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ASM and RACGP agree: non-reusable sharps containers need strengthening
Healthcare Infection 2008; 13: 29–32
Letters to the editor ASM and RACGP agree: non-reusable sharps containers need strengthening Terry Grimmond1,3 FASM Nick Demediuk2,3 MBBS, FRACGP 1
Australian Society for Microbiology, Suite 23, 20 Commercial Road, Melbourne, Vic. 3004, Australia. 2 Royal Australian College of General Practitioners, RACGP College House, 1 Palmerston Crescent, South Melbourne, Vic. 3205, Australia. 3 Corresponding author. Email: TGrimmond@danielsinternational. com The Australian Society for Microbiology and The Royal Australian College of General Practitioners write in support of Sue Atkins’ letter1 regarding the need for stronger non-reusable sharps containers. Data on sharps injuries (SI) as a result of container penetration is hard to come by, not because of their non-occurrence but because there is no robust external reporting regime for incidents in primary care, nor is there an Australian repository of data of SI that occur in laboratories or hospitals. Furthermore, state health jurisdictions are reluctant to publish SI data and when they do, container-penetration SI are often agglomerated under ‘Other’. Container-penetration SI are occurring. One of the authors suffered such an injury when attempting to insert a needle and syringe into a sharps container. In September 2007, a nurse at a GP practice in Armadale suffered such an injury with a 5L container. We are also aware of a nurse in a Melbourne hospital who suffered an SI from container-penetration. These incidents, coupled with the data from Atkins’ letter, show clearly the current Australian Standard for non-reusable sharps containers (AS 4031 1992) requires strengthening. The reason it is not working is that its ‘minimum 12.5N penetration force’ is even lower than the seminal 1990 British Standard, which required 15N average and 12.5N minimum.2 However, 15/12.5N is not sufficient either. In countries with 15/12.5N Standards, container penetration SI occur at a rate up to 3 per 1000 reported SI (M. Nguyen, pers. comm., November 2006).3,4 As Atkins’ stated, France and Canada raised their penetration requirement (to 18N and 20N, respectively) in an effort to eliminate this cause of SI. Australia must do same.
Australian Infection Control Association 2008
We are not alone in our quest. In 2006 one of the authors wrote to 32 Australian Infection Control Practitioners and asked their opinion on raising the penetration test for non-reusables to 20N – all 32 agreed. Although the advent of needle safety devices will help decrease container penetration SI, not all sharps are available with safety devices and not all safety devices are activated correctly at disposal. Engineering stronger containers is the only means of eliminating this cause of SI. In 1995, Janine Jagger stated, ‘It is possible to eliminate all sharps injuries that occur when needles pierce the sides of disposal containers by requiring all sharps containers to have high puncture resistance; this is a readily achievable goal.5 Atkins’ stated, in 1994 Standards Australia set a new benchmark in raising the reusable Standard to 20N and it eliminated container-penetration SI among users of compliant reusable containers. The evidence is clear and the solution available and proven – we must now do same for non-reusable sharps containers.
Declaration of interests TG is Clinical Director of The Daniels Corporation, a manufacturer of reusable sharps containers, serves on sharps container Standards in several countries and is the Australian Society for Microbiology Delegate to Australian Standard HE-011. ND is the Royal Australian College of General Practitioners Delegate to Australian Standard HE-011.
References 1. Atkins S. Strengthening of Australian Sharps Container Standard. Healthcare Infect 2008; 13: 20. doi: 10.1071/HI08007 2. BS 7320: 1990. British Standard. Specification for Sharps Containers. London: BSI Standards; 1990. 3. IHWSC EPINet Sharps Injury Surveys 2000–04. Available online at: http://www.healthsystem.virginia.edu/internet/epinet/ [verified 30 April 2008]. 4. Health Protection Agency. Survey of Significant Exposure To BBV in HCW. London: HPA; 2004. Available online at: http://www.hpa.org. uk/publications/2004/occupational_exposure/6year_analysis.pdf [verified 30 April 2008]. 5. Jagger J, Bently MB. Disposal-related sharp-object injuries. Adv Exposure Prev 1995; 5: 1–11.
