Sharps disposal containers
Joanna Ford, SMTL
Originally published October 2008, updated June 2014
Disposal-related sharps injuries are commonplace. They are of particular concern because they expose the injured person to the risk of infection from blood borne viruses if the sharp is contaminated. The Health and Safety (Sharps Injuries in Health Care) regulations came into force in the UK in May 2013 following an EU Directive (2010/32EU). The regulations stipulate the legal obligations of health care employers with regards to sharp safety in the work place.
Most disposal-related injuries are caused by user error. In a Welsh prevalence study SMTL conducted in 2004 involving 6 Trusts, 24% of all sharps injuries were disposal related (unpublished) and other studies show similar trends (May and Churchill 2001, Weltman et al., 1995). Situations where injuries occur include disposing of sharps in an incorrect container (such as a bin bag), pushing a sharp into an overfilled sharps container, misplacing a contaminated sharp amongst other devices during a procedure or leaving a used sharp within drapes or bed linen (Moss et al., 1994).
An additional concern for these type of injuries are that in some cases, the source patient is unknown, which can lead to additional stress, and the dilemma of whether post exposure prophylaxis (PEP) should be initiated.
A range of traditional sharps disposal containers are available, but a new generation of sharp disposal devices are now also on the market.
The table below lists the main companies who manufacture sharp disposal containers (also known as "Sharps Bins") available in the UK. Disposal containers come in different sizes depending on the settings and purposes they are designed for. The most common disposal containers have yellow lids (for sharps containing medicines), orange (sharps not containing medicines) and purple (sharps containing cytostatic and/or cytotoxic medicines).
Daniels Sharpsguard is available with yellow, orange and purple lids, ranging from 0.5 to 22L in size.
Daniels Sharpsmart Ltd.
|Sharpsmart (Reusable system)||Daniels Sharpsmart is available with yellow lids, ranging from 6.5 to 23.5 L in size.|
|Frontier Medicinal Products||Sharpsafe||Sharpsafe is available with yellow, orange and purple lids, ranging from 0.2 to 30L in size.|
Terusafe is available with yellow lids, ranging from 0.25L to 6L in size.
Sharpak is available with yellow, orange and purple lids, ranging from 0.5L to 22L in size.
Considerations when purchasing a sharps container
The section below lists some criteria which should be considered when a sharps disposal system is being chosen for a particular purpose and setting (ECRI 2003, Health Devices 1993).
- Usable volume - the size of the unit chosen depends on the size and volume of disposable sharps items used. (Please note: Safety engineered sharps devices are often larger than their conventional counterparts and this must be taken into consideration when purchasing disposal containers.)
- Assembly - some units are easier to assemble than others.
- Overfill warning - some have a 'fill line' or a 'lockout' mechanism to prevent overfilling.
- Inlet and closing mechanism - these include a simple hole or 'mailbox' slot. In addition, some possess a 'counter balanced door inlet' where the door rotates to drop a device.
- Free-standing capability - some units can be mounted on brackets, it is important that the unit is positioned where it will not topple.
- Handling - all containers should possess a handle. The best type of handle allows the unit to be picked up and carried without the health care worker touching the main body of the container and risking injury.
- Type of sharps waste - there are differently labelled/colour-coded containers available for different types of sharps waste ( HTM 07-01 'The safe Management of Healthcare waste' 2013)
In addition to traditional disposal containers, there is now a generation of disposal devices and kits which are currently on the UK market, as shown in the following table:
|Supplier||Type of product||Name of product||Comments|
Balcan Hypodermic needle Destructor
Cuts needle from syringe and into pieces
|York Medicinal Technologies||Needle destroyer||DAC 3000||Electronic needle destroyer|
|Cory Bros (now Purple Surgical)||Blade remover||Safety station||Scalpel shield and blade remover in lockable sharp resistant case|
|Cory Bros (now Purple Surgical)||Sharps pad||Purple Turtle||Sharps pad with case for disposal of needle and blades|
|Barber Medical||Blade remover||Qlicksmart||Wall mounted single-handed blade remover|
Published data on disposal-related injuries
Published data suggests that over half of disposal-related injuries are due to 'inappropriate disposal' rather than a problem with the sharps container itself (EPInet 2001, 2007). The accessibility of containers appears to be a crucial factor in reducing injury rates (Weltman et al., 1995). On other occasions a combination of container design and inappropriate use may cause injuries such as forcing too many needles through a large 'straight drop' apeture of a container (Hatcher 2002) which is more difficult to achieve with a counter-balance lid. This highlights the necessity of training and increased awareness as well as intelligent device design in the fight against sharps injuries.
