Accident | Blenkharn Environmental

Seven-year-old faces uncertain future after stepping on needle

A worried mother faces months of uncertainty after her son stepped on a used syringe at a South Mackay playground.

The seven-year-old boy underwent the first of a long series of tests at Mackay Base Hospital on Saturday.

He would have to have more tests in three months and again six months after that before being cleared of any infection, the mother of five said.

“I’m staying positive, but I’m prepared for the worst,” she said. “I just want him not to worry about it.”

Mum is now campaigning by distributing flyers to neighbours warning of needle dangers an advising on safe disposal. As she says, “having a diabetic child I know how to dispose of needles, it’s easy“.

Mackay is a small coastal city in Queensland, Australia, looking out to the Coral Sea. Regrettably, it is not free from IV drug abuse, and this is the consequence.

Though it is reported that people congregate in the unlit park after dark, police and other direct action will only drive the push elsewhere, without necessarily reducing the risk of accidental sharps injury. Since this is a considerable hazard and major public health issue, the next option might be to provide a secure sharps box, though few residents would be likely to accept that, especially in a children’s playground.

This leads to two questions. Are there enough funds to provide a secure and safe location for injections, a “shooting gallery” and would the community accept this? And secondly, what about offering fully automatic or passive engineered safety sharps that would deactivate and return to a safe condition once used?

Both options will cost money. But in the long term, how much will they save?

http://www.news-mail.com.au/news/child-steps-on-needle-in-mackay-health/2187271/

Last updated: Thursday, March 6, 2014

One third of NHS acute Trusts in breach of EU & UK sharps rules

Needle with drop of blood A MindMetre research note on the implementation of EU Directive 2010/32/EU in UK NHS Acute Trusts paints a poor picture of sharps safety compliance.

Now long after the required date for implementation, the introduction of safety engineered safety sharps, and everything else that goes along with the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013 which became live on 11th May 2013, a third of hospital trusts in England are failing to comply with safety regulations designed to reduce the risk of sharps injuries to staff.

MindMetre analysts found 33% of Trusts did not instruct staff to use safety devices “wherever possible” in their sharps policies, despite it being an explicit requirement of health and safety regulations introduced last year on the back of the European Union directive.

The report from business analysts MindMetre investigated the implementation of directive 2010/32/EU, which came into force in May 2010, and was followed by UK guidance from the Health and Safety Executive.

Using the Freedom of Information Act, the analysts obtained details of safety policies from 159 hospital trusts.

Their report said: “The emerging picture is one of widespread progress towards adoption and compliance, but also one which shows that there is considerable ground yet to be covered.” Continue reading “One third of NHS acute Trusts in breach of EU & UK sharps rules” »

Last updated: Friday, March 7, 2014

Accidental death from ‘Mummy’s sweets’

A 16 month old toddler has died after overdosing on iron tablets he thought were ‘Mummy’s sweets’ after his sister climbed onto the bathroom sink to reach them.

When children are in the house, ALL tablets and capsules etc are dangerous and should be kept under lock and key to prevent accidental poisoning.

For adults, the additional risks of stockpiling old and unwanted medicinal products, whether prescription drugs or not, include unwanted adverse effects from deteriorating and out-of-date medicines, and in a few of intentional self-harm.

Though limits on prescriptions should alleviate the latter, GPs and others have repeatedly blamed patients for asking for a prescription, and then for repeat prescriptions, without a hint of irony since it is their own responsibility, not the patient’s, to assess each request and prescribe accordingly. Regrettably, that takes just a little too much time and effort.

And our concern, of disposal of these unwanted products that accumulate in a kitchen or bathroom cupboard, is to ensure environmentally sound disposal. That cannot happen if unwanted pharmaceuticals are thrown into a black sack or poured down the toilet.

Until the Environment Agency awake from their slumbers and address this issue, instead of fussing about an occasional blister pack that the might observe in an orange sack, the better and safer this will be. Lower NHS costs, fewer accidental overdoses, less intentional self-harm, and far lower environmental impact from inappropriate disposal.

There is a GP surgery or clinic, or a family pharmacy in every High Street and shopping precinct, and in every large supermarket. The opportunities to operate a properly funded and effective take-back scheme are there, but need purpose and negotiation, and a willingness to make an effort at least to initiate those negotiations and drive them forward in a positive and encouraging way. Regrettably, that isn’t the way of the Environment Agency, but why not?

and Cutting medicines waste through prescription control

and Wales urges patients to avoid prescription waste

and Presciption numbers rocket to new high

and Drug residues from wastes – the impact on the environment?

and http://www.ianblenkharn.com/?s=prescription

Last updated: Monday, February 24, 2014

City Hall bathrooms to get needle containers

City Hall (Town Hall) bathrooms in the city of Racine, Wisconsin, are to get needle containers.

“Mayor John Dickert and Racine Public Health Administrator Dottie-Kay Bowersox said Thursday that they had been wanting to install the receptacles for a while, especially given the high rate of diabetes in the city and county at large.

“Many diabetics must give themselves daily insulin injections and those injections can often take place when they are away from home.

“The city was also prompted to install the containers after two city employees — a public works employee and a health department employee — each accidentally pricked themselves last year with used syringes.

“The Health Department employee was accidentally pricked while administering a blood draw at the clinic at City Hall, 730 Washington Ave. The incident with the public works employee occurred out in field, when the employee accidentally came in contact with a syringe that had been thrown in the trash, Bowersox said. It was not clear what the needle had been used for, she said.

We just wonder quite how many insulin-dependent diabetics work at or visit City Hall? What are the rest injecting?

