4th National Symposium on Biosafety

Sharps Management in Animal Care

Linda Martin, PhD
Director, NIOSH HIV Activity
Centers for Disease Control and Prevention
1600 Clifton Road, F40
Atlanta, GA 30333
404-639-1530

I have learned quite a lot in the past few months about Sharps in Animal Care Facilities. I've had extensive experience in working in hospitals. Exposure prevention is the goal in a Sharps Management Program. If you can engineer out the needle, then you have solved your needle stick injury. That is not always possible in every case, and personnel protective equipment plays a role. In some cases, heavy duty gloves might prevent a needle stick injury, but in general, latex gloves do not provide protection against needle sticks. What kind of Sharps do you find in animal care facilities? I think one of the first things which are not thought about are the cages. Frequently, these cages are old, have been handled a lot, and may have some sharp edges. Needles and syringes, of course, are always a problem if you are giving injections or drawing blood. There are safety syringes and needles available. If these can be used and they are appropriate for your institution, I would strongly urge you to consider using a re-shaving needle or a needle with some type of safety feature.

Two thing we don't find in hospitals, in general, are wet floors and very large cutting instruments. In this particular case, there are knives, a sharp cutter, and a wet floor. At the time no one was working in this room, but probably before the floor dries someone will enter. This is something that needs to be considered in large animal facilities in prticular. Dissection of animals usually involve some type of sharp. Even the forceps tend to be very sharp, and safe handling of these is important. What happens to these instruments when you are finished with them? In this case, we saw a sink filled with soapy suds and a knife in the sink. The person who put the knife in there knew it was there, but others would not. A warning sign or putting the instrument in a container with soap suds are safer alternatives. Every injury, whether it involves a pathogen on it or not, potentially causes pain, suffering and lost time from work. In this case, there might not have been a pathogen involved, but an injury would have been harmful to the person.

All animals, whether they are in your home or in a laboratory, have claws and teeth. An animal that is not anesthetized presents a hazard. Well-trained staff are part of the answer to solving the problems when handling animals. In some cases, a restraint system is appropriate, as with a bunny box. Another solution is giving the animal some type of anesthetic cocktail which facilitates handling the animal without putting them in some type of restraint. A very important topic is the training of the people who are handling and manipulating animals. At the University of Georgia, there are trained professionals who handle the animals, and who perform manipulations necessary for the research project. This would be the ideal if it's an affordable option in your institution. Many people have expressed concern about students, who in many cases are not adequately trained. The ideal situation would be to have all animal work performed by trained, certified personnel. While providing the best trained personnel, it may generate problems in scheduling, communication, etc. Training of all personnel, especially students, visiting scientist, etc., is mandatory. Before being granted permission to work with animals, knowledge of safety precautions and proficiency in performing the procedures should be demonstrated.

When liver biopsies were performed on anesthetized animals, an ultrasound was used to guide the biopsy needle. The staff pointed out quite a lot of problems with the biopsy needles including misfiring, not being sharp, and that they are long and difficult to dispose of. In this room, which is not very large, there were three people working. I was impressed with this group of people, because it was clear that they not only knew what they were doing, but they worked well together and were able to anticipate each other's actions and needs even as a long biopsy needle was passed from one person to the other. Since I have recently learned quite a lot about respirators, I must point out that these people were not wearing them for their own respiratory protection. When asked, they said it was to reduce the smell and protect the animal. I reminded them that beards did interfere with the fit of a respirator! One of the steps in this procedure was to shave a small part of the animal. In this room, there really was no place to put a sharps disposal container, so they put one on the floor next to the table where they were performing the biopsy. This is not the ideal situation, but in this case, it worked for this particular set up. It was located out of the way where none of the other people working in the room were likely to run into or knock over the sharps disposal container. The lab tech had a cart set up with all the items that were needed. Unfortunately, there was no place for her to sit down and she actually had to stand while manipulating her specimens. She has a biopsy needle with the specimen that has been handed to her from the person taking the sample. She had to remove the specimen from the biopsy needle and manipulate it in such a way that it was still usable when she got to the laboratory. The sample was cut into two pieces with the scalpel blade, but she also manipulated the sample with the scalpel blade. She actually used it like a pair of forceps. This is an example of when another instrument that is not sharp, or is sharp, such as fine forceps, might be substituted to reduce the risk of injury while still preserving the integrity of the specimen.

