Making a Sharp Example

Lisa J .Prescott, MT(ASCP)22nd Maine Geriatrics Conference 2012

Bar Harbor, Me

Community medical sharps What devices are considered medical

sharps Who uses these medical devices The problem Special concerns with older individuals What can be done in Maine The Aroostook County Solution Questions

Overview

Sharps include items that are capable of puncturing the skin such as syringes, needles, lancets, or similar sharp objects.

What are medical “Sharps”?

Diabetics are the largest group using lancets, needles, and syringes

About 1/3 of use is illicit drug use2/3 of use is medical

Who Uses Medical Sharps?

It is estimated that 1 in every 12 households uses some type of medical sharp

In Maine alone, individuals complete 12 million injections by sharps every year.

In Aroostook County, more than 6,000 people use sharps on a routine basis.

Other medical use in the home : Arthritis Osteoporosis multiple sclerosis HIV/AIDS hepatitis C migraines Cancer

Who Uses Medical Sharps?

Psoriasis Infertility Allergies Anemia self administration of blood thinners growth hormone injections Pet/livestock owners

Who Uses Medical Sharps?

 “13.5 million people in the United States are discarding 7.8 billion used needles outside the traditional healthcare setting. ” (This number doesn’t reflect veterinary useage)

October 13, 2011- Jenny Schumann, Coalition for Safe Community Needle Disposal

What are the Statistics?

4 percent of users put used needles in a puncture-resistant container

3 percent flush them down the toilet 93 percent throw them in the trash.

Tom Erickson, CEO of Ulti-Med, Inc. (McConville & Hamilton, 2002).

What is the Problem?

If they do get put into a container, containers are thrown into the regular waste stream and often break open or apart on their way to their final destination in a landfill.

“a tripling of the number of used needles tossed into household garbage during last 10 years”

Coalition for Safe Community Needle Disposal

Going back to the user statistics

Sharps in the environment (waterways, beaches, etc)

Needle stick Injuries with used sharps in homes, in public areas… places where one wouldn’t suspect such hazards to exist.

Each year some 600,000 to 800,000 sharps related injuries occur in the U.S.

Because of Improper Disposal

The Problem (cont) Many needle sticks go unnoticed in the

public or are unreported Children are especially vulnerable Everyone is at risk of a needle stick injury

because of the extent of the problem. People at higher risk are those whose occupation puts them in more frequent contact with used sharps such as waste haulers .

What are the Real Dangers of a needle stick injury?Blood Bourne infections: HIV /AIDS) HBV- Hepatitis B Virus HCV- Hepatitis C Virus Tetanus

The Risk Hepatitis B – no risk if person has been immunized; 6-30% risk if not

Hepatitis C – no vaccine; 1.8% HIV- 0.3% or 1 in 300 chance if exposed-no vaccine – some anti-retroviral drugs may reduce transmission but these drugs have serious side effects.

Infection With HCVThe most common blood borne illness, the

leading cause of chronic liver disease, and the primary reason for liver transplant in the U.S.

Acute Hepatitis Chronic Disease – Cirrhosis- Many of the

3.2million people living with this infection are unaware.

Liver Cancer Death

Scary to get a needle stickHealth care workers are used to the risk- use universal precautions

People in the public are unaware of risks and unfamiliar with the followup. This causes a lot of anxiety.

Followup : Vaccines for tetanus/hep B Blood work to check for immunity; exposure to HCV, HIV, Hep B, and liver enzymes

Blood work again (1-2 mo for Hep B vaccine)

And 4-6 months more blood work to check for signs of HCV infection; liver enzymes again.

Life is good and we know the statistics but we really don’t deal

with this stuff…Or do we?