Last updated: Sunday, February 23, 2014

Distraught child finds needles on seat of Melbourne tram

A young girl was reportedly “distraught” after finding syringes on her seat on a Melbourne tram seat, according to a witness.

The needles were concealed on her seat, according to a post on the user-generated website reddit.

“The needles were jammed into the back and bottom of the seat, between the cushions. Angled outwards,” the witness explained. “The child was crying and distraught.”

Melbourne’s Yarra Trams confirmed that an incident occurred, but a spokesman insisted that the needles were capped, facing inward, and neither mother or daughter were harmed.

The reddit thread also detailed a new style of game where people jab unwitting strangers with fresh needles “to scare the sh*t out of them”.

“It’s done from behind in the back of the arm or leg,” the user wrote.

“You feel the prick of the needle but might not realise what it is and just think you bumped into something sharp until you see some f***er with a needle”.

Takes all sorts!

Last updated: Monday, January 20, 2014

HIV transmission by needlestick

In an astounding piece from the Armenian News Agency, it is claimed that “A person cannot be infected with AIDS with a needle”!

The Head of the Armenian AIDS Prevention Centre, Janetta Petrosyan, commenting on incidents where persons are striking individuals with a needle as they pass in crowded public spaces, it is said with some authority that this cannot transmit HIV infection.

It is unlikely, and as stated the HIV virus does not survive drops in temperature, exposure to sunlight or ozone, or desiccation well. With further limitations on transmissibility by the volume of blood present and how fresh that blood is, the concentration of virus particles in the blood (virus titre), the type of needle (hollow or solid), the depth of injury, and first aid measures together with the efficacy of post-exposure prophylaxis, if indicated, HIV transmission is indeed perhaps unlikely.

However, it cannot be overlooked that in such circumstances there are other nasty virus agents that are far more infective and easily transmitted such as Hepatitis C. Thus, bold statements that HIV cannot be transmitted by a sharps injury of this type seem scientifically unfounded and clinically misleading, since it may dissuade affected individuals from seeking medical assistance and follow-up.

With HIV and Hep B/C on the rise in Armenia, if Petrosyan is so sure of this perhaps she would like to try it herself. It’s a risk not worth taking, which harks back to the earlier AIDS prevention slogan, ‘Don’t die of ignorance’.

Last updated: Saturday, January 18, 2014

HIV positive nurse injects baby with needle she used on herself

In Uganda, an HIV positive nurse has injected a 2-year old baby with a needle she had used on herself.

The baby’s parents discovered the nurse at Victoria Medical Centre, injecting their child with a needle after taking the baby girl to the hospital for a treatment. It was discovered soon after that the nurse was HIV positive and had used a needle on the baby that had made contact with her own blood.

The nurse claims that she accidentally pricked herself with the needle while trying to administer a shot to the baby and that she didn’t intend to infect the child, but authorities are still investigating.

http://www.opposingviews.com/i/health/hiv-positive-nurse-injects-baby-needle-she-used-herself

Last updated: Tuesday, January 14, 2014

Cheltenham General Hospital’s cleaners traumatised by needlesticks

“More than a dozen cleaners at Cheltenham General Hospital say they have been left severely traumatised after they were stabbed by hypodermic needles in the last 12 months.

“At least 13 members of staff at the hospital have reported being pierced by used syringes in the last year due to “improper disposal” by medical teams.

“The “domestic assistants” have condemned “poor practices” by the hospital’s doctors and nurses which they say are putting the health of the cleaning teams at risk.

“Cheltenham General Hospital has admitted liability for seven cases of piercing by hypodermic needles and one case of contributory negligence.

Regrettably, there is no mention of intervention by any of the various regulators that might step up to the plate here, either HSE or CQC, perhaps even the Environment Agency.

One can only hope that the costs of a private compensation claim has been sufficient to drive a sustained improvement in disposal practise.

Although sharps injury rates are highest among frontline healthcare professionals, we should remind ourselves that a US study comparing injury rates with employment statistics revealed an overall rate of injury among support staff 10x greater than that for nurses, and 30–40x greater than for clinicians (Leigh et al. Characteristics of persons and jobs with needlestick injuries in a national data set. Am J Infect Contr 2008; 36(6): 414–20).

I guess that the cleaners at Cheltenham General Hospital found that out the hard way.

Last updated: Tuesday, December 31, 2013

ISC waste woes

Clinical wastes and indeed just about all other waste streams are managed poorly right across the Indian sub-continent.

A good friend living and working in Goa tells tales of almost daily waste mismanagement, waste-related crime and, more often than not, relatively simple problems that can have far reaching consequences solely due to lack of joined-up waste management systems.

A report from Kerela, of clinical wastes dumped at the roadside, is typical. Wastes have been bagged but dumped, or perhaps dropped accidentally, at the roadside, creating a problem for those using the road, and those tasked with the clean-up. But the TV news report shows much of the wastes smoke stained but essentially unburned. Has someone tried to do the right thing, but been thwarted by a fundamental lack of resources?

Last updated: Monday, December 30, 2013

Commercial success in 2013

Good to read CIWM Journal this month, and the annual review of the industry’s fastest growing waste and resource management companies.

High on the list at number 24, having previously been unlisted, is Healthcare Environmental Services Limited. Clearly, a clinical waste sector success for 2013.

Though its possible to view tables such as this in so many different ways, by employee numbers, by turnover or profit/dividend, 2 year CAGR (Compound Annual Growth Rate ), by gross geographic area of operation or contract futures, even by number of RIDDOR incidents and/or lost day incidents.

