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Guidelines for Pharmacies Interested in Accepting Hypodermic Needles, Syringes and Other Sharps Used Outside of Health Care Settings for Safe Disposal

I. Purpose

This document provides guidance for New York State-licensed pharmacies interested in offering their customers who use syringes, lancets, and other "sharps" an added service of collecting used sharps at the pharmacy. By doing so, pharmacies can join with other local agencies and organizations to help safely remove used syringes and other sharps from their communities. This will help prevent these items from ending up on the streets, in parks, in schoolyards, in municipal wastewater treatment plants, in the solid waste stream, or in recycling.

Together, the NYS Department of Health (NYSDOH) and the NYS Department of Environmental Conservation (NYSDEC) seek to facilitate proper and safe disposal of hypodermic needles, syringes, lancets, and other sharps used outside of health care settings in communities statewide. NYSDOH and NYSDEC staff are available to provide technical assistance to interested pharmacies. Information on how to contact NYSDOH and NYDEC staff is included in Section V of these Guidelines.

II. Introduction

Pharmacies can play active roles in providing access to clean, new hypodermic needles and syringes and assuring their proper disposal after they have been used. To assure ready access to hypodermic needles and syringes, pharmacies may register to participate in the Expanded Syringe Access Demonstration Program (ESAP). ESAP registration enables pharmacies to sell hypodermic needles and syringes to individuals age 18 and over without a prescription.1 Information about ESAP, including the ESAP provider registration form, is available from the NYSDOH contact person listed in Section Vof these Guidelines and through the NYSDOH ESAP web site.

To promote safe disposal of used hypodermic needles and syringes, lancets, and other sharps used outside of health care settings, pharmacies can do the following:

  • Distribute copies of the ESAP brochure - also called the "safety insert" - which discusses safe disposal. ESAP requires all pharmacies to give a copy of this brochure to any person who receives syringes.
  • Make available the NYSDOH brochure How to Safely Dispose of Household Sharps.
  • Participate in local efforts to educate the public about the importance of safe and proper disposal of household sharps.
  • Refer individuals to local sharps disposal programs - in hospitals, nursing homes, and other settings.
  • Sell or furnish puncture-resistant containers for storing used sharps at home before disposal or provide sharps disposal by mail.
  • Accept hypodermic needles and syringes, lancets, and other sharps used by individuals outside of health care settings for safe disposal.

Pharmacy involvement in accepting used sharps for safe disposal is a well-established practice in various locations around the country, including San Francisco, Rhode Island, and Wisconsin.2-4Pharmacy acceptance of used sharps for safe disposal is supported by the American Pharmaceutical Association (APhA) policy statement on syringe disposal, which states that:

APhA supports collaboration with other interested health care organizations, public and environmental health groups, waste management groups, syringe manufacturers, health insurers and patient advocacy groups to develop and promote safer systems and procedures for the disposal of used needles and syringes by patients outside of healthcare facilities.5

While pharmacy acceptance of used sharps for safe disposal is not a widespread practice in New York State, results of a NYSDOH survey of pharmacies conducted in July 2000 revealed that many pharmacies were interested in doing so in the future.6Currently, in New York State, 19 pharmacies participate in the sharps disposal program. This suggests a commitment to community service, community health and safety, and the perception on the part of pharmacists that additional disposal options are needed in New York State. Experiences in other states attest to the fact that pharmacies in New York State can play a role in safe sharps disposal.

III. Pharmacy Acceptance of Sharps for Safe Disposal

Any NYS-based pharmacy interested in participating as safe sharps collection site must:

  • Register with the NYSDOH under ESAP as a collection site; and
  • Comply with NYSDEC regulated medical waste regulations.7

Pharmacies may also need to comply with the Federal Occupational Safety and Health Administration, U.S. Department of Labor. OSHA Directives CPL 2-2.69 - Enforcement procedures for the occupational exposure to blood borne pathogens 11/27/2001.8

Only household sharps - which include lancets, hypodermic needles and syringes used by individuals outside of health care settings - may be accepted by pharmacies. Sharps generated by a licensed health care provider offering services in the home, for example, may not be accepted. In this instance the home health care provider is responsible for the safe disposal of the sharps. Sharps brought to a pharmacy for disposal must be contained in sealed, rigid, puncture resistant, leak-proof containers. Customers with loose sharps should be advised to place them into puncture resistant containers such as sharps disposal containers or bleach or laundry detergent containers. Pharmacies may make such containers available to their customers.

