Nobody wants to fund collections of clinical waste from the community. Though some companies make a business out of ‘smalls’ it operates generally on small margins and yet is costly to the PCTs, and now their new era replacements, and to Local Authorities.
Some GP surgeries will receive properly packaged sharps, though often failing to provide on prescription those sharps bins that diabetics will should use. Likewise, some high street pharmacists will accept used needles, as do some hospitals as part of their commitment to outpatient support from diabetic clinics and the like.
It the latter case, patients may take their boxed needles at the next outpatient visit, or drop them off at reception. This creates its own problems since the receptionist will not be able to issue by prescription a new sharps bin, creating problems of continuity. In every case, the diversity of options makes administration and funding something of a nightmare.
The US is far behind, since until recently used sharps have entered the trash in the absence of any better and more organised route for safe disposal. But that is changing. For most, the solution has been to prohibit disposal of sharps in household garbage, and to provide sharps safes in accessible locations, at the Police of fire station, at a local supermarket – in the Mall – or at the local County building.
Their are economies of scale. Most self-injecting patients, whether diabetic or others, and almost all IV drug users are sufficiently ambulant that there is no barrier to a visit to the local sharps disposal point. With a network of conveniently located and accessible disposal points, there are logistics advantages as well as savings in administration for funding arrangements. This might also capture some of those ‘private enterprise’ needles from IV drug users and those injecting bodybuilding steroids and tanning supplements that is now on the increase.
The advantages are many and obvious. Perhaps all that stands in the way of this improvement is predictable administrative inertia and public perception issues that can stimulate objections to needle safes placed in locations across the community.
But it seems a good idea, and far better than the present mish-mash arrangements that are many and varied, and subject to frequent change as if deliberately to confuse the service users.
Litter officers are investigating how bottles of prescription medicines, unused syringes and packets of past-use-by-date pills have ended up in the North Island New Zealand Hutt River.
Not for sharps users, the clinicians, nurses and scientists who might wield a syringe and needle to draw blood or administer an injection, but for those working as ancillary and support staff, and waste handlers, who might be exposed to used sharps as they pass along the disposal chain.
Sharps incidents and sharps injuries to waste handlers have reduced only where mechanisation and bulk handling of carts, as opposed to manual handling of individual clinical waste bags and sharps bins, reduces opportunity for direct contact. Even where this has been possible, waste containers are still managed by hand as they are removed from wards and clinics, generally by cleaners and other ancillary workers who might have access to latex gloves or a pair of Marigolds but who will never have the benefit of sharps-safe gloves.
