The Clinical Waste Discussion Forum has previously considered the risks to ancillary workers and waste handlers of sharps carelessly discarded in clinical waste sacks or laundry, or spilled from inadequately sealed sharps bins. Safety sharps were expected to reduce, perhaps to eliminate, sharps injuries but the reality is somewhat different.

Sharps injuries to users are much reduced since the introduction, in the US, of safety shards but in the UK and Europe we still have a considerable wait until these enter routine use and even then it is likely that coverage will be substantially less that 100%.

What goes wrong?

In a thoughtful comment posted by Barbara DeBaun on the Occupational Health & Safety blog the importance of active (having positively to activate a safety feature) or passive (automatic) safety needles are discussed. Also considered as reasons for failure are the attitudes of the user and reluctance to change, training issues and perception (that a safety device may be more troublesome or time-consuming in use, or may hurt a patient). None seem to be good excuses to bypass safety, but these are nonetheless real reasons and explain the failure of some safety sharps to reduce completely the incidence of sharps injury.

To this, we can add a further act of complacent, that with the introduction of safety sharps some users will take less care in disposal that they ill [hopefully] do at present. Where this includes also the actions of sharps users who fail to activate a safety device then, assuming that the device is inherently safety, toss it into a thin-walled waste sack intended only for soft wastes the risk to ancillary staff and waste handlers is considerable, perhaps even increased when compared to the present rate of sharps injury.

Sadly, the intense study of sharps injury and the value of sharps safety devices has inevitably focused on sharps users. Extending those studies to ancillary staff and waste handlers takes investigators outside the relatively manageable confines of the hospital or clinic, to consider also the welfare of contract ancillary workers and those waste handlers who may visit infrequently to collect wastes and work at some distant site. Quite simply, they appear invisible and are generally excluded from further consideration.

 While it is reasonable to deduce that some users of safety sharps will still suffer a sharps injury, perhaps due to a failure to use the devices properly then also there will be a percentage of used sharps still entering the disposal chain without adequate protection.

For the waste handler, the introduction of safety sharps may be a false dawn.