The manufacturer of the re-usable Sharpsmart disposal containers carried out an evaluation study in 8 hospitals (Grimmond et al., 2003). The Sharpsmart system has a number of safety features such as overfill prevention, hand entry prevention, high puncture resistance and it is pre-assembled when it arrives on the wards. The company reported an 87% decrease in container-related sharps injuries (CRSI), 25% decrease in non-related CRSI and a 32% decrease of SI overall following the introduction of the Sharpsmart. The same author carried out a similar study more recently, trialling the Sharpsmart container in 14 hospitals over the period of a year, comparing NSI results with another 14 hospitals who did not introduce the new sharps container (Grimmond et al., 2010). NSI comparison data from study and 'control' hospitals was taken from the year before the introduction. Again, container associated injuries significantly reduced in the study group following the introduction of the new container but not in the 'control' group. However, the designs of both studies is potentially flawed as it is not possible to determine how much of the NSI reduction is directly attributed to the introduction of the device. For example, it is likely that the training and increased sharps awareness which accompanied the introduction of the container also had an impact on staff behaviour. The study does not indicate whether the staff at 'control' hospitals were aware of the study, therefore it is not possible to know what the NSI reduction rate would have been if those control staff had undergone sharps awareness training but continued with their old devices. In the second study, there was a decrease in NSI rates between use and disposal within the study group (which may be associated with increased awareness and training), but an overall increase in injuries during use (which may be due to increased reporting - again possibly associated with the increased awareness after training). Just being part of a study is known to improve subject performance (Hawthorne effect). Similar studies but with more rigorous controls would help understand the real benefits of the 'safety engineered' disposal container.
In conclusion, there are now a number of sharps disposal containers available with specially engineered features that may help to reduce needle stick injuries in the workplace. However, the importance of ongoing training and awareness of the issues associated with sharps and their disposal must be emphasised if improved long term outcomes are to be achieved.
ECRI. Sharps Disposal Containers. 2003. Health Devices: 32 (7); 253-58
EPINet 2001. International Healthcare Worker Safety Center, University of Virginia. U.S. EPINet Sharps Injury and Blood and Body Fluid Exposure Surveillance Research Group. Sharps Injury Data Report for 2001; 58 hospitals contributing data, 1929 total injuries. Report available at http://www.healthsystem.virginia.edu/pub/epinet/rates.html
EPINet 2007 International Healthcare Worker Safety Center, University of Virginia. U.S. EPINet Sharps Injury and Blood and Body Fluid Exposure Surveillance Research Group. Sharps Injury Data Report for 2007; 29 hospitals contributing data, 951 total injuries. Report available at http://www.healthsystem.virginia.edu/pub/epinet/rates.html
Grimmond T, Rings T, Taylor C, Creech R, Kampen R, Kable W, Mead P, Mackie P, Pandur R. Sharps injury reduction using Sharpsmart - a reusable sharps management system. 2003. Journal of Hospital Infection:54;232-8
Grimmond T, Bylund S, Anglea C, Beeke L, Callahan A, Christiansen E, Flewelling K, McIntosh K, Richter K and Vitale M. Sharps injury reduction using a sharps container with enhanced engineering: A 28 hospital non-randomised intervention and cohort study. 2010 American Journal of Infection Control:38;799-805
Hatcher I B. Reducing sharps injuries among health care workers: A sharps container quality project. 2002. The Joint Commission:28(7);410-14
Health Devices. Technical Overview. Sharps Disposal Containers. 1993. Health Devices:22(8-9);362-412
May D and Churchill P. Sharps injury surveillance: a pilot study. 2001. Aids & Hepatitis Digest. May(83):4-7
Moss S, Clark R, Guss D, and Rosen P. The management of sharps in the emergency department: is it safe? 1994. The Journal of Emergency Medicine:12(6);745-52.
Weltman A, Short L, Mendelson M, Liienfeld D and Rodriguez M. Disposal-related sharps injuries at a New York City teaching hospital. 1995. Infection Control and Hospital Epidemiology:16(5);286-274