Whatever the measure, Healthcare Environmental Services Limited has had another good year. Well done.

Last updated: Saturday, December 7, 2013

Which is the best sharps safety glove?

The Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), established in Québec since 1980, is a scientific research organization well-known for the quality of its work and the expertise of its personnel. It has just released an important research assessment, Evaluation of Manual Dexterity, Tactile Sensitivity and Comfort When Wearing Needlestick-Resistant Gloves.

This new study from the IRSST is an exploratory evaluation of manual dexterity, tactile sensitivity and comfort when needlestick-resistant gloves are worn on the job. Continue reading “Which is the best sharps safety glove?” »

Last updated: Friday, December 6, 2013

Boy on AIDS drugs after needlestick

A bag of hypodermic needles dumped outside a school has turned a Cape Town family’s lives into a “living hell”.

This was after the bag, dumped near a Junior Primary School in Brooklyn, was found by pupils and brought to the playground on Monday. One of the pupils, an 8 year old boy, paid the price.

“We don’t know exactly what happened, but they were playing with the bag and then he got pricked,” said his older brother. The used needle went deep, puncturing the skin and drawing blood.

The doctors started doing all these blood tests , sticking all these needles in his arms. He just sat there with this blank face, he was really brave,” said his mother.

While the blood test results will be available in three months, doctors have already started the child on anti-retrovirals to prevent a possible HIV infection.

Sitting with his family at their Milnerton home, the boy does not seem to understand the seriousness of the situation. The anti-retrovirals have made him nauseous and tired, but to him it is a lot of fuss about a wound that has already started to heal.

Despite the young boy’s bravery and stoicism, the implications may be profound. Stress and anxiety through and beyond that long wait for confirmation that all is well will affect Mum and Dad and the entire extended family.

Last updated: Thursday, November 7, 2013

Horror of boy stuck by needle on Dundee bus

A Dundee family face an agonising six-month wait after their young son was pricked by a used needle on a bus.

The six-year-old boy was injured following an incident aboard the bus last Monday.

He was taken to Ninewells Hospital where medical staff took blood and gave him a booster injection. And now the family must wait six months to find out if their child has been infected with a virus like hepatitis or HIV.

Interestingly, that booster injection is described as a tetanus booster in this report. However, in this circumstance, a tetanus booster would be as much use as a chocolate teapot. In the circumstances, I would be equally concerned to know what more sensible interventions and precautionary or forward-looking plans have been put into place in case something more appropriate had been overlooked.

The child’s father said: “When they got on the bus he asked if he could go up stairs. The next thing he came down looking chalk white and said to his mum: ‘I’ve been stabbed’.

“She asked him what had stabbed him and he said one of those dirty needles. He said it had browny red stuff in it.

Good luck to the little lad, and to his family.

see http://www.eveningtelegraph.co.uk/news/local/dad-speaks-of-horror-after-boy-jagged-by-needle-on-dundee-bus-1.142110

and http://www.bbc.co.uk/news/uk-scotland-tayside-central-24533028

Last updated: Saturday, October 19, 2013

Discarded sharps litter from IV drug abuse

A local newspaper reports a Muskegon County, Michigan, man found with heroin needle in arm in a parking lot.

That is not uncommon, and is a situation that ambulance crews and other first aider’s will be familiar with. So, what to do?

Firstly will be care of the individual, which in itself can be particularly challenging and often rather unrewarding. The needle must be removed, and disposed safely.

The situation does give a lie to the expectation that placing sharps bins in those areas where IV drug abusers congregate will reduce the incidence of carelessly discarded sharps. If the drugs do their job, either as the user might hope for or less safely due to contaminants and adulterants, then the individual will be in a fit state to consider sharps safety and the welfare of others.

Safety sharps may help, but who will pay for these, and then risk a backlash from the moral majority when teaching addicts and others just how to use them?

Passive, spring loaded safety sharps might work, and have the advantage of preventing reuse thus eliminating needle sharing. But they are expensive and if any safety system is to be used it will most likely be the much cheaper active safety device. These require the user to flip over a sheath, that can be later removed to allow the syringe to be reused. However, if an addict cannot even withdraw a needle from their arm, then the advantaged of any safety engineered needle device is as slight as a sharps bin for field use in local hot spots of drug abuse.

Safety sharps can help reduce the incidence of needle and syringe sharing. Thus, without any additional impact on reducing risks from sharps injury, the public health advantage of reduced needle sharing is reason enough to go ahead. This would be money well spent.

Getting these needles into sharps bins is a key goal and we support it fully. But don’t expect that it will be hugely successful.

Last updated: Saturday, October 5, 2013

Ohio temporary waste workers exposed to medical wastes

Temporary workers hired by Ohio State University to separate plastics and cardboard came across medical waste and various medical files, the workers told 10 TV News in Columbus.

The workers were separating items as part of the university’s zero waste program. Several workers described various medical waste in the items they were separating, including needles, catheters and IVs. Those workers also told the television station that they saw patient records in the paper as well.

Officials from the university declined to go on camera for an interview, but provided the station with a list of procedures on how it would be impossible for medical waste to end up in the stream that workers were sorting.

As we noted recently, green initiatives can and do go badly wrong and perhaps this is just another example.

Details of the Ohio incident are limited. Medical files should be managed securely, particularly in the US where patients and next of kin will file a lawsuit for any breach in confidentiality at the very drop of a hat.

As for the medical (clinical) wastes, clearly something has gone badly wrong in segregation and management of separate waste streams.

