It’s no secret that needlestick injuries (NSI) represent a significant risk to all healthcare setting staff — from clinicians to cleaners. Leaders know that robust mitigation strategies are an essential and mandatory way to protect people from harm, and organisations from avoidable costs. However, it’s also important to recognise that some of these strategies can have knock-on effects of their own. Limited capacity sharps containers made from a low percentage of recycled plastic, for example, can be a significant drain on sustainability efforts, at a time when healthcare settings across the country are striving to meet their Net Zero commitments.
The importance of NSI risk mitigation, from both a human and business perspective, should not be overstated. Needlestick injuries are a relatively high-risk incident, and Estates managers will be well aware of the need to mitigate risk where possible. Meanwhile, innovation within this space has created new disposal solutions which, when combined with creating a culture of sustainability, can help hospitals, clinics, and surgeries, build safer policies that do not cost the Earth.
Needlestick injuries: ‘common and consequential’
Everyone who may come into contact with sharps during the course of their duties — from healthcare professionals to cleaning staff and waste handlers, is at risk of an NSI. These injuries, defined as an accidental, skin-penetrating stab wound from a needle containing another person’s blood or bodily fluid, are extremely common.1 Globally, an estimated two million occupational NSIs occur every year,2 with 40,000 being recorded across the UK medical profession alone.3 The true number, however, is thought to be much higher, as many incidents are never reported.
Every single one of these injuries has the potential to do harm. NSIs can transmit at least 20 different pathogens. The most critical are Hepatitis B, Hepatitis C, and HIV,4 all of which are serious infections with long-lasting health implications, that often require extensive medical care.
Alongside the physical health impact, the injuries also carry a significant mental health risk. One review, published in 2022, for example, found that healthcare workers may experience post-traumatic stress disorder, anxiety, and depression, following a sharps injury.5
What’s more, NSIs often result in increased costs that healthcare systems can ill afford. Post-exposure prophylaxis, medical treatments, and potential lost work time, can all add up, and, with safe sharps management being strictly regulated, lapses can lead to expensive legal action.
Under the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, for example, all healthcare settings must have a written sharps management protocol. This should include a risk assessment, a commitment to only using sharps where they are required, and a policy to use ‘safer sharps’, rather than traditional, unprotected sharps, wherever ‘reasonably practicable’. Secure containers and instructions for safe disposal should be situated close to work areas, and all staff should be trained in how to work safety with sharps, how to safely dispose of them, and what to do if an injury occurs.6
Failure to comply can be costly. Between 2021 and 2022, the NHS Resolution (an arm’s-length body of the Department of Health and Social Care that provides expertise on resolving concerns and disputes fairly) received 2,600 NSI-related claims. As of December 2022, these claims had cost the service £10,799,616 in damages and legal costs, a figure that is expected to increase as the remaining 167 claims are processed. Interestingly, 1,460 of the claims settled so far were made by ancillary workers, including cleaners, porters, laundry and maintenance staff, and just 432 by clinical staff. This clearly demonstrates the importance of NSI risk mitigation in all areas of healthcare provision.7
Non-compliance the main cause
The main causes of the breaches included non-compliance with standard infection control precautions, inadequate disposal of clinical waste, and the overfilling of sharps bins7 — all of which are entirely preventable with the right policies, practices, and equipment.
The journey to Net Zero
Healthcare settings are well aware of their ethical and regulatory responsibility to set robust sharps management policies. Sharps containers are an essential part of these strategies, but these high-volume plastic items can also be a drain on sustainability efforts. The planet is in the midst of a climate crisis, and reducing emissions is a critical global challenge that requires the active participation of every segment of society. Medicine and healthcare, while essential for public well-being, are not immune from this effort, significantly contributing to climate change, both directly and indirectly. The sector’s environmental impact is substantial, driven by energy consumption, waste generation, resource use, and the carbon footprint of medical products and services.