We live in Maine….and we’re dealing with an older

population

Hepatitis B, acute Case Total 13Maine Rate 1.0 per 100,000U.S.rate (2009) 1.1 per 100,000

Maine Center for Disease Control and Prevention 2010

Maine Statistics

The incidence of acute hepatitis B is nearly 2x as high among adults with diabetes as in those without

Reported by Internal Medicine News 3/3/11

Hepatitis B, chronic2010 Case Total 101Maine Rate 7.7 per 100,000U.S.rate (2009) Not available

Maine Center for Disease Control and Prevention 2010

Maine Statistics

Hepatitis C

2010 Case Total 1142Maine Rate 87.0 per 100,000U.S. rate (2009) N/A

Maine Center for Disease Control and Prevention 2010

Maine Statistics

Most acquired the disease earlier in life

“The burden of chronic HCV infection in elderly persons is expected to increase significantly in the US during the next two decades”

“Chronic infection may be more severe in the elderly”

Journal of Clinical Infectious Disease(2005)

Chronic Hepatitis C Virus Infection in Older Adults

Are often overwhelmed by their medical diagnosis and problems

Easily confused/forgetful May be in group settings where blood borne infection can occur through shared contaminated devices

May not realize the risk of their used contaminated sharps

May not know that they have a infection

Older Individuals…

Elderly Diabetic Inpatient –evaluated for MI

A “pet mission”What I discovered

How it all Started: My Story

How it all started…1. One individual-20102. The Cary Medical Center Laboratory2. A Vision to protect the Community3. Cary Medical Center Administration

support4. Cary Medical Center Committee5. Community Support

“Education is the most powerful weapon which you can use to change the world.”

― Nelson Mandela

A Safer Aroostook

Cary Medical Center Committee

Rotary/others(funding)

Education Home Containers Kiosks

Community Leaders

Our MissionWe are a Cary Medical Center Committee formed to investigate and implement community safe needle disposal in Aroostook County as well as develop educational programs for the public about safe needle disposal.

Education Brochures- full color tri-fold brochure.

Public Service TV and Radio Spots Web site Promotions Press Releases Public Presentations Exhibits at health fairs and trade shows

Cary Medical Center Committee will monitor efforts and advocate for the Community Sharps legislation and associated rulings in the State. Aroostook County Pilot is a model for legislative and community efforts to establish workable solutions in sharps collection and safety.

Advocacy:

Home Containers Free personal sharps containers. Customized with names of sponsors.

Available currently at diabetes education classes, Pines offices, Police Depts, and Cary Medical Center Laboratory

Needle Collection Kiosk

Features and Cost $2900 to purchase Electronic sensors/light- signal when

container is ½ full; battery operated Tamper proof features- similar to “book-

drop” at library; heavy gauge sheet metal Lock when full Customizable with sponsor’s names and

insignia

Kiosk’s Location Initial Sites1. Caribou Police Department2. Presque Isle Police

Department-(added later )7days/wk;24 hours/day

Our Kiosk PartnersPolice Departments chosen because of: Accessibility Willingness & Training Added/Fit with unused prescription drug collection efforts

Currently had sharps dropped off Commitment to pick up and drop off personal sharps containers to the elderly and shut-ins.

Press Release: “On Wednesday, February 23, 2011,Cary Medical Center, with the generous

support of the Caribou Rotary Club, launched the Cary Medical Center Safe Sharps Disposal program.”

February 23, 2011

free personal sharps containers, brochures to the public community drop off /sharps disposal kiosk

located at the Caribou Police Department Oxus Environmental, a waste disposal

facility located in Pittsfield, Me., picked up sharps collected in the kiosk.

The pilot program

A decision to move the waste disposal site occurred in June 2011, after discussion with the committee and key partners.

Costs of the program dictated this move in order to ensure sustainability.

Nick Archer, Regional Director of the Northern Maine Regional Office, Maine Department of Environmental Protection (DEP) worked with the Maine State DEP allowing the Cary program to dispose of the waste in the local landfills.

Adaptations

Both Presque Isle and Tri Community Landfills agreed to take the sharps free of charge and dispose of them in a safe manner.

Agreement to provide all the protections previously provided in the Oxus disposal agreement, and maintain public safety were reached.

Sharps from the Police Departments would go directly by Cary transportation or landfill transportation to designated landfills and be disposed of immediately in an area away from public access.

The Cary Community Sharps Disposal Program added a kiosk and drop off location at the Presque Isle Police Department on November 15th, 2011 as a result of the generous support from the Maine Community Foundation.