Options available for pharmacies interested in offering their customers who use syringes, lancets and other "sharps" an added service of collecting used sharps include:

A. Installation of a tamper proof sharps collection "kiosk" or "drop box" for direct deposit of contained sharps by customers.

In this case, customers deposit contained sharps into "kiosks" or "drop boxes." Collection "kiosks" or "drop boxes" must be properly secured to assure that the contents, once deposited, cannot be removed except by authorized personnel. Only pharmacy staff or other appropriately trained personnel have access to the sharps. Collection "kiosks" or "drop boxes" must be maintained and cleaned appropriately. Sharps collected in the "kiosks" or "drop boxes" must be transported appropriately.

Pharmacies that locate a collection "kiosk" or "drop-box" on-site and that arrange with a health care facility or a regulated medical waste hauler to maintain and clean the "kiosk" or "drop-box" (including emergency clean-up of any spills), empty the "kiosk" or "drop-box," and pick up and transport the sharps are not subject to the OSHA provisions and are not required to develop an Exposure Control Plan..8

In this case, pharmacy staff would not be expected to come into contact with sharps and there would be no potential for occupational exposure.

If pharmacy staff will be handling the sharps - accepting them from customers for placement in a puncture resistant container behind the counter (see below); opening, cleaning or emptying a "kiosk" or "drop box," or transporting sharps for safe disposal - the pharmacy must develop an Exposure Control Plan (see Appendix 5) and comply with any pertinent OSHA provisions.8 A "Model Policies and Procedures" is included as Appendix 1.

B. Use of pharmacy staff to receive contained sharps from customers for placement into a receptacle "behind the counter" or in another secure location.

In this case, customers hand sharps that are already enclosed in sealed, puncture resistant containers to pharmacy staff for placement by staff into a container or receptacle.

Pharmacies whose staff are actively involved handling individuals' personal sharps containers for placement into a larger, puncture resistant container and/or opening and emptying a kiosk or receptacle and/or transport household sharps must have an Exposure Control Plan in place that describes how the pharmacy will address potential worker safety issues associated with the handling and transportation of residential sharps, including assuring compliance with OSHA standards for blood-borne pathogen.8 Pharmacies must assure that staff are aware of the risks associated with handling sharps and are knowledgeable about safe handling procedures. In this situation, an Exposure Control Plan should be established that describes the following:
  • All occupations in which individuals may, under reasonable situations, be at risk for needle stick injuries while on the job.
  • Potential circumstances that may lead to needle stick injury.
  • Engineering controls to prevent needle stick exposure or injury.
  • Availability of hepatitis B prophylaxis for employees determined to be at risk for needle stick injury.
  • Record keeping for employee training and needle stick injury incidents.

A "Model Policies and Procedures" is included as Appendix 1. A "Model Exposure Control Plan" is included as Appendix 5.

IV. Transport of Sharps for Safe Disposal

Sharps collected at a pharmacy must be transported to a NYSDEC-approved storage, treatment or disposal facility. This may be accomplished by the pharmacy itself or through an agreement with another entity. Each of these options is described below:

Option #1: Transport by the Pharmacy to an Approved "Storage, Treatment or Disposal Facility"

Pharmacies may transport less than 50 pounds of  "regulated medical waste" per month to a facility authorized to accept medical waste as long as they register their intent to transport and the final destination with NYSDEC. Appendix 2 contains the Regulated Medical Waste Self-Transport Registration Form that needs to be filed with the NYSDEC.