Every healthcare setting, then, has a role to play in helping the NHS meet its goal of being the world’s first Net Zero national health service. The organisation has pledged to reduce scope 1 and 2 emissions, i.e., those it is directly responsible for, by 80% between 2028 and 2032, with the aim of meeting Net Zero by 2040. In terms of scope 3 emissions, or those connected to suppliers, and factors such as staff travel and goods transport, the goal is to reach Net Zero by 2045.8
Achieving this will not be easy. In England, the NHS is responsible for 4% of the country’s emissions.9 Medicines, equipment, and ‘other supply chain’ sources, make up the majority, and clinical waste — which includes sharps disposal, accounts for a large proportion. Every year the health service generates around 156,000 tonnes, equivalent to 400 fully loaded jumbo jets, of clinical waste.10
Many hospitals, clinics, and surgeries, have moved to reusable containers in a bid to reduce their environmental impact. This approach, however, is not always the most reliable. Firstly, there is a risk to breaking the chain of infection that responsible sharps disposal is designed to disrupt. Incinerating sharps containers, rather than disinfecting them, ensures the complete destruction of pathogens, including the most resistant bacteria, viruses, and spores. In fact, research from the US has found that Clostridioides difficile rates were 15% higher in hospitals that used reusable bins than in those that used single-use disposable containers. In addition, incineration physically eliminates the sharps, removing any subsequent risk of NSIs, or even needle re-use.11 Secondly, reusable containers cannot service every necessary function within an acute setting — there will always be a need for single-use items. As a result, two system practices will need to be implemented.
Safer, greener sharps management
Luckily, responsible, safe sharps disposal and sustainability are not mutually exclusive. There are lots of things that healthcare settings can do to make their policies as ‘green’ as possible, without ever compromising on safety. Comprehensive staff training is essential to ensure that all workers involved in sharps use and disposal understand the importance of safe practice, and their impact on sustainability. Educated staff are much more likely to follow procedures for reducing waste and support sustainability goals.
It is all part of creating a culture of green awareness that is essential for the long-term success of sustainable sharps disposal policies. As well as training and education, leaders can engage staff at all levels in sustainability initiatives by establishing ’green teams’, recognising and rewarding sustainable practices, and encouraging innovation in waste management. This will help make sure that sharps disposal practices are consistently aligned with environmental goals.
Material composition
Examining the materials and processes used to produce the sharps containers can also help. In the past, sharps bins were made from virgin plastic, which is extremely resource-intensive. Newer, more innovative designs incorporate durable, puncture-resistant recycled plastic. The Sharpsafe container, for example, uses a locally sourced recycled polypropylene base that has a much lower carbon footprint than virgin plastic, resulting in a 94% reduction in CO2e compared with previous products.
In addition, some industry-leading manufacturers have adapted their manufacturing process — to use more energy-efficient machines and processes. By choosing products and suppliers that focus on the sustainability of their single-use products, healthcare settings can definitively break the chain of infection, while also reducing the carbon footprint of sharps disposal. Optimising sharps container use can also help make NSI prevention strategies more sustainable. Intelligent design has allowed some manufacturers to increase the capacity of their containers, while maintaining the same footprint, helping to reduce the overall number of products needed, for example. Not only does this cut down on the number of products going for incineration, but it can also lower the carbon emissions associated with their transport, from procurement to disposal. One hospital found it could save 195.6 kg CO2e a year, simply by switching to these new designs. The saving was equivalent to five overnight hospital stays, at 37.9 kg CO2e each, four ambulance trips to A&E, at 49 kg CO2e each, or 3.5 hours of surgery, at 53 kg CO2e each. In addition, this approach can help reduce the number of bins being handled by ancillary and cleaning staff, further reducing their risk of NSIs.
