Removing needles from trash in Indiana: a necessary effort.

It has been estimated that as many as 3 billion used needles or syringes are generated in homes and other unregulated sites throughout the United States. Current needle disposal regulations apply only to health care settings, such as doctors' offices and hospitals, leaving family members and solid waste collection and recycling workers exposed to the possibility of injuries.

Syringe disposal is a "hot" issue and of concern for the following reasons:

* Needle stick injuries are a common hazard.

* With a predicted 165 percent increase in Americans diagnosed with diabetes over the next 50 years, the problem of improper syringe disposal will get worse.

* Sharps get thrown into the trash, posing risk of injury and infection.

* Current guidelines from the U.S. Environmental Protection Agency (U.S. EPA), which call for drop-off collection sites, household hazardous waste centers, residential special-waste pickup service, syringe exchange programs, mail-back services, or home destruction devices, are a significant change from previous recommendations that residents put needles in a plastic container or coffee can, write "do not recycle," and throw the container in the trash.

* Used needles can transmit diseases such as HIV/AIDS and hepatitis B and C.

* In very rare cases, diseases such as tuberculosis, syphilis, herpes, malaria, toxoplasmosis, diphtheria, and blast mycosis have been transmitted through needle stick injuries. Plastic containers with sharps can burst open when compressed in garbage trucks. Solid waste recycling has exacerbated the problem:

* Contents of waste collection vehicles may be dumped onto conveyor belts at recycling facilities.

* Workers' gloves are no match for needles.

* Needle stick injuries on the job can be costly to the employer and the employee. One case of serious infection by blood-borne pathogens can result in significant employer costs related to

-- tests and follow-ups;

-- increase in missed work days and lost time;

-- increase in workers' compensation costs; and

-- the waiting period for results of blood tests, which can be psychologically traumatic.

In 2001, the Boone County Health Department in Indiana approached the Boone County Solid Waste Management District with a request that a portion of an already existing Solid Waste District/Health Department grant program be utilized to purchase sharps containers for distribution free of charge to diabetics in Boone County. Once the container is full, the patient returns the container to the health department, where the container is properly disposed of. The sharps program provides needle users a safe way to dispose of their equipment. Currently, Stericycle picks up the full sharps containers from the health department.

Solid waste collection companies that are represented on the Boone County Solid Waste Management District Citizen's Advisory Committee (CAC) have enthusiastically supported this effort to remove needles and syringes from the municipal solid waste and recycling stream. One company has provided photographs of needles encountered during the separation process at their recycling facility. The needles enter the recycling stream when they are placed in plastic jugs (bleach or detergent containers) that then get inadvertently thrown into recycling bins.

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Cal Davidson of Ray's Trash Service has indicated a noticeable drop in "sticks" suffered by his employees since the inception of the sharps program: "We have appreciated working closely with the solid waste district since the program started up. Helping to minimize the potential injury to our employees underscores the importance of the public/private-sector partnership that the Boone County Solid Waste Management District has exhibited. We have supported this effort since its inception and believe this is a cost-effective alternative for sharps management that should be replicated statewide."

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In addition, a suggestion was made at a CAC meeting that area physicians be provided with literature for use when they are counseling diabetic patients; the literature should describe and depict appropriate sharps disposal alternatives (Figure 1). Stuffing needles into plastic jugs or coffee cans that may find their way into recycling or the municipal solid waste stream is not a procedure that we recommend. The collection, recycling, and disposal of municipal solid waste is dangerous enough as is without burdening the system with additional unseen hazards.

Lisa Disbrow of Waste Management of Indiana, LLC, sees the program as another alternative for provision of secure handling and disposal options to insulin users: "The program safeguards both the interest of the public at large and those employed in the waste services industry and is fully supported by Waste Management."

Rachel E. Weinrich of the Indiana State Department of Health Diabetes Prevention and Control Program stated:

  I had the privilege of seeing how Boone County's Health Department and
  Solid Waste Management District worked together to operate their
  syringe disposal program. I was very surprised on how inexpensive it
  was and how little it involved to operate such a successful program.
  Obviously, every county in Indiana is different, and what may work in
  one county may not work for another county. However, the success of
  Boone County's program should get the attention of counties that are
  interested in starting up their own programs, if not to model their
  program after Boone County then at least to get an idea of what
  options may work and are available to them for providing better
  service to the people in their community.