DOI:10.1071/HR08012 10.1071/HI08011
29
Letters to the editor ASM and RACGP agree: non-reusable sharps containers need strengthening Terry Grimmond1,3 FASM Nick Demediuk2,3 MBBS, FRACGP 1
Australian Society for Microbiology, Suite 23, 20 Commercial Road, Melbourne, Vic. 3004, Australia. 2 Royal Australian College of General Practitioners, RACGP College House, 1 Palmerston Crescent, South Melbourne, Vic. 3205, Australia. 3 Corresponding author. Email: TGrimmond@danielsinternational. com The Australian Society for Microbiology and The Royal Australian College of General Practitioners write in support of Sue Atkins’ letter1 regarding the need for stronger non-reusable sharps containers. Data on sharps injuries (SI) as a result of container penetration is hard to come by, not because of their non-occurrence but because there is no robust external reporting regime for incidents in primary care, nor is there an Australian repository of data of SI that occur in laboratories or hospitals. Furthermore, state health jurisdictions are reluctant to publish SI data and when they do, container-penetration SI are often agglomerated under ‘Other’. Container-penetration SI are occurring. One of the authors suffered such an injury when attempting to insert a needle and syringe into a sharps container. In September 2007, a nurse at a GP practice in Armadale suffered such an injury with a 5L container. We are also aware of a nurse in a Melbourne hospital who suffered an SI from container-penetration. These incidents, coupled with the data from Atkins’ letter, show clearly the current Australian Standard for non-reusable sharps containers (AS 4031 1992) requires strengthening. The reason it is not working is that its ‘minimum 12.5N penetration force’ is even lower than the seminal 1990 British Standard, which required 15N average and 12.5N minimum.2 However, 15/12.5N is not sufficient either. In countries with 15/12.5N Standards, container penetration SI occur at a rate up to 3 per 1000 reported SI (M. Nguyen, pers. comm., November 2006).3,4 As Atkins’ stated, France and Canada raised their penetration requirement (to 18N and 20N, respectively) in an effort to eliminate this cause of SI. Australia must do same.
Australian Infection Control Association 2008
We are not alone in our quest. In 2006 one of the authors wrote to 32 Australian Infection Control Practitioners and asked their opinion on raising the penetration test for non-reusables to 20N – all 32 agreed. Although the advent of needle safety devices will help decrease container penetration SI, not all sharps are available with safety devices and not all safety devices are activated correctly at disposal. Engineering stronger containers is the only means of eliminating this cause of SI. In 1995, Janine Jagger stated, ‘It is possible to eliminate all sharps injuries that occur when needles pierce the sides of disposal containers by requiring all sharps containers to have high puncture resistance; this is a readily achievable goal.5 Atkins’ stated, in 1994 Standards Australia set a new benchmark in raising the reusable Standard to 20N and it eliminated container-penetration SI among users of compliant reusable containers. The evidence is clear and the solution available and proven – we must now do same for non-reusable sharps containers.
Declaration of interests TG is Clinical Director of The Daniels Corporation, a manufacturer of reusable sharps containers, serves on sharps container Standards in several countries and is the Australian Society for Microbiology Delegate to Australian Standard HE-011. ND is the Royal Australian College of General Practitioners Delegate to Australian Standard HE-011.
References 1. Atkins S. Strengthening of Australian Sharps Container Standard. Healthcare Infect 2008; 13: 20. doi: 10.1071/HI08007 2. BS 7320: 1990. British Standard. Specification for Sharps Containers. London: BSI Standards; 1990. 3. IHWSC EPINet Sharps Injury Surveys 2000–04. Available online at: http://www.healthsystem.virginia.edu/internet/epinet/ [verified 30 April 2008]. 4. Health Protection Agency. Survey of Significant Exposure To BBV in HCW. London: HPA; 2004. Available online at: http://www.hpa.org. uk/publications/2004/occupational_exposure/6year_analysis.pdf [verified 30 April 2008]. 5. Jagger J, Bently MB. Disposal-related sharp-object injuries. Adv Exposure Prev 1995; 5: 1–11.
DOI:10.1071/HR08012 10.1071/HI08011
29