Filling to maximum capacity
Departments can compound the benefits of container use utilisation by ensuring that all containers are filled to their maximum capacity before disposal. There are risks associated with the overfilling of sharps bins; namely that it can leave staff vulnerable to NSIs. However, innovative solutions, such as safe fill container lids, can help mitigate this challenge. The Dual Protect Pro, for example, is a fully integrated, flexible yet durable safety shield. This stops contents from spilling from the container, whilst encouraging horizonal filling, to maximise the capacity of the box, and also discourages users from placing their hands inside the container.
Healthcare settings are responsible for a significant proportion of the country’s carbon footprint, and reducing that burden is a key priority for the NHS. Simultaneously, clinical waste disposal — which includes sharps waste, is a safety-critical arena. The prevalence of NSIs among healthcare and ancillary staff is high, and their potential health and financial costs are significant. There is then, no room for complacency.
Luckily, the innovative design of modern sharps containers means there is no need to choose between safety and sustainability. Today’s leading products use recycled plastics and are manufactured in greener factories. They can hold more sharps, increasing their lifespan without increasing their footprint, and new safety features demonstrate that it is possible to enhance safety and sustainability at the same time.
Ultimately, by embracing innovative and sustainable practices, healthcare settings can protect their staff, reduce healthcare costs, and contribute to the larger goal of environmental stewardship. The journey to Net Zero is a collective responsibility, and all stakeholders — including those involved in sharps disposal and management — have their part to play.
Jenna Davies
Jenna Davies, Global Product manager for Clinical Waste Management at Vernacare, joined the company in 2021, and was part of the team responsible for launching the world’s first full range of sustainable single-use sharps containers that year. She continues to innovate and bring new products to the market, including the new 5 and 7 Litre Sharpsafe containers this year. She works closely with healthcare professionals and healthcare facilities delivering training and educational workshops on reducing the risk of needlestick injuries, and the potential harmful effects of clinical waste. An expert in her field, she is ‘passionate about developing the best solutions on the market for sharps and clinical waste disposal, and ultimately creating the best solutions for healthcare professionals and patient safety’.
References
1 Pavithran, VK et al. (2015). Knowledge, attitude, and practice of needle stick and sharps injuries among dental professionals of Bangalore, India. Int Soc Prev Community Dent 2015; Sep-Oct; 5(5):406-12.
2 Hosseinipalangi Z, Golmohammadi, Gashghaee A, Ahmadi L, Hosseinifard H, Mejareh ZN et al (2022). Global, regional and national incidence and causes of needlestick injuries: a systematic review and meta-analysis. East Mediterr Health J 2022; 28(3):233-241.
3 Imran, A, Imran H et al. (2018). Straight to the point: considering sharp safety in dentistry. Br Dent J 2018: 225(5), 391-394.
4 Cooke C E, Stephens J M (2017). Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Med Devices (Auckl) 2017; 10: 225-235.
5 Hambridge K, Endacott R, Nichols A (2022). Exploring the psychological effects of sharps injuries sustained by healthcare workers. Nurs Stand 2022; Feb 28. doi: 10.7748/ns.2022.e11785. Online ahead of print.
6 Care Quality Commission. (2023). Dental mythbuster 7: Use of safer sharps. Available at: https://tinyurl.com/447zs2kj
7 NHS Resolution. (2022). Did you know? Preventing needlestick injuries. Available at: https://resolution.nhs.uk/learning-resources/preventing-needlestick-injuries
8 NHS England. Delivering a ‘Net Zero’ NHS. 1 October 2020. Available at: https://tinyurl.com/3ewewwh5
9 Faculty Of Public Health Special Interest Group: Sustainable Development. (n.d.) The NHS: Carbon Footprint. Available at: https://tinyurl.com/2vtemjx2
10 NHS England. (2023). NHS clinical waste strategy. Available at: https://www.england.nhs.uk/long-read/nhs-clinical-waste-strategy/
11 Ford S. Reusable sharps bins linked to higher C. difficile rates. Nursing Times July 2015; 015 Jul; 111(28-29): 6.