What is most obvious is the matter of temporary workers. They are called in from an agency and put to work within minutes. Any induction is, at best, notional in content and in all probability of limited value. Essential PPE items will be recycled from a previous user – no problem there if they are in good condition. But what about supervision. At the very bottom of the pile, those agency staff that make a substantial contribution to the workforce of most UK waste management companies, including those handling clinical wastes, receive inadequate training to do their job safely. That is huge problem, since training an agency worker for 1/2 day of more, when they may only stay for a short time is not money well spent.

Supervision is the key, but that is rather limited in scope, even in the best of companies. Once more, supervision of costly, and that hits the bottom line.

But these agency workers need some reasonable standard of protection for injury and infection. First among this must be a mandatory selection of appropriate PPE items, and a list of do’s and don’ts.

That list should be in the worker’s own language, since there is no value in a brief spoken introduction to a worker who cannot or does not understand because of their nationality and limited English language skills.

And then they’re gone back to the agency. But responsibility does not finish then and there, though many would like to think otherwise.

Perhaps the ideal solution to this tricky problem is a written list of those do’s and don’ts, in a range of languages - check first that they can read – supplemented with some take-home information about hygiene and the need to report any exposures, with necessarily some reasoned explanation of how those exposures may arise ie, sharps injury, contamination of broken skin, splashes to the mouth or eyes.

The purpose if to inform, not frighten, so great detail is not required. Inevitably, information should be supplemented with some basic hygiene information. On arrival, this written sheet would supplement, not replace, a basic induction delivered orally. And none of this is an excuse for inadequate supervision!

Is this value for money?

Yes it is, if it prevents a claim and even more so if it prevents an avoidable incident that now would be likely to incur additional costs when HSE come knocking. And those agency workers, who disappear back into a transient pool, might just be back again, better and more efficient or effective than before. Of better still, future employees, setting off from day one on the right foot.

Last updated: Saturday, October 5, 2013

Another sharps injury

A New Castle, Pennsylvania police officer accidentally punctured his thumb with a needle allegedly used by a man to inject heroin.

Police had been called to a man who was on the ground in the park but when they arrived the man refused help and walked away.

Fire department personnel informed the responding officer of a hypodermic needle with suspected heroin residue that was on the grass near where Park had been lying. The officer picked up the needle to discard it and as he tried to cap it, it went through the cap and punctured his thumb.

http://www.ncnewsonline.com/update/x862171488/Man-charged-in-heroin-needle-incident

This is obviously a devastating injury for the policeman, but does suggest a lack of common sense. Picking up the needle may have been the obvious thing to do, to retain evidence perhaps, r simply to prevent injury to others. But without suitable puncture resistant gloves, or some tool such as forceps, then the risk increases. And trying to recap the needle is a recipe for disaster.

And disaster did occur. Recapping of needles has long been abandoned in healthcare. It is a manoeuvre that is prone to sharps injury in the contralateral hand and once prohibited those vast number of sharps injuries fall in number dramatically.

Obviously, that important safety message hasn’t spread far outside the healthcare arena.

And yet recapping of needles might protect. Safety engineered needles rather does away with the problem – if those safety needles are activated by the user before discard – but these are not yet in universal use. No needle exchange services are yet using safety engineered needles since they are marginally more expensive and take some time to learn the new look and feel in order to be proficient in safe injection, and disposal, practice.

And few diabetics are using them. Many will be moving to insulin pens but there are still millions of insulin needles used without safety devices, justified by cost and the need for training that is simply far too resource intensive to consider.

Until that changes, discarded or wrongly packaged or dropped needles spilled form an improperly closed sharps bin are going to be uncapped. For the unwary, that accidental needlestick might be devastating.

Last updated: Wednesday, October 2, 2013

Needlestick on Australian beach

A mother has an anxious after a ‘dirty needle’ prick at Frankston Beach near Melbourne.

As always, the beach-side area attracts IV drug users who seek some degree of isolation and privacy, at least from the Police, while buying and selling, and consuming their drugs. This creates particular problems for those responsible for beach security and cleanliness, and for those tasked with the mechanics of beach cleaning since discarded needles settle rapidly into soft sand making their location and retrieval particularly difficult.

“I went to the doctor’s straight away to get a blood test done and I won’t get the results until October some time.”

Despite being nervous about the results, the mother said she was staying positive.

“I am quietly optimistic. I am angrier if anything, (I believe) the council is only raking the beach once a fortnight.”

“Council undertakes constant beach cleaning during peak summer times, and cleaning is also more frequent in cooler months following storms when needles are more likely to be washed ashore.

http://www.heraldsun.com.au/leader/bayside/mother-anxious-after-dirty-needle-prick-at-frankston-beach/story-fngnvli9-1226718798811

The quotes appearing in the original news report are quite interesting. If she had blood tests and now faces an anxious wait for the result, why not any precautionary treatment, for Hepatitis B or even for HIV (there is no preventative treatment for Hepatitis C)?

It is interesting also to know that “the council is only raking the beach once a fortnight.” That may be a resource-driven decision, and/or one that has been risk assessed. But with this sharps injury, has the risk assessment been reviewed and is their any evidence to justify its revision, thus with more frequent patrols and cleaning?

And lastly, I might question the focus on needles being washed ashore, when the strong likelihood is of a problem and source far closer to home, with a solution that must be managed locally.

Last updated: Saturday, February 1, 2014

Young boys suffer sharps injury

Two young lads have suffered near-miss sharps exposures in separate incidents in the UK, in each case while enjoying an outing to play in the park.