I am going to briefly discuss criteria for selection and evaluation of sharps disposal containers. Several groups cooperated with us to conduct research on the sharps containers and a document will soon be published. The design, placement and safe use of these containers is the application of four safety principles. First, containers should be functional, accessible, visible, and should provide accommodation for the user, the facility, and the environment. We welcome suggestions as to a "title" for this last principle. First and foremost, they should be functional and they should not create an additional hazard. OSHA requires that they be "puncture resistant". If you are disposing of a butterfly with the very long tubing, the container should be able to accommodate the tubing without putting fingers into the container to get the butterfly in there. Containers should be available in a variety of sizes and once you close it permanently, it should not come open again.

Containers should be accessible. You should have enough sharps containers to dispose of all types of sharps. In the illustration I used where the people were disposing the razor, they also used the container to dispose of the biopsy needle. Therefore, that container needed to be much larger than one that might just accommodate the razor. The inlet port, particularly in an animal care facility where you are not worried about children putting their hand in, the entry should be entanglement free. A lot of these containers have flanges to keep people from putting their hand in, but which can impede the disposal of a sharp. Containers should be located where they are accessible within arm's reach, and disposal should not impose a hazard for the worker. Sharps disposal containers should be of sufficient thickness to be durable, leak-resistant, and puncture-proof under normal use which includes storage, handling, installation, sharps disposal, closure, and transport. Containers, even those designed to be kicked and/or wheeled, should be stable when placed on any horizontal surface. Containers should be available in sufficient quantity, sizes and shapes. There should be safe access to the disposal opening. Sharps disposal container location and placement should be readily visible and within easy horizontal reach of the users. Ideally, sharps disposal containers should be placed within an arm's reach from their point of use and below eye level.

In this animal facility, the sharps disposal container was located next to the sink. It was accessible, nothing was in the way, and it had all the appropriate markings. Another container, on the other hand, was somewhat obscured by being used as a bookend. Also, the very narrow opening probably did not make it very easy to dispose of sharps which may be why we saw used syringes and needles being left on a cart right outside the animal room rather than being taken to the sharps container. This might be an example where the sharps disposal container was not located close enough to the source, point of use for the person, to feel like they could safely dispose of the sharp, particularly without recapping. We strongly discourage recapping. Even the one handed technique is not as good as disposing of the sharp immediately after use.

The container should be visible and the fill status easily determined. This may be a problem with many containers because the opaque plastic is more durable, and more puncture resistant, but you can not see through it. In general, the clearer plastic is not as puncture resistant. It is difficult to design a sharps disposal container that is puncture resistant and still be able to be seen through when full. The friendliness or accommodation factor is becoming more and more important in terms of waste disposal. Containers should be easily manipulated for pickup and disposal. At one of the institutions I visited, the county did not allow medical waste in the landfill if it was recognizable as medical waste. This means it has to be ground up, smashed, or changed in some way. This probably is more of a perception problem than a true risk.

ne facility used the grinder method to dispose of a small number of sharps generated by its research department. Each department is responsible for its own sharps disposal. The container shown here is ready for grinding. Although this may solve the disposal problem, it can create other hazards. This container is tall and not very stable on the table. In addition, the top is a screw top and must be removed prior to sharps disposal.