Option #2: Transport and Disposal by Another Entity

The pharmacy may enter into an agreement with an approved entity - either a health care facility licensed by NYSDOH under Article 28 of the NYS Public Health Law or a NYSDEC-permitted regulated medical waste hauler - to pick up, store and, if necessary, assure ultimate safe disposal of sharps. The pharmacy and transporting entity must have a signed agreement that specifies the roles and responsibilities of each party. This agreement must be submitted to both the NYSDEC and the NYSDOH. A Model Agreement for Sharps Transport and Disposal is included as Appendix 3.

Regardless of the disposal option selection, a Regulated Medical Waste Tracking Form must accompany all shipments of used sharps. The entity managing the "kiosk," "drop box," or other receptacle must maintain a copy of all tracking forms for a period of three years. A "Regulated Medical Waste Tracking Form" is included as Appendix 4.

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Questions and requests for technical assistance concerning pharmacy acceptance of hypodermic needles, syringes and other "sharps" used outside of health care settings for safe disposal can be directed as follows:

NYSDEC:

Division of Solid and Hazardous Materials, Bureau of Solid Waste and Management, Dr. Alan Woodard, (518) 402-8693.

  • NYSDEC Regulations
  • How to locate a NYSDEC-permitted Regulated Medical Waste Hauler
  • Pharmacy transport of collected "sharps"

NYSDOH:

Bureau of Narcotic Enforcement, Glenn DelGrosso, (518) 402-0707

  • ESAP registration

Bureau of Hospital Services, Delton Courtney, (518) 402-1004

  • How to locate a NYSDOH-approved health care facility

AIDS Institute Harm Reduction Unit, (212) 417-4770

  • General information about the Expanded Syringe Access Demonstration Program (ESAP)

Notes

  1. Klein SJ, Birkhead GS, Candelas AR. Expanded syringe access demonstration program in New York State: an intervention to prevent HIV/AIDS transmission. J Urban Health: Bulletin of the New York Academy of Medicine. 2000; 77(4): 762-767.
  2. American Pharmaceutical Association House of Delegates. 2001. Policy Statement New Business Item - Subject: Syringe Disposal. Adopted March 17-20, 2001. Accessed on February 12, 2002 at: www.aphanet.org/govt/hod_action.pdf
  3. Michaels J. Norcal Waste System, Sanitary Fill Company. San Francisco Safe Needle Disposal Program: Program Overview. Presented at: Safe Community Syringe Disposal: Understanding the Barriers and Creating Solutions. Convened by: American Pharmaceutical Association. January 29-30, 2001. Washington DC.
  4. Diabetes Foundation of Rhode Island. June 22, 2001. The SharpSmart Program - One's State's answer to the public health crisis in residential needle disposal. Personal communication from Cherie Kear, Diabetes Foundation of Rhode Island.
  5. Derflinger B. How Wisconsin promotes sharps collection: Case studies of sharps collection programs in Wisconsin. Presented at: Safe Community Syringe Disposal: Understanding the Barriers and Created Solutions. Convened by: American Pharmaceutical Association. January 29-30, 2001. Washington DC.
  6. Klein SJ, Harris-Valente K, Candelas AR, Radigan M, Narcisse-Pean M, Tesoriero JM, Birkhead GS. What do pharmacists thinks about New York State's new non-prescription syringe sale program? Results of a survey. J Urban Health: Bulletin of the New York Academy of Medicine. 2001; 78(4): 679-689.
  7. NYS Department of Environmental Conservation. 6 NYCRR Parts 360 and 364. Available at : http://www.dec.state.ny.us/website/regs/index.html
  8. Occupational Safety and Health Administration, U.S. Department of Labor. OSHA Directives CPL 2-2.69 - Enforcement procedures for the occupational exposure to blood borne pathogens 11/27/2001. Available at:
    http://www.osha-slc.gov/OshDoc/Directive_pdf/CPL_2-2_69.pdf