In Maidenhead, a nine-year-old boy had a lucky escape after picking up a used needle while playing innocently in a park. He was enjoying a family trip to Boyn Grove Park on Monday when he made the shocking discovery while playing in an overgrown wooded area of the park

he returned from the bushes with the needle, to the horror of mum and dad. “I was actually terrified for him,” said mum. “At first we thought it was just a pencil.” Unaware of what he had picked up, he was quickly told to drop the needle which he had found alongside a pile of empty beer and wine bottles.

“The first thing we did was to make sure his hands were all OK and there was no break of the skin,” said mum.

The mum-of-two regularly visits the park with her two sons, and now wants to warn parents to be more careful when letting their children play in open spaces. She is also calling on the council to take more action to thoroughly clean parks of any dangerous debris.

“Those responsible for leaving behind these hazardous objects are thoughtless and show no consideration for the safety of the public and their use of open spaces,” she added.

A spokesman from the council said it took the issues of people finding needles ‘extremely seriously’ and urged anyone who made an unwanted discovery to contact the council immediately.

http://www.maidenhead-advertiser.co.uk/News/Areas/Maidenhead/Warning-after-boy-9-picks-up-used-needle-at-park-28082013.htm

And in an unrelated incident, an unfortunate 9-year-old boy pricked his finger on discarded needle at Castle Hill, Huddersfield.

The lad was playing with his little brother and cousins near Jubilee Tower in Huddersfield. As he was picking up stones from beneath a tree he was jabbed by the needle, causing his thumb to bleed.

Thinking he would get into trouble, the boy at first said he’d cut his thumb on a tree branch but then admitted what had happened. The family had the forethought to collect the needle and took him to Huddersfield Royal Infirmary.

He had a blood test to check for infections but must wait three months for the results. The hospital started him on a course of injections for hepatitis B as a precaution.

“He had the first hepatitis injection at the hospital, which was pretty unpleasant, and he has to have another in a couple of weeks and then a third in three months.”

So, the poor lad has 3 painful injections, and still bears the risk of Hepatitis C infection or HIV, and will no doubt pick up on the inevitable distress of his parents and relatives who will face many months of anguish and who will, no doubt, watch him like a hawk for years to come.

http://www.examiner.co.uk/news/west-yorkshire-news/nine-year-old-huddersfield-boy-pricked-finger-5793367

Good luck to them all.

Last updated: Thursday, August 29, 2013

Plotting the distribution of needle finds

We have reported many needle find incidents recently, and that is barely the tip of a very big iceberg. So, as data accumulates concerning reported needle finds, can anything be achieved by collating those data?

Another report of a needle find, this time of a Toronto lady who had the misfortune to step on a discarded syringe, the needle of which pierced deep into her heel reveals just what can be done.

So, when the local paper submitted a Freedom of Information request to the city authority, 18 months of data on discarded syringe-related reports to the city’s 311 service line was obtained.

The data revealed 137 requests were submitted to the city’s 311 help centre between January 2012 and June 6, 2013, resulting in the recovery of 571 discarded needles from Toronto parks, sidewalks and alleys. The number may actually be higher, since the Star lowballed the total due to vague estimations within many of the 311 requests.

The consolidated information shows the number of needles reported in Ward 6 — which encapsulates Mimico — increased from one last year to five so far this year — not including the one Monk stepped on. Also, out of 44 wards, this outlying Etobicoke-Lakeshore ward ranks seventh for the most needle-related 311 reports.

The data can be found here.

It’s a great resource, to consider the simple practicalities of litter management and in particular of hot-spot management, to consider placement of secure sharps bins, to focus needle exchange services and other support to IV drug users, an to identify those highest risk areas that require regular patrols. Police might cross-reference the data with crime reports, to improve patrol and surveillance activities.

This is a great resource. Though similar data must be available to all UK local authorities never have I found anything like this. A missed opportunity, though with many local authorities expecting those who report needle finds to go back and pick it up themselves, I have doubts if data could be collated in any useful way at all.

Last updated: Saturday, August 17, 2013

Bizarre needle finds

Is there no end to the places people find a discarded hypodermic needle, some discarded quite casually, others hidden in an attempt to hide the evidence, and some placed far more maliciously, intended to harm others?

We have described many of these on the Clinical Waste Discussion Forum. Here is yet another.

A mother purchased a pair of shoes for her child, but when he put them on she discovered that there was a needle inside, fashioned so it would poke the young victim.

She discovered a small hypodermic needle glued inside the red croc-style shoes she purchased for her seven-year-old son at Walmart.

http://www.terracestandard.com/news/219128691.html

Last updated: Wednesday, August 14, 2013

Sanctions and penalties for unsafe sharps disposal

There have been mutterings recently from the Scottish Parliament of sanctions to be held against healthcare professionals – doctors were singled out but this presumably embraces all – who fail on hand washing.

That would help, though how it might be managed is really beyond comprehension for all but the most serious breaches in hygiene precautions. However, stamping those out of the system would have a great impact and may reduce still further the rate of infection among hospital patients.

But what about more serious failings? Do not some of those pass unnoticed and with neither sanction of penalty? What about carelessly leaving a needle in among the patients bed linen, to strike a nurse or care assistant, a porter or laundry worker? What about the over-filled sharps box with needles and syringes protruding, or the bin left unsealed but tossed into a waste cart to spill some of its content?