Another option is to ship the waste somewhere else and this is frequently done with larger amounts. There are a number of things that you need to consider before you buy a sharps disposal container. One container may not be appropriate for every place in your animal facility or laboratory. It is recommended that workers who are using these containers be involved in evaluating them before purchase. There is no single container type which meets all the disposal containment needs for an entire facility. Selection should be based on a comprehensive site-specific hazard analysis, including: assessment of workplace hazards; assessment of size and type of sharps to be disposed; appropriate placement; compliance with regulations; security needs; laboratory equipment variability; environmental and disposal constraints; and economic cost considerations. A sharps management program must contain provisions for injury reporting and follow-up. Workers should be involved. Application of strategies to prevent sharps injuries in animal care facilities will provide an environment in which to foster research, worker safety, and patient (animal) safety.

Sharps Management in Animal Care Breakout Session
Rapporteur: Murray L. Cohen, PhD, MPH, CIH Chief, Medical Device Evaluation Lab Centers for Disease Control and Prevention 1600 Clifton Road (MS-CO1) Atlanta, GA 30333 404-639-3821

Clearly the biggest problem noted has to do with a fundamental misapplication or misdesign of all of the new injury prevention safety devices that are coming on the market. They're designed specifically for procedures and circumstances used for patient care in the health care industries. The same devices are nevertheless used in animal care and they're not necessarily going to apply or fit nicely into what's being done in this arena.

Let me give you a few examples. First of all, although many patient care procedures may require multiple injections, they are not nearly so common in health care as they are in animal research. So a lot of the new safety devices don't apply (particularly hypodermic needles). When there may be a requirement in laboratory work to give multiple injections to an animal, either the needle can't be recapped, or once recapped, can't be reopened for the purpose of giving multiple injections. The kind of creativiy and innovation that we try to design as safety devices for our hospital workers is quite a safety liability when they try to mishandle, take apart, or disassemble these devices that were designed not to be reused.

Another example of this mismatch between health care and animal research is the design of the operating workplace. The safe operating procedure in health care is to assemble and put the material to be injected inside a syringe as close to the patient use site as possible. That's one of the critical designs in health care safety for hospital settings. Yet, the way our animal laboratories are very often set up, you're not only far away, you may even be remote from the point of preparing the syringes or devices. You then have to cart them, often in a lab coat pocket, to the site where you're actually going to use the device in animal care or animal research. Once you've done all that preparation off site and then carried it over to your animal facility, you then have to carry the sharps devices back out again, often in a laboratory coat or some place that clearly is not what we would want to maximize safety. Not only is it a problem by being carried in a lab coat, but a lot of times sharps devices are left in a lab coat and then become a problem downstream when the laundry is being done by other workers.

Another critical point of sharps injury prevention and the designs of safety programs in health care has to do with the selection and location of sharps disposal boxes. That's also a real problem when we try to take what's designed for healthcare and apply it in animal research laboratory facilities. Clearly, sharps disposal containers for hospitals designed to be located as close to patient use as possible would not be appropriate to be left in some animal facilities. So again, you have this problem of carrying the products from where they're used to where they're going to be disposed, and that causes lots of concerns.

So a first real problem area is this category of a mismatch. A lot of new safety products are coming on the market. We'd like to be able to use them in laboratory research and animal care. But there's just not a very good fit, because they weren't designed specifically for use in animal care and animal research.

The second priority problem area that we identified has to do with the infrastructure, again for safety and specifically sharps injury prevention. In the health care setting, over the last five years in particular, we've done a lot of work and made a lot of progress in what we might call the safety infrastructure. It has not developed yet in animal research facilities. In an animal research facility you typically do not have a product selection committee or a product evaluation committee composed of multi-disciplinary professionals who can: Keep up with the explosion of devices as they are being developed and introduced into the market; and, Evaluate their specific utility in your own facility circumstances. That is becoming a norm in health care, but it just does not exist in animal research yet.

So, the problem here is this big trickle down lag time. New devices that could be very useful, potentially very useful, in animal research facilities aren't even known aboutby animal care personnel. If they are known abot you don't have an infrastructure to change the products you're buying and using today. You may not get some of these new safety products until they become antiquated technology when a new generation of devices becomes available.