Expanding the program

First Public Service Announcement is produced at WAGM by Cary Medical Center and the Northern Maine Development Commission with funding provided by a solid waste management grant through the United States Department of Agriculture (USDA).

February 2012

American Legion Auxiliary Caribou Police Department Caribou Rotary Cary Medical Center City of Presque Isle Maine Community Foundation Northern Maine Development Commission Pines Health Services Presque Isle Kiwanis Presque Isle Police Department Tri-Community Landfill United Baptist Church

Businesses/organizations that provided financial support

Aroostook Area Agency on Aging Caribou Fire andProtection Agency Oxus Environmental University of Maine at Presque Isle  Ambulance Chrysalis Environmental Solutions City of Caribou Healthy Aroostook Jefferson Cary Foundation Maine Department of Environmental Protection Maine Environmental Coalition for Safe Needle Disposal

Other contributors with expertise, letters of commitment, etc.

Our Cary Medical Center Safe Sharps Disposal Program can’t put a number to how many sharps injuries we have prevented in our local communities.

over 4150 lbs of used medical sharps have been collected at two sites

over 1500 personal sharps containers

Approximately 500 brochures have been distributed.

As of April 30,2012:

Aroostook County Community Sharps Disposal Budget

Projected Expenses to expand the Cary Community Sharps Program Funds to sustain the Caribou and Presque Isle sites plus expand to Limestone, Mars

Hill, Ft Fairfield, Washburn, Madawaska, Ft. Kent, Van Buren, Mapleton, Ashland, and Houlton

EXPENSES ____ Year One

Equipment:

Electronic Kiosks for 10 communities (one time) $ 30,000

Labeling of kiosks 256 each $ 2560

Operation:

Biohazard Bags 430 @.50 $ 215

Plain Boxes 430 @3.85 each $ 1656

Tape, Batteries $ 60

Containers 4,400 @1.50 $ 6,600

Brochures 1000 $ 1,000

Labeling of containers @.50 each $ 2,200

TOTAL EXPENSES FIRST YEAR $ 44,291

The above expenses are for supplies and equipment only. Significant costs for this program include coordination of the program, transportation of supplies and full boxes and disposal costs. These are to be provided by the local communities as well as volunteer business efforts.

EXPENSES Five Year Costs

Above costs for operation only: 11,731 x 5 $ 58,655

Hope to eventually add more sites in Aroostook County

Partnership with Aroostook Area Agency on Aging to develop elderly sharps education project

Funding to develop another Public Service Announcement

Plus more….

Exiciting Developments on the horizon 2012

The Aroostook Area Agency on Aging & Cary Medical Center

Elderly and Disabled Education Program

Goal: To educate and increase safety of the elderly and disabled communities regarding sharp use dangers while providing individualized guidance and solutions for proper disposal.

  

Aroostook Area Agency on Aging Partnership

Training of University of Maine, NMDC Students and/or volunteers

Develop and utilize training manuals Utilize the AAA’s standard volunteer training along

with information on biohazard materials and sharps safety.

Develop and utilize a Power point and/or Flip chart presentations to be presented by trained individuals in the following settings:

Group presentations in community groups, housing complexes, and other setting requested by community individuals.

Home presentations by referral and request 

Overview of plan

1.One person can make a huge difference and a champion is essential!

2.Research the disposal options in your community.

3. Establish a committee 4. Need a Foundational Organization (s) to

support5. Develop Key Partnerships in the

Community with businesses and organizations

Applying the Cary Model to Your Area

Educate yourself Educate others – Particularly the elderly

that you work with or family members who may use medical sharps

You’ll never know if you have prevented an injury but you’ll feel good knowing that it’s a good possibility!

Or…

Cary Medical Center: www.carymedicalcenter.org

Centers for Disease Control and Prevention (CDC): www.cdc.gov/needledisposal

 

Coalition for Safe Community Needle Disposal: www.safeneedledisposal.org

Environmental Protection Agency (EPA): www.epa.gov/wastes/nonhaz/industrial/medical/med-govt.pdf

 

Educational Sites include

Questions