There are still sharps bins left in inappropriate areas. On the floor of a clinic room is most obvious, in a location where a child may be attracted to put their hand inside, and every 2 or 3 months we report on the Clinical Waste Discussion Forum of such an incident. And of course those needles and other sharps discarded into soft walled sacks intended only for soft clinical wastes or worse into black bags.

And more generally, source segregation of wastes is still a persistent problem. It could be better (though it might be rationalised somewhat first) and yet those who fail to comply are not the ones who might be affected by any financial or other penalty. It simply passes unnoticed and, as a penalty, its value is negligible if non-existent.

Of course, penalties may apply as waste contractors may impose an additional fee but that is unseen by those responsible. In extremis, the Environment Agency or HSE may become involved, but once more their negotiations will centre on discussion with site waste managers and not have any impact on those responsible. Though such visits may prompt some additional training and a few extra posters, not much will change.

It’s a pity, since sanctions and penalties are among the most effective means of effecting change, in source segregation and safe management of sharps. However, like penalties and sanctions of breaches in hand hygiene there seems no likely remedy here, as much as we may like one.

Unless, of course, you know differently?

Last updated: Sunday, August 11, 2013

Positive results from needle exchange programme

Needle exchange schemes are controversial.

Why should we give needles to addicts? Why spend tax payers money to allow these people to inject themselves? Why in my back yard? Why help at all?

These are typical and predictable sentiments but betray a false economy. Needle exchange, though actually difficult to study in depth, is of proven benefit in disease reduction, reducing or eliminating needle sharing and thus disease transmission, and taking many needles off the streets to reduce also the change of accidental sharps injury to an innocent member of the public, a street sweeper or waste handler.

A recent report from Santa Cruz County, US, records distribution of not less that 50,000 clean syringes and needles in the first 3 months of its operation! That vast amount might, in the first instances, suggest that much of America is drug ravaged and high as a kite.

However, they took in slightly more needles than they gave out, and county officials say they are starting to gain the trust of the local intravenous drug user community as they work to halt the spread of communicable diseases such as hepatitis C and AIDS and keep infection rates on the decline.

Fantastic, and congratulations to all involved.

Some caution is needed, since in US collection arrangements for diabetic needles is generally poor and some of the excess may have been unrelated to IV drug users. But nonetheless, the scheme is of value. 55,000 or more needles not being shared. 55,000 fewer disease transmission opportunities; 55,000 fewer needles dropped into Coke Cola cans, and in all probability 55,000 fewer items of discarded drug litter to contaminate the community and invoke feelings of fear and revulsion, as well as costing vast sums of money to retrieve, since no other disposal route would be available.

Though needle exchange schemes remain controversial, this is a win-win situation and nobody should object, even if its located in their own back yard!

Last updated: Saturday, August 10, 2013

Updated guidelines for HIV post-exposure prophylaxis after occupational exposure

The US Public Health Service Working Group has published updated guidelines for HIV post-exposure prophylaxis after occupational exposures.

This should guide the approach to management of sharps injuries and other non-sharps exposures such as splash of blood to the mouth or eyes, and exposures involving contamination of existing open skin lesions such as recent cuts and grazes, eczematous lesions and the like.

Kuhar DT et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infection Control and Hospital Epidemiology 2013; 34, 9: 875-92.

HIV PEP 1

Much of the paper considers the benefits and disadvantages of one antiretroviral drug or drug combination over another, and the importance of rapid timing and reduction of any delay between injury or exposure and the initiation of post-exposure prophylaxis.

The paper does not differentiate between sharps injury exposure and exposure by contamination with blood or bloodstained body fluids of broken skin or mucous membranes (mouth and eyes), though in all sectors outside healthcare these additional exposure routes are overlooked or dismissed entirely. However, the Clinical Waste Discussion Forum has, for many years, stressed the importance of precautions to prevent exposure by these additional routes, and the procedures to follow if they should occur.

Box 1 from the paper is reproduced here. It contains several thought provoking entries. Most important to us, in the list of situations for which expert consultation for Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (PEP), is the recommended that where injury or exposure has occurred from an unknown source (eg, needle in sharps disposal container or laundry) patients must be referred to a specialist for careful and thorough review on a case-by-case basis.

That should send ripples of alarm through the waste sector, since each and every exposure that occurs to a waste handlers or ancillary worker will fall into that category. No more should exposures be dismissed as trivial, by workers in this sector, or by an A&E nurse who might sarcastically fob off a worker for such a trivial injury that can barely be seen. The mid-way option, to make an appointment with a GP is similarly unacceptable since it incurs often considerable delay and takes the victim no nearer a specialist.

Make a fuss. Be bold and stroppy if necessary, but do not accept anything but immediate review AND urgent referral to a specialist. Of course, that might be difficult, initially since in A&E there may be life threatening cases requiring immediate attention. but an urgent assessment is essential, even if the wound is so small it can now barely be seen. Onward referral to a specialist is essential, and it may be necessary to remind a busy junior A&E doctor that referral is not only desirable but essential., and that it must be an urgent referral since delay can be serious.

There can be no remaining doubt that in the waste and related sectors sharps injury remains common and will fall into an inevitably high-risk category. The risk is yet higher for those managing drug litter or otherwise struck with a discarded needle since the likelihood is that it has been used by an IV drug user. We are aware that the in this group the rate of Hepatitis C and HIV are high, and increasing. No longer should the injury be dismissed as trivial and low risk ‘since the needle is old and any virus will be dead’.

How old?

How do you know?

Which virus?

How much, and how fresh?

Do you want to find out the hard way?

