whitepaper: market survey on impact to sharps

8/8/2019 Whitepaper: Market Survey on Impact to Sharps

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STC_SMSWP_1109

(866) 338-5120www.stericycle.com

SMS White Paper (10-09).indd 2 11/4/09


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November 2009

Table of contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Meeting the Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Study Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Demographics - who was surveyed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

Identifying the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Why Stericycles SMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Implementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Results

Staff Safety - Needlestick Reductions

Staff Response

Environmental Impact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Market Survey on Impact to SharpsInjuries and the Environment

P R O T E C T I N G P E O P L E . R E D U C I N G R I S K .TM



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STUDY OBJECTIVESDuring February and March of 2009, an independent market

research consultant conducted a nationwide telephone survey

of 52 hospitals who are Stericycle SMS customers.

The focus of the interview was threefold:

1) To evaluate the impact of SMS on needle sticks trendsduring the disposal process due to vertical drop;

2) The influence of the Bio Systems reusable container

on staff, the hospital and the community at large and;

3) The direct impact of the SMS pro-active change out

of the Bio Systems reusable containers (1/3 1/2 full

when exchanged) on clinical staff.

Hospitals randomly chosen were current users of the Sharps

Management Service.

A research tool was developed to address the above areas.Each interview took approximately 20 minutes to complete.

An independent researcher was engaged to conduct thesurveys to ensure all data was obtained in an impartial and

objective process. All data was consolidated to ensure

confidentiality of the hospital and participant.

Meeting the Challenge

REDUCE RISK TO STAFF WHILE BEING ENVIRONMENTALLY FRIENDLY

Increasingly in todays healthcare environment, there are two major issues that are growing

concerns for hospitals as they strive to deliver optimal clinical care. They are:

1) The increased risk of occupational injury to healthcare workers

2) The increased generation of medical waste and its impact on the environment

Stericycles Sharps Management Service (SMS) using the Bio Systems reusable containers

addresses both of these issues as they relate specifically to needle disposal and Sharps

Injuries (SIs). SIs are a significant occupational risk to all clinicians and support staff within

the hospital care setting. In addition, the disposable sharps containers are defined as

regulated medical waste and must be treated prior to disposal in local landfills - negatively

contributing to the environment. SMS provides protection to hospital staff working with

sharps by decreasing the risk of exposure to potentially hazardous bloodborne pathogens.

Through the use of Stericycle SMS Bio Systems reusable sharps containers, the direct impact

to the environment can be quantified due to a decrease in landfill waste.

Demographics

All geographic regions of the country (Figure 1) wererepresented in the final survey results. A representation

of hospital size is also noted in Table 1. The target survey

participant was the hospital staff person responsible for the

monitoring of SIs - principally the Infection Control Practitioner,

with sporadic participation from Environmental Services orEmployee Health.

Breakdown of interviewees are:

85% of the participants worked in Infection Control,

11% in Environmental Services (EVS)

4% were in Employee Health or Risk Management.

The majority of participants, 72% had extensive experience(over 5 years) in infection control expertise, with 40% of

those having greater than 10 years. Professional titles can

vary from hospital to hospital, but included Director (9),

Manager (24), Practitioner (7) Coordinator (8), Safety Officer(2), Team leader (1) and Epidemiologist (1). All respondents

were familiar with the SMS, the Bio Systems ReusableContainers, their hospitals process for measuring SIs and

the impact on staff, both clinical and non-clinical.

Stericycle, Inc. SMS WHITE PAPER 2 www.stericycle.com



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FIGURE 1

15 West Hospitals(CA,CO,AZ)

10 Midwest Hospitals(KS,MI,OH,WI)

8 S/SE Hospitals(TX,FL,TN,KY,SC,NC)

19 N/NE Hospitals(NY,MA,NJ,PA,RI)

Beds # Hospitals Respondents69 100 5101 299 16300 500 15

500 699 8700 999 6

> 1000 2

Table 1

Table 2

Table 3

# Years Using SMS # % responses< 1 6 11%

1 3 years 21 40%>3 5 years 14 27%

>5 10 years 5 10%> 10 years 6 11%

Phase 4/5 Needle Sticks # % responses0 21 40%

0 - 1 12 23%2 5 7 13%>5 1 2%

Unknown 9 17%

No change 2 4%

Key

Surveyed States

Not Surveyed States

housekeeping was accountable for monitoring and removingthe sharps containers prior to overfilling. In 19% of the

hospitals, nursing staff was responsible for the monitoring,

reporting and/or changing the containers. In all situations,

the management of the sharps containers was an additional

responsibility to their primary job responsibilities, often

Identifying the Problem

To evaluate the impact of the SMS on the hospital, a review

of the prior sharps disposal process was recorded, specifically

who was responsible for managing the sharps containers and

how were SIs recorded. Overwhelming, 67% stated that EVS/

Housekeeping were primarily responsible for managing the swapout of sharps containers. In addition to their basic duties, EVS/



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perceived as a distraction. Training was provided to hospital

staff, both nursing and housekeeping, on the approved process

to check and swap out the containers. The containers were to bechecked daily and changed when 2/3 3/4 full, varying based

on individual hospital protocol. Frequent survey comments on

the prior sharps container management included everyone was

responsible, therefore no one was responsible, it was a mish

mash mess, to it was not a reliable system. The hospitalswere looking for a better system for their staff and their patients

that would provide direct accountability for the replacement

of sharps containers. In evaluating processes for sharps

management, hospitals were looking for a system that would

decrease staff exposure to risk, minimize costs and diminish

environmental impact.