The current program is a way to assist residents in the implementation of safe and effective needle disposal in Boone County. The extent and cost of the program to date are summarized in Table 1.

To date, approximately 150,000 needles have been removed from the trash and sent to appropriate disposal facilities in Boone County alone. This is a significant reduction in potential needle hazards posed to solid waste collection, recycling, and disposal workers. A program with costs of under $2,000 per year currently removes approximately 45,000 needles per year from the waste stream. As a result of the success of the program, the Solid Waste Management District anticipates a budget increase in 2006 to support continuing efforts to protect Boone County citizens and solid waste workers.

Sharon Adams of the Boone County Health Department and David Lamm of the Boone County Solid Waste Management District presented a report on the success of this program at the Indiana Environmental Health Association (IEHA) conference in Jasper, Indiana, in September 2003. As a result of this presentation, the Hamilton County Health Department and the Hamilton County Solid Waste Management District have cooperated on a similar joint venture. According to Jason LeMaster of the Hamilton County Health Department, in 2004 these agencies successfully collected over 21,300 needles (355 quart containers) and in 2005 collected an additional 21,000 needles (342 quart containers). Free containers are distributed both at the health department offices and at the Hamilton County Household Hazardous Waste Center. They are received for disposal at the Hamilton County Household Hazardous Waste Center.

The Hamilton County program uses the same public information pieces that were developed in Boone County. Because of the success of the program so far, significant growth is anticipated. A presentation was also made to the Indiana Household Hazardous Waste Task Force about the success of this program. Considerable interest was generated, with a very real possibility of cooperative program expansions into other areas of Indiana. The task force participated in a group purchase of sharps containers that could then be distributed by the members to their local health departments. At present, the task force has 36 members, comprising 30 solid waste districts, two businesses, two individuals, a local health department, and a not-for-profit association. The coordination of crucial public and environmental health programs with solid waste district activities is very real and produces results that benefit all participants.

As a result of the presentation to the Indiana Household Hazardous Waste Task Force, the Johnson County Health Department and the Johnson County Solid Waste Management District have also implemented a sharps removal program. In Johnson County, the health department is bearing all of the costs of container collection and disposal. The Solid Waste Management District is assisting the effort by providing advertising and covering some printing costs. Since July 5, 2005, the health department has distributed 323 new sharp containers. Ninety of these containers have been returned to date, along with 13 nonmedical containers (coffee cans, detergent bottles, etc.).

Representatives of the American Diabetes Association and the Coalition for Safe Needle Disposal were both quite taken with the Boone County sharps removal effort, particularly given its low cost. We would anticipate that cost per population would be similar in larger metropolitan areas.

The health-related sectors are unfortunately not the only ones that may generate needles. In order to ensure adequate protection from needles in the solid waste stream, Boone County staff also investigated needle generation and disposal activities associated with on-farm vaccination practices in the agricultural community. Local veterinarians and co-ops have become an integral part of the effort as well. Agricultural-community participants can secure the same free sharps container service.

As we have seen, programs that successfully remove needles from the trash and safeguard solid waste workers can be implemented at low cost with the cooperation and leadership of solid waste districts, health departments, and private-sector service provider participants.

Corresponding Author: David D. Lamm, Administrator, Boone County Solid Waste Management District, 416 W Camp St. Room # 103, Lebanon, IN 46052. E-mail: [e-mail].

David D. Lamm, R.E.H.S.

Sharon Adams, R.E.H.S.

TABLE 1 Sharps Container Distribution and Collection Costs in Boone
County

       Containers   Purchase  Containers  Disposal
Year   Distributed  Cost      Collected   Costs      Total Costs

2001    16                      6                      $121.60
2002    57                     52                      $604.70
2003    62          $599.47    68         $1,166.34  $1,765.81
2004   113          $568.62   106         $1,333.20  $1,901.82
2005   157          $742.61   131         $1,179.00  $1,921.61
2006    95          $449.35   103           $927.00  $1,376.35
Total                                                $7,691.89