Stop what you are doing. Take immediate steps to gently clean the wound – do no squeeze, but encourage it to bleed – or rinse mouth and eyes. Seek immediate medical help in a nearby A&E, and after assessment demand urgent specialist referral. Nothing else will do.

Last updated: Saturday, August 10, 2013

Safety sharps, or not?

It should be a no-brainer. Everyone uses a safety-engineered safety sharps device and the era of sharps injury will be at an end. Or perhaps not?

There are many sources for sharps, ready and able to inflict a wound and perhaps transmit infection including those discarded by people who inject drugs. They will, inevitably, be at the end to the queue when funding for safety sharps is being considered, which is perhaps rather bizarre since the highest risk receives the lowest priority.

Of course, even with safety sharps there is a risk of injury and infection during use, and during disposal of those devices which are not fully automatic and which rely on some user action to engage the safety feature.

Choosing a product is a complex matter that must be fully risk assessed. Does it offer protection to the user and to others? Does it perform as well as or better that the conventional product that it will replace? Is the look and feel acceptable to users? Does it cost more, or need any different storage facility or dispensers?

The key question is, do it protect?

This is generally considered a foregone conclusion. Based on design attributes manufacturers will claim a great degree of protection to users though evidence if generally lacking. The manufacturer alone cannot provide that data though they might, but probably won’t, support its collection.

Regrettably, when that data is lacking many healthcare professionals carry on regardless happy to believe that a safety-engineered device is safe without any objective evidence to support that opinion. Now, a Canadian group has investigated the use of safety scalpels in the operating theatre.

They conclude that there is insufficient evidence to support regulated use of safety scalpels. Instead, or more reasonably, in addition, injury-reduction strategies should emphasize proven methods including double gloving, blunt suture needles and use of hands-free sharps transfer.

As with most things, training and technique are of great importance. Safety sharps are only one part of a complex issue. There is no need to believe the claims made by safer sharps manufacturers, and great care must be taken to ensure users do not relax in their approach to sharps safety.

DeGirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED. Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: What is the evidence? Can J Surg 2013; 56(4):263-9

Last updated: Wednesday, July 31, 2013

Anxious wait for council cleaner

A Sunderland council cleaner faces an anxious wait after a sharps injury incurred while cleaning public toilets in the town centre.

The use of effective PPE items is essential, but this must take second place to awareness and sharp observation to spot discarded needles, then to remove them for safe disposal using litter pickers of equivalent. Regrettably, this cleaner had worn only a pair of Marigold gloves which would clearly have been inadequate for the task.

People who inject drugs (PWIDs), the new name of intravenous drug users (IDUs), often use public toilets to inject, and then will go to great lengths to cover their tracks by hiding needles in corners, in cisterns, and in other locations away from sight. On occasions, it seems that PWIDs will deliberately create a booby trap for others, placing needles in locations intended to do harm to the unwary. This creates a particular hazard for cleaners and others, who may come across exposed needles and/or be tasked with their removal.

City centre toilets are likely hotspots and construction (refurbishment) and maintenance should eliminate any hiding places or recesses to prevent needles lying unseen. Blue lighting will discourage PWIDs, while if the problem persists placement of one or more secure sharps boxes will be advantageous.

There is an uncomfortable future for this particular cleaner, who faces an anxious 3-6 month wait for serological tests and perhaps far longer period of post-traumatic anxiety disorder even if seroconversion does not occur.

We can only wish him well for the future.

Last updated: Tuesday, July 30, 2013

Needle woes

Needle with drop of blood A mixed bag of needle woes this weekend, which are no doubt just the tip of the iceberg!

So, and just to make the point, we must start with the results of a thoughtful and rigorous Australian study of Hepatitis C virus infection among IV drug users provided with clean needles through a needle exchange scheme demonstrated a significant reduction in hepatitis C incidence among those who attended needle and syringe programs.

Iversen J et al. Reduction in HCV Incidence Among Injection Drug Users Attending Needle and Syringe Programs in Australia: A Linkage Study. Am J Pub Health 2013; 103/8: 1436-44 doi: 10.2105/AJPH.2012.301206

This tells that, as we would predict, that clean needles prevent disease. But more than that, it is an effective measure to capture used needles and syringes that are exchanged for new, thus reducing overall the scourge of discarded needles and associated disease transmission. Continue reading “Needle woes” »

Last updated: Friday, July 19, 2013

Jump in sharps injury rate in Ireland

“Last year saw the highest number of needlestick or sharps injuries among hospital doctors in at least five years, internal HSE Ireland figures show.

“In 2009, the HSE recorded 102 incidents where consultants and junior doctors were wounded with needles or syringes, representing the highest number of injuries since at least 2004.

“Figures released to the Medical Independent under the Freedom of Information Act show that more than 400 consultants and NCHDs have suffered needlestick injuries over the last five years.

“The data shows that the number of incidents has been increasing steadily year-on-year and has almost doubled since 2006, when 57 such incidents were reported.

“The highest single number of incidents last year occurred in University Hospital Galway, where 23 NCHDs and one consultant were injured with needles or syringes. The hospital recorded the highest proportion of injuries in all HSE hospitals since the beginning of 2007, with 68 incidents involving 66 NCHDs and two consultants. Thirty-five NCHDs and one consultant reported needlestick incidents in 2009 across the HSE South hospitals in Cork, Mallow and Bantry. Continue reading “Jump in sharps injury rate in Ireland” »

Last updated: Wednesday, July 17, 2013

Headteacher ‘not told’ about addict’s needle exchange next to primary school

Needle with drop of blood A Surbiton primary school head teacher was ‘not told’ about an addict’s needle exchange service set up next to his school. He complained that he was not “kept in the loop” about the needle exchange for drug addicts which was put next door to his new primary school.

