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 Market Survey on Impact to Sharps
Injuries and the Environment

Table of contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Meeting the Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Study Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Demographics - who was surveyed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
Identifying the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Why Stericycle’s SMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Implementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Results
Staff Safety - Needlestick Reductions
Staff Response
Environmental Impact
November 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

TM

PROTECTING PEOPLE. REDUCING RISK.

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 Executive Summary
Hospitals today are under increasing pressure to deliver cost
effective quality care in a safe and clean environment. Although
there are obvious variables that contribute to the patient
experience, administrations must also identify and improve on
processes that have an indirect effect on clinical care. Sharps
Injuries (SIs) can influence patient and staff satisfaction in two
key ways:
1) distracting healthcare workers from their primary
responsibilities – nursing from patient care and
housekeeping in providing a clean patient room
2) increasing the occupational risk to all hospital staff
to bloodborne pathogens, especially hepatitis B and
C viruses and human immunodeficiency virus 1
The government response to the risk of SIs from the US
Occupational Safety and Health Administration (OSHA) has
been the release of the Bloodborne Pathogens Standard to
improve the workplace setting against disease transmission
in 1991. In 2001, the US Congress passed the Needlestick
and Safety and Prevention Act directing OSHA to establish
detailed requirements to ensure employers identify and make
use of effective and safer medical devices.3
In spite of these regulations, SIs continue to be a category
of occupational risk for healthcare workers. 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 System for Health
Care Workers (NaSH) and estimated that 384,325 SIs occur
every year.4 However due to a lack of a national systemic data
collection process, the true number of injuries is unknown, with
an estimate for underreporting placing the total annual number
of SIs in excess of 576, 000.5 Detailed analysis of SIs collected via
NaSH reveals that 16% of SIs occurs during or after disposal.5
This article will report the impact of Stericycle’s Sharps Management
Service (SMS) and the BioSystems reusable sharps containers
on hospitals with regards to SIs and risk exposure. A national
telephone survey was conducted with hospitals using SMS to
determine its impact on employee exposure to SIs as well as
impact to the environment. Survey demographics included:
s Survey participants primarily worked in Infection
Control or Environmental Services.
s Current users of the SMS averaging 3.5 years
Hospital size ranged from 69 to > 2000 licensed beds.
Survey highlights reflected that since implementing the SMS:
s 100% of respondents indicated a significant decline in
disposal needle sticks with 77% averaging 0 – 1/year.
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s 85% agreed that utilizing the SMS increased safety
outcomes due to the proactive exchange of the
BioSystems containers by Stericycle technicians.
s 91% agreed that using the Sharps Management
Service is a clinical best practice.
s 100% preferred the reusable container for its positive
environmental impact.
s 100% of clinicians like the open vertical drop for ease of use.
s 90% responded that they would highly recommend
Stericycle’s Sharps Management Service to their peers
at other hospitals and plan to continue to use the service.
With this increased regulatory and public awareness regarding
the impact of waste on the environment and the demands
on hospitals to manage and decrease the generation and
treatment of medical waste, Stericycle Sharps Management
Service provides hospitals with a program to help meet these
demands and focus on providing patient care.
PROCEDURAL PERIOD
METHODOLOGY (PPM) (SIDEBAR 1)
PPM is a classification system introduced by the Infection
Control Department of Brookdale University Hospital and
Medical Center (BUHMC) at the Association for Professionals
in Infection Control and Epidemiology (APIC) meeting, June
2006.6 Sharps injuries (SIs) were analyzed and segregated
into five major segments in the procedure timeline. An SI
could potentially occur in any of these five time periods.
Phase 1 – The period from when the cover of the sharps
device is removed to the point when the sharp
contacts the patient’s skin and/or body fluid;
Phase 2 – The period from the withdrawal point of needle
or other sharps device from the skin or other site;
Phase 3 – The period from withdrawal to the time the
worker begins the disposal process;
Phase 4 – The period of disposal into the sharps container;
Phase 5 – Any actions in handling the sharps containers, such
as occurs when the container is being replaced.
The PPM classification allows for detailed tracking by procedure
categorization and allows for prevention measures to be
tailored to specific areas of improvement/need.
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 Meeting the Challenge
REDUCE RISK TO STAFF WHILE BEING ENVIRONMENTALLY FRIENDLY
Increasingly in today’s 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

Stericycle’s 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.