The third priority problem area is summarized very simply in the word "training". We discussed lots of different aspects of problems in training. The core from which they emanate has a lot to do with the nature of the kind of workers we're usually employing in our animal research laboratory settings. For example, we're often using students or high turn-over technicians who don't have a lot of experience, and who therefore lack basic confidence in working with animals. And/or they may not be particularly experienced. They're in a learning phase regarding the procedures that they're doing in the laboratory. When they lack confidence in handling the animals and they lack confidence in the procedures that they're doing, they are often difficult, if not impossible, to train adequately. Or by the time you get them trained, they're gone and you start all over. This is a recurring theme.

Another problem in the area of training is that the animal care givers and the principal research investigators don't talk to each other very often. This seems to be a very real problem. So, we spent some time talking about creative ways to try to get each side to communicate better; to encourage the investigators and the animal care givers to get a better idea of what each other are doing so we are all singing from the same sheet of music.

That's essentially our priority problem list. Three categories. First, this mismatch of technology that's developing very rapidly to effectively prevent sharps injuries in patient care which is not being applied in animal research. Secondly, we need to build a strong infrastructure to bring new safety technology into animal laboratory studies and facilities. The third is training, the need for a focus on creative ways for training.

Now on to our priority wish list. Given all these problems, if we could just do a few things quickly, what would we want to do? First, a clearing house on safety device products, their performance, and their efficacy. Everybody wants that. We didn't decide who ought to do it or how it might be done. We just know we want it.

Secondly, specific research and development involvement for the creation of sharps injury prevention devices in the animal care facilities, in animal handling, and in veterinary medicine. One thing that we've clearly seen in medical device manufacturing in the last few years has been second and third generation sharps injury prevention technology development based on the needs expressed by the front line health care workers. What procedures are they performing? There have been studies of the ergonomics associated with their work stations and problems based on the actual use of instruments in patient care. We don't have anything like that in veterinary medicine or in animal care. So, the second item on our priority wish list would be direct involvement in research and development between animal care laboratory research folks and the people who are manufacturing and designing safer veterinary medical devices.

Third, since so many of the problems that were discussed in our horror stories had to do with syringes and carting them around and disassembling and reassembling for multiple injection purposes, we had a lot of talk about some kind of better, easier, mor accessible needle cap holders. Something specific to cap and recap for multiple use syringes. It is a real problem. CDC guidelines and OSHA regulations say "thou shalt not recap," and that is in fact clearly a procedure that needs to be performed commonly in animal research. There needs to be some way to do that without trying to do a single-hand resheath, as we might do in a health care setting.

Our final item on the wish list, which has a couple of sub-headings, is simply better and faster trickle down of information regarding the development of new technologies and safer medical devices. We had a couple of ideas on how to do that. First of all, the use of on-line bulletin boards. There are several that members of our breakout group talked about where occasionally you pick up an item, but if we had a concerted effort on some of these information bulletin boards (taking advantage of Internet access and on-line services) to specifically disseminate information on products, tests in the field of efficacy, safety performance, etc., that would be a big help to overcome the problem and infrastructure that I mentioned that you typically don't have in animal research facilities. A committee or some group of folks could get information quickly. Secondly, sometimes the easiest answer is the one right in front of your nose and you miss it: have exhibitors of the safety products, who typically go to professional medical society meetings, demonstrate and exhibit their injury-prevention devices and sharps disposal devices and products at meeting such as this one on biosafety. Also specifically at veterinary society meetings, probably in every state, and at other professional groups like AAALS, the American Association for Animal Laboratory Science.

A new publication on sharps disposal containers will be available from NIOSH by November, 1996 [1800-35-NIOSH].

Office of Health and Safety, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mail Stop F05 Atlanta, Georgia 30333, USA Last Modified: 1/2/97
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Sharps Management in Animal Care