Why Stericycles SMS using Bio SystemsReusable Containers?

Why Stericycles SMS?

The process for choosing a partner for sharps management variedfor each hospital. In describing their role within the hospital

process for choosing SMS, 69% felt they played an active roleas a team leader/member evaluating all various options for

sharps management. This role included an assessment of current

practices, identification of key requirements for a vendor partner,

research of all potential vendor services offered, evaluating

vendor sites and reviewing available vendor references. 31%stated they were the driving force in securing the SMS using

Bio Systems reusable containers for their facility with the final

decision generally made in the executive suite.

When asked why the hospital chose the SMS with Bio Systemsreusable containers, responses reflected these 3 main areas,

cost savings, risk reduction and environmental impact.

Cost (29%):To measure the total cost savings, 11% of the respondents also

specifically mentioned the labor savings in addition to the direct

costs of container replacement. Although implementing the SMS

did not necessarily eliminate staff headcount, it did allow EVS toredirect housekeeping to focus on their primary role of cleaning

and disinfecting patient rooms. Relieving nursing staff of this

additional responsibility and allowing them to focus on patient

care derived an added benefit.

Decrease SIs Risk (27%):Closely related to the cost concerns was the need to reduce therisk of exposure to sharps injuries. Sharps injuries continue to be

a category of occupational injury exposing staff to bloodborne

pathogens, which include hepatitis B and C viruses and human

immunodeficiency virus (HIV). Several researchers have

examined the extent of SIs in the United States. Panlilio

and colleagues reviewed data from fifteen healthcare

facilities participating in the National Surveillance Systemfor Healthcare Workers (NaSH) and est imated that 384,325

occur every year.4 However, due to the lack of a systemic

data collection process, the true number of injuries is

unknown, with an estimate for underreporting placingthe total annual number of SIs in excess of 576,000.5

Detailed analysis of SIs collected via NaSH, reveals that 16%

of SI occur during or after disposal.5 The unique vertical

drop design of the Bio Systems reusable sharps containers

reduces the potential risk of needle injury by eliminating steps

required in handling the needle during the disposal step. Byoutsourcing the container monitoring and providing pro-active

swap out when 1/3 1/2 full, the SMS provides additional

protection to staff by eliminating the need to handle needle/

sharp materials during container replacement.

Environmental Impact (22%):Respondents felt that a key social responsibility of all

hospitals was to minimize the amount of treated regulated

medical waste disposed in our landfills diminishing their

carbon footprint. However, once cost and risk reduction

goals were met, environmental impact was factored intothe switch from disposable to reusable containers. It was

felt that media coverage and community activism increased

the overall community awareness of the impact hospital

waste, specifically medical waste, has on the environment.

For hospitals that had recently converted to the SMS (within

the past five years) using the Bio Systems reusable sharpscontainer to directly manage their environmental effect was

weighted more heavily. Progressively more hospitals are making

purchasing decisions that allow for sustainable practices and

to be more green. See Sidebar 2 for Carbon Estimator.



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www.stericycle.com 5

and disinfected containers that were installed and replaced,

any apprehension regarding sanitary conditions of thecontainers was diminished. As potential aesthetic concerns

were eliminated, 100% of hospitals stated they now prefer

the Bio Systems reusable containers as an environmentally

friendly way to decrease landfill usage and an opportunity

for the hospital to decrease their carbon footprint.

To remove potential risk during the Phase IV (see Sidebar

for PPM definition) step of sharp disposal, the Bio Systems

reusable container has a vertical drop design. When

questioned on the reaction of clinical staff to this design,

42% raised an initial safety concern in the area of pediatrics.

Staff was fearful of the potential of young patients gainingaccess to the sharps, causing increased need to monitor

and protect patients. Pre-education on the benefits of the

containers along with proper positioning with container

height and location (per National Institutes of Safety and

Health standards) dismissed this fear. Outside of the pediatricarea, there was minimal to no reaction to the open verticaldesign of the Bio Systems reusable sharps containers.

Implementation

On the whole, the switch to the Stericycle Sharps Management

Service occurred without incident. A preliminary concern by many

of the respondents was in managing a non-hospital employee

on the patient floors for the container replacement. This wasquickly eliminated as SMS technicians were professional,

responsive and followed specific hospital protocols as required.

It was felt that having an expert responsible for the monitoringand management of the container removed this burden on staff

to allow them to perform their primary responsibilities. Clinical

satisfaction continued to grow as SMS technicians automaticallyreplaced Bio Systems reusable containers, eliminating the

responsibility from healthcare workers. On average the longevity

of these customers with the SMS was 3.8 years, with a range

from < 1year (11%) to > 10 years (11%). See Table 2 on page 3.

It was stated that by removing this task, healthcare workers

were able to focus on providing quality patient care in a cleanand safe environment.

Regarding the staff acceptance of the Bio Systems reusablesharps containers, 77% were surprised at how effortless and

smooth the transition occurred. In 58% of the facilities, clinical

staff (nurses and nurse assistants) had no concerns regardingthe use of a reusable container for sharps management. In 29%

there was initial concern from clinical staff on potential problems

with the cleanliness of reusable boxes. Once exposed to the clean

(SIDEBAR 2)CARBON ESTIMATOR

CARBON FOOTPRINT ESTIMATOR EXAMPLE

For a 200 bed acute care hospital, by using the StericycleSharps Management Service and Bio Systems Reusable Sharps Containers

YOUR CO2 DIVERTED IS:

13,180 Pounds of CO2

This is equal to the followingstatement below:

CO2 Emissions fromGallons of Gasoline.

CO2 Emissions fromPropane Cylinders usedfor Home Barbeques

679 pounds

249 pounds

1 ReusableSharps Container

prevents 600

Disposable Containers

from going

into landfills.



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Results

Sharp injury cases are segregated into five major segments

based on the procedure timeline. Phase IV involves the sharpdevice disposal and Phase V defines any actions in handling the

sharps container as during replacement. The survey questions

were directed at the impact of SMS using Bio Systems reusable

containers on the Phase IV and Phase V injury rate.

Overall, since implementing the SMS using Bio Systemsreusable containers, hospital customers indicated that

needlesticks associated with the sharps disposal (Phases

IV and V) fell significantly:

63% experienced a decline of needle sticks to 0 1 per year;

40% eliminated all Phase 4/5 needle sticks a 100% reduction.

52% saw a greater that 30% reduction in disposal needlesticks after SMS was implemented. See Table 3 on page 3.

100% felt that the unique design of the container combined

with pro-active swap out of the Bio Systems reusable

containers contributed to the decline in needle sticks.

For hospital staff, safety and risk reduction were the primary

goals of the SMS implementation. Regarding safety outcomes,85% of hospital staff responded that they strongly agreed/

agreed that utilizing the SMS increased safety outcomes in

their facility due to the proactive swap out of the Bio Systems

reusable containers by Stericycle Service Specialists. By eliminating

the need for hospital staff to handle the container exchange,

it directly decreased the staff exposure to injury. Applying thesame measurement scale, 91% strongly agreed/agreed that

using the Sharps Management Service with Bio Systems reusable

containers is a clinical best practice.

Interviewees were questioned on their potential referral of

the Stericycle SMS using Bio Systems reusable containers to

their hospital peers. On a scale of 1 10, 90% responded inthe top two categories (9 or 10) that they would highly

recommend Stericycles Sharps Management Service using

Bio Systems reusable containers to their peers at other

hospitals and plan to continue to use the service. Overall,

92% responded in the top of the scale that their overall

experience with Stericycles SMS service was excellent.

In closing, when asked what they would say to their peers

at a healthcare facility using disposable sharps containers,

comments included:

Recommend everyone investigate the reusable system

It is a win/win

Save the landfills, environmentally safe, earth friendly

This is the wave of the future

Benefit is employee safety safer all around

This is easy, a seamless system, one person accountable

Just do it! Only way to go

Stericycles Sharps Management Service using Bio Systems

reusable containers provides a comprehensive process

that reduces risk to healthcare workers while decreasing

waste in our landfills. By providing service specialists that

are responsible for managing the monitoring and disposalof sharps containers, your staff can focus on their primary

responsibilities of patient care and environmental services.

1 Beekmann SE, Henderson DK. Protection of healthcare workers from bloodborne pathogens. Curr Opin Infect Dis. 2005:18:331-62 Occupational Safety and Health Administration, Department of Labor. 29CFR Part 1910.1030, Occupational exposure to bloodborne pathogens; fina l rule. Federal Register 1991:56:64004-182.3 OSHA, Department of Labor, Bloodborne Pathogens and Needlestick Prevention. April 2001. Avail able at: http://www.osha.gov/SLTC/bloodbornepathogens/standards.html Accessed 04/30/2007.4 Panlilio AL, Orelien JG, Srivastava PU, Jagger J, Cohn RD, et al. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-198. Infect Cont Hosp Epidemiol 2004;25:556-562.5 Centers for Disease Control & Prevention (CDC). Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. February 12, 2004. Available at: Http://www.dcd.gov/sharpssafety/index.html.6 Garcia R. Time for a new focus on Sharps injury prevention: using procedural period methodology to produce rapid rate reduction {lecture} APIC 33rd Annual Educational Conference & Internal Meeting, June 15, 2006. Tampa, FL

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