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NYS Department of Health - Guidelines for Health Care Facilities

Guidelines for Health Care Facilities

Introduction

The New York State (NYS) Legislature amended New York State Public Health Law to authorize a demonstration program to expand access to sterile hypodermic needles and syringes effective January 1, 2001. This is a public health measure to prevent blood borne diseases; most notably HIV/AIDS and hepatitis B and hepatitis C. ESAP became effective January 1, 2001 and as of the summer of 2009, became a permanent program.

Health care facilities licensed under Article 28 of the NYS Public Health Law, licensed pharmacies, and health care practitioners who can otherwise prescribe hypodermic needles or syringes may register with the NYS Department of Health (NYSDOH) to sell or furnish up to 10 needles or syringes, without a prescription, to persons 18 years of age or older. Registered providers must cooperate in a program to assure safe disposal of used hypodermic needles or syringes. Hypodermic needles and syringes provided through ESAP are accompanied by a safety insert explaining proper use, risk of blood borne diseases, proper disposal, dangers of injection drug use, overdose, how to access drug treatment, and information about HIV/AIDS.

The decisions concerning how ESAP is implemented within a registered health care facility, including roles and responsibilities of personnel, are made by the facility. Health care facilities are required to develop policies and procedures regarding all services, including ESAP. These guidelines have been developed by the NYSDOH to assist health care facilities in meeting this requirement.

Registration for ESAP

Facilities must register to participate in ESAP. The ESAP registration packet allows for health care facilities to specify off-site locations from which they seek to sell or furnish hypodermic needles and syringes. In each case in which a facility has identified off-site locations, upon approval, separate registration certificates will be provided for each site. The registration certificate must be prominently displayed.

Policies and Procedures

Health care facilities must have policies and procedures, provide training to identified staff involved in ESAP, assure that syringes are properly secured and that handling and disposal is safeguarded, and adhere to the overall requirements of ESAP.

Staff Training

Facilities are required to designate staff to perform ESAP-related activities and ensure that staff who furnish, sell, or accept syringes for disposal have appropriate training. Staff may be identified individually or certain classes of staff may be authorized to sell or furnish syringes on behalf of the facility. The regulations which define ESAP do not specify who within a registered health care facility may be involved in the sale and/or furnishing of syringes under ESAP. The fact that practitioners otherwise authorized to prescribe may also register as ESAP providers does not mean that, within a health care facility, only such practitioners can be involved in sale/furnishing.

Most staff are already mandated to receive training in infection control which includes:

  • facility procedures to ensure that hypodermic needles and syringes are properly secured and that their handling and disposal is safeguarded;
  • facility procedures for safe disposal of used hypodermic needles and syringes; and
  • prevention of needle-stick injuries and how to report needle-stick injuries.

All facilities participating in ESAP must cooperate with safe disposal of syringes. Staff should be educated about:

  • the locations of facilities that are mandated to accept syringes;
  • policies regarding disposal in their work areas, if applicable;
  • facility procedures to ensure that hypodermic needles and syringes are properly secured and that their handling and disposal is safeguarded; and
  • how to properly dispose of syringes in household waste

In addition, staff involved in selling or furnishing hypodermic needles and syringes under ESAP may benefit from further education. It would be beneficial for these staff to be familiar with the information on the safety insert that must be provided to patients each time they obtain hypodermic needles and syringes through ESAP. This insert explains proper use, risk of blood-borne diseases, proper disposal, dangers of injection drug use, overdose, how to access drug treatment, and information about HIV/AIDS.

Eligibility for Receipt of Hypodermic Needles and Syringes

A health care facility may choose to sell or furnish syringes to persons who are patients at the facility or extend the service to persons who are not patients at the facility. Only individuals 18 years and older may receive syringes under ESAP.

When Hypodermic Needles and Syringes May Be Furnished

Facilities must develop policies about when syringes will be furnished and whether they can be furnished only during scheduled visits (medical, case management, etc.) or if they can be furnished on a walk-in basis.

How Many Hypodermic Needles and Syringes May Be Distributed

Patients may receive up to 10 syringes per encounter. Facilities must decide how frequently eligible encounters may occur, such as on a daily or weekly basis.

Where Hypodermic Needles and Syringes May Be Furnished

A health care facility may choose a single location or multiple locations from which hypodermic needles and syringes will be furnished.  Each location must provide appropriate safeguards so that needles and syringes can be properly and safely secured.  Primary care clinics and pharmacies are examples of locations which offer such safeguards. As noted above, syringes and needles may be furnished at off-site locations, as long as each site is included in the facility’s registration.

Who May Furnish Hypodermic Needles and Syringes

Facilities must designate which staff/employees may provide syringes. Examples of staff whose training and function lend themselves to involvement in ESAP include licensed medical providers, pharmacists, case managers, counselors and other staff properly trained and authorized by the facility.

Distribution of Mandated Safety Insert

Each time a person receives needles and syringes, he or she must receive an ESAP safety insert (brochure). Facilities may choose to have the patient and staff member review together the safety insert and/or other educational materials regarding injection drug use.

Safety and Security of Syringes

Syringes distributed through ESAP must be stored in a manner consistent with the other clinic policies.

Disposal

All ESAP registrants agree to cooperate in the safe disposal of syringes. This cooperation ranges from the mandated provision of a safety insert that addresses safe disposal to accepting syringes for safe disposal. Hospitals and nursing homes are already required by NYS law to accept household sharps, including used needles and syringes. Clinics in these facilities should post the location, hours of operation, and packaging requirements for syringe disposal. ESAP providers not located at these facilities should be aware of disposal sites and communicate this information to its patients.

Other health care facilities - specifically, diagnostic and treatment centers - wishing to accept household sharps for safe disposal under ESAP must register with the NYS DOH for this program component.

Clinics that choose to accept syringes must establish appropriate policies, including:

  • where syringes will be accepted;
  • what sort of packaging will be required; and
  • availability of safety equipment (e.g., tongs, bleach, gloves).

ESAP providers should also educate consumers about appropriate disposal of sharps in household trash, with attention to local requirements.

Record-keeping

Documentation of furnishing or selling syringes should conform with the facility’s current record-keeping policies. ESAP registrants will be requested by the NYSDOH to voluntarily provide aggregate data on syringe transactions as part of the evaluation process.

Promotion of ESAP

Facilities are encouraged to educate and inform patients and the community at large about ESAP services within the facility. Community awareness will enhance participation and help meet the ESAP goal of preventing the spread of blood-borne diseases.

Sales

ESAP-registered facilities may either sell the syringes or furnish them for free.

What To Do if You Have Questions Concerning ESAP

Information about ESAP is available on this web site. Other questions concerning ESAP can be directed as follows:

  • ESAP registration process: Bureau of Narcotic Enforcement (518) 402-0707.
  • Health Care Facility requirements: Bureau of Hospital and Primary Care Services at (518) 402-1003.
  • Other program information: AIDS Institute at (212) 417-4770.
  • By e-mail to: ESAP@health.state.ny.us.