STUDY OBJECTIVES Demographics

During 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 trends
during the disposal process due to vertical drop;
All geographic regions of the country (Figure 1) were
represented 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 or
Employee Health.

2) The influence of the Bio Systems reusable container Breakdown of interviewees are:
on staff, the hospital and the community at large and; 85% of the participants worked in Infection Control,
3) The direct impact of the SMS pro-active change out 11% in Environmental Services (EVS)
of the Bio Systems reusable containers (1/3 – 1/2 full 4% were in Employee Health or Risk Management.
when exchanged) on clinical staff.
The majority of participants, 72% had extensive experience
(over 5 years) in infection control expertise, with 40% of
Hospitals randomly chosen were current users of the Sharps
those having greater than 10 years. Professional titles can
Management Service.
vary from hospital to hospital, but included Director (9),
Manager (24), Practitioner (7) Coordinator (8), Safety Officer
A research tool was developed to address the above areas.
(2), Team leader (1) and Epidemiologist (1). All respondents
Each interview took approximately 20 minutes to complete.
were familiar with the SMS, the Bio Systems Reusable
An independent researcher was engaged to conduct the
Containers, their hospital’s process for measuring SIs and
surveys to ensure all data was obtained in an impartial and
the impact on staff, both clinical and non-clinical.
objective process. All data was consolidated to ensure
confidentiality of the hospital and participant.

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 FIGURE 1

Key 19 N/NE Hospitals

Surveyed States (NY,MA,NJ,PA,RI)

Not Surveyed States

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

15 West Hospitals
(CA,CO,AZ) 8 S/SE Hospitals
(TX,FL,TN,KY,SC,NC)

Table 1
Beds # Hospitals Respondents
69 – 100 5
101 – 299 16
300 – 500 15
500 – 699 8
700 – 999 6
> 1000 2

Table 2
# 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%

Table 3
Phase 4/5 Needle Sticks # % responses
0 21 40%
0-1 12 23%
2–5 7 13%
>5 1 2%
Unknown 9 17%
No change 2 4%

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 swap
out of sharps containers. In addition to their basic duties, EVS/
housekeeping was accountable for monitoring and removing
the 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

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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 be
checked 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 hospitals
were 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 Stericycle’s SMS using Bio Systems
Reusable Containers?
Why Stericycle’s SMS?
The process for choosing a partner for sharps management varied
for each hospital. In describing their role within the hospital
process for choosing SMS, 69% felt they played an active role
as 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 Systems
reusable 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 to
redirect 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.
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 System
for Healthcare Workers (NaSH) and estimated 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 placing
the 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. By
outsourcing 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 into
the 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 sharps
container 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.

Decrease SIs Risk (27%):

Closely related to the cost concerns was the need to reduce the
risk 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

Stericycle, Inc. SMS WHITE PAPER 4 www.stericycle.com

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 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 was
quickly eliminated as SMS technicians were professional,
responsive and followed specific hospital protocols as required.
It was felt that having an “expert” responsible for the monitoring
and 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 automatically
replaced 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 clean
and safe environment.
Regarding the staff acceptance of the Bio Systems reusable
sharps 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 regarding
the 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
CARBON ESTIMATOR
1 Reusable
Sharps Container
prevents 600
Disposable Containers
from going
into landfills.
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SMS White Paper (10-09).indd 8
and disinfected containers that were installed and replaced,
any apprehension regarding sanitary conditions of the
containers 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 gaining
access 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 pediatric
area, there was minimal to no reaction to the open vertical
design of the Bio Systems reusable sharps containers.
(SIDEBAR 2)
CARBON FOOTPRINT ESTIMATOR EXAMPLE
For a 200 bed acute care hospital, by using the Stericycle
Sharps Management Service and Bio Systems Reusable Sharps Containers
YOUR CO2 DIVERTED IS:
13,180 Pounds of CO2
This is equal to the following
statement below:
CO2 Emissions from
Gallons of Gasoline. 679 pounds
CO2 Emissions from
Propane Cylinders used 249 pounds
for Home Barbeques
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 Results
Sharