Phase 2 (Ph2), this stopped and a safety-engineered 32L reusable container (the Device; Sharpsmart, SteriHealth) was mounted in medication stations only and sharps were carried to and from patient rooms using kidney dishes. In Phase 3 (Ph3), the Device was wall-mounted in patient rooms. Sharps injuries were categorised as 'duringprocedure', 'after-procedure but before disposal', 'CASI', and 'improper disposal SI'. Disposal-related SI comprised CASI plus improper-disposal SI. Injuries per 100 full-timeequivalent staff were analysed using Chi 2 ; p ≤ 0.05; and relative risk and 95% confidence limits were calculated. In Ph1 (small containers) 19.4% of SI were CASI and transport injuries were zero. In Ph2 (Device in medication station) CASI fell 94.9% (p <0.001); Disposal-related SI fell 71.1% (p=0.002) but transport injuries rose significantly. In Ph3 (Device in patient room) zero CASI occurred (p<0.001); Disposal-related SI fell 83.1% (p=0.001). Recapping SI fell 85.1% (p=0.01) with the Device. The Device's volume, large aperture, passive overfill-protection and close-at-hand siting are postulated as SI reduction factors. IntroductionCommercial sharps containers (SC) were first advocated for use in healthcare facilities (HCF) by Osterman (1975), but their adoption created a new sharps injury (SI) hazard: container-associated sharps injuries (CASI). These are sharps injuries sustained while depositing sharps into, or during the handling of, SC (Grimmond et al, 2010).National annual SI data are unavailable in the UK, but the annual number of healthcare workers sustaining SI is estimated to be between 56,000 (Elder and Paterson, 2006) and 100,000 (Godfrey, 2001). In a Royal College of Nursing (RCN) survey (2005) of 19 trusts, 11.5% of total SI were CASI, which translates to 6,000-12,000 UK healthcare workers sustaining CASI annually. This may indicate that safer SC and SC protocols are needed as previous studies indicate CASI incidence can be significantly reduced with the use of safety-engineered SC (Grimmond et al, 2003(Grimmond et al, , 2010.Australian federal regulations do not cover the siting of sharps containers, which is regulated by state guidelines that commonly require containers to be sited "as close as practical to the point of use of sharp devices" (NSW Health, 2007) and most Australian hospitals place containers on the wall in the patient's room (or occasionally on a cart brought to the bedside). In the UK, the Control of Substances Hazardous to Health (COSHH) regulations require that containers "be provided for the disposal of contaminated waste" (COSHH, 2002) and the more recent Sharps Regulations require containers to be, "located close to areas where medical sharps are...

Needlestick and sharps injuries at a German university hospital: epidemiology, causes and preventive potential – a descriptive analysis

“…As reported by Grimmond et al [ 28 ], >90% of CASI are related to container design. Sharps containers with a large aperture, a deep atrium and a passive overfill protection allowing for one-handed deposit and that are situated close-at-hand seemed to reduce the risk of obtaining a CASI [ 29 ].…”

“…In another study by Grimmond and Naisoro [ 29 ], the rate of CASI could be significantly decreased by replacing small transportable SC with SC that had a large capacity and were constantly placed in the room where the sharps were used. Bearing these results in mind, SC presently used at the UKE should undergo an evaluation and the placement of SC in each hospital room should be considered.…”

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“…The proportion of sharps injuries that were container-related also fell from 11.6% pre-implementation to 1.1% post-implementation ( 17 ). Grimmond and Naisoro ( 18 ) conducted a 6-year three-phase transition from disposable sharps containers to a wall-mounted, advanced engineering container in patient rooms. Compared to phase 1 (disposable containers), data collected in phase three (wall-mounted containers) saw an 83.1% statistically significant decrease in disposal-related sharps injuries.…”