At the same time, local councillors faced an onslaught of angry parents and teachers, who claimed the drug rehabilitation service at Surbiton Health Centre was deliberately kept secret.

Why should that be a problem? It’s understandable that parents and teachers are concerned, but walking past an IV drug user as thy walk down the street is not a problem, and if that upsets the sensibilities then so what? The risks of discarded needles is perhaps lessened rather than increased since the service will insist on recovering used needles before issuing new gear, thus reducing the risks of discarded used needles.

But schools seem to be particular targets for discarded drug litter. It is unknown why this should be. Few Local Authorities are willing to do much about it and reject requests for assistance in clearing this, insisting that each school should or will have the training and equipment necessary for the safe retrieval of discarded sharps. Whether that is true or not I don’t now, but I doubt it.

And of course, perhaps it’s just too much for Surbiton

Last updated: Monday, July 15, 2013

Needlestick campaign?

Awareness of sharps injury has never been greater, and much is written about every aspect of sharps injury, its prevention and management. We at the Clinical Waste Discussion Forum make our contribution as best we are able, and within the HonCode rules framework that requires all of the information which we present to be authoritative:

Authoritative
Complementarity
Privacy
Attribution
Justifiability
Transparency
Financial disclosure
Advertising policy , clearly distinguishing advertising from editorial content

In this context, it was thus disappointing to see a new website, the Needlestick Campaign.

As far as I can tell, there is no company name provided; no address. There is a UK telephone number.

It’s another personal injury claims company. Nothing wrong with that, but in an attempt to get to the top of the search system listings they have chosen to present themselves as The Needlestick Campaign. That is their business.

Our own concerns focus in particular in their web page, linked boldly directly from the home page, to a Needlestick Injury Protocol. One would expect that a needlestick protocol would give details of cleansing a wound; some important first aid do’s and don’ts. An evaluation of the source patient, if known; the type of needle or blade; the location, was it likely to be a freshly used needle of something excavated from a mound of rubbish that had been there for months or longer. How deep was the wound. Blood for baseline serology. Counselling for HIV and other antibody testing, if indicated; administration of Hepatitis B immune globulin and possibly HIV prophylaxis using a combination of antiretroviral drugs in high dose.

It is with great regret that those who might find themselves directed to The Needlestick Campaign will find a Needlestick Injury Protocol that lists, in order, a brief but incomplete summary of [some of] those at risk and approaches to prevention, and an exhalation to make a claim for compensation. What to do, How to claim, and a little about Time limits follow, detracting and diverting from the purpose of any solid needlestick campaign.

Misrepresentation? Well, probably not, and as a claims company it is not unreasonable that they need to compete to be found by potential claimants. But thank goodness not everybody presents their sales pitch in quite this way. It’s misleading, possibly not sufficiently so to attract the attention of the ASA who require advertisements to be legal, decent, honest and truthful by applying the Advertising Codes.

But it’s sure as hell misleading for anyone wanting to join one of the various needlestick or sharps injury campaigns, in the UK or elsewhere, or seeking guidance concerning a needlestick injury protocol.

Last updated: Tuesday, July 9, 2013

US: Clinical waste containers fall from truck

In the early hours of Thursday morning, State and local Henrico County Police were called to a scene on Interstate 64 eastbound near the 195 mile marker in Henrico County. Virginia.

They found two boxes of regulated clinical (medical) waste along the left side of the roadway. The two boxes fell out of a 2012 Chevrolet Box Truck after the driver failed to properly secure the rear doors.

According to the driver, these were the only two boxes that fell out of the truck. The driver did retrieve the two boxes.

The driver has been charged with failure to properly secure the vehicles load.

It’s a long time since I have witnessed clinical wastes falling from a vehicle but there have been incidents. Most common have been fluids seeing from wastes trickling from beneath and behind the tail lift of a large truck stacked to the roof with loose waste sacks, the lower layers of which must have been under such compression that seepage should have been predicted, and prevented.

Less often but perhaps more serious was the lackadaisical approach of Local Authority staff collecting clinical and sanitary/offensive wastes from householders. Throwing these waste sacks from the pavement, across parked cars and into the rear of a box van parted several yards away with its tail lift up but roller door wide open to create a tempting and perhaps easy target. But not always was the target reached, and some waste sacks hit the hard edges of the vehicle and fell to the road. One other sack missed the truck entirely and hit a car parked on the other side of the road.

The waste sector is required to operate purpose-designed trucks to carry clinical wastes. The fittings and construction of the waste compartment is well-described and need not be rehearsed here. Most operators comply. However, Local Authorities perform generally less well but seem to avoid the attentions of HSE and EA inspection. Vehicles used for domiciliary clinical waste collections may be drawn from a fleet of general waste and environmental services department vehicles but rarely if ever meet the standards described in HTM 07:01.

Open cage backs are not uncommon and it was from one of these, piled high with bright yellow clinical waste sacks projecting far above the sides of the cage that I was able to see tow waste sacks falling as the vehicle rounded Hammersmith Broadway in West London at some speed. To make matters worse, the driver slowed and some 100 yards further on, in the centre of the carriage way to the annoyance of other drivers, leant out of the cab door and looked back, then drove off.

Sometimes, it just can’t get worse can it?

and Vehicle accidents

Last updated: Friday, July 5, 2013

Blenkharn Environmental Led by Science Driven by Research

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Blenkharn
Environmental

Led by Science
Driven by Research