US and other legislation mandates introduction of engineered safety sharp devices within a year and already there has been wide uptake. Similar European legislation applies through Council Directive 2010/32/EU but implementation, due by may 2013, is moving at a predictably slow pace.

Some Trusts are trialing safety sharp devices, while others have made them available for high risk use only; at the present time, still fewer have made safety sharp devices universally available. Almost everywhere, cost has been the primary barrier to introduction, with some degree of obfuscation though the need for trials to assess the most suitable product from the diverse range of safety sharps now available on the market.

But the question is, will safety sharps eliminate disposal-related sharps injury? Automatic devices that need no user intervention are presumably safety since it is unlikely that these will be discarded without activation. However, safety needles that require positive user action may perhaps be discarded without activation.

A paper by Stringer and Haines (Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada. Journal of Occupational and Environmental Hygiene 2011; 8: 154–160) reports the state of discarded sharps after formal introduction of sharps safety legislation.

In the 149 audited sharps containers, 55% of all syringes found were conventional compared with 45% that were safety syringes. In the three hospitals studied, the percentages of conventional (non-safety) vs. safety syringes found in used sharps containers were as follows, respectively: (i) 72% conventional and 28% safety, (ii) 55% conventional and 45% safety, and (iii) 65% conventional and 35% safety. In addition, it was found that 77% of 2131 Terumo butterflies, 97% of 1117 Insyte Autoguard IV catheters, and 87% of 4897 VanishPoint syringes in the containers had been activated.

Clearly, something prevents users activating safety sharps devices and many of these are discarded with the point still exposed. This creates a sharps hazard for waste handlers.

It is reasonable to expect that those who will exercise insufficient care and discard used sharps into thin-walled waste sacks intended only for soft wastes will make no effort to activate the safety safety system beforehand. neither will those who allow used sharps to find their way into soiled laundry, another common error associated with sharps injury among laundry staff.

The widespread implementation of sharps safety devices in the UK has hardly begun. Many Trusts are dragging their heels on the basis of cost alone. Even when implementation becomes more widespread, waste handlers should not expect any reduction in sharps injury risk.