Sydney Adventist, a 350-bed acute care private Hospital noted excessive container-associated sharps injuries using small sharps containers that were carried to and from patient's rooms.
Prior to intervention, sharps containers were not fixed on patient-room walls for reasons of aesthetics and visitor safety. Although safety engineered devices (SED) were used at SAH, the incidence of Container-Associated Sharps Injuries (CASI) was disturbingly high. At incident follow-ups, staff commented to one of the authors (WN) that the increased sharps injuries with small sharps containers was likely due to their small aperture, limited capacity and temptation for users to push more sharps into them.
The 6-year study (2004 to 2010) utilised a 3-phase, before-after intervention model. In phase 1 healthcare workers at Sydney Adventist Hospital carried disposable 0.37 gallon sharps containers (Tray Collectors, BD Australia) to and from patient rooms in a tray along with injection items. Used sharps too large for the small sharps containers were transported in the tray to each ward’s medication station for disposal into a single-use 6 gallon Sharps container (Nestable Collectors, BD Australia).
In phase 2, use of small sharps containers ceased and an 8.5 gallon reusable Sharpsmart sharps container with large aperture, counterbalanced door and passive overfill protection was placed in all med rooms (one per department), and staff received mandatory in-service training in the use and handling of the Device. In this phase of the study, the sharps container was not sited in patient rooms for reasons of aesthetics and safety. Sharps were transported to and from patients’ rooms using kidney dishes or trays.
In phase 3 of the study, a 5.8 gallon Sharpsmart sharps container was wall-mounted in patient rooms at an ergonomic height and as close as practical to patients’ beds. Employee descriptions of their sharps injuries were obtained retrospectively from the hospital’s sharps injury log during Phase 1 (20 months), Phase 2 (30 months) and prospectively in Phase 3 (20 months). Data in each change-over month was excluded to avoid the possibility of placing sharps injuries in an incorrect study phase.
This study validates the necessity of the international recommendations that sharps be placed immediately after use into well engineered, safe sharps containers sited close to the point of sharps generation. Compared to small portable sharps containers, use of the larger, safety-engineered sharps containers mounted on patient room walls can result in significantly fewer staff sustaining disposal-related sharps injuries annually.
Phase 1: (Non-Sharpsmart disposable containers)
19.4% of SI were container-related.
Phase 2: (Sharpsmarts in med-rooms)
Container-Associated SI fell 94.9%
Disposal related SI fell 71.1%
Transport injuries rose
Phase 3: (Sharpsmarts in patient rooms)
Container-Associated SI were zero
Disposal related SI fell 83.1%
Recapping SI fell 85.1%
“Compared to small portable Sharps Containers, use of the larger, safety-engineered Sharpsmart mounted on patient room walls can result in significantly fewer staff sustaining disposal-related sharps injuries annually. The Sharpsmart containers’ volume, large aperture, passive overfill protection, one-hand deposit and close-at-hand siting are postulated as contributing to the reduction in disposal-related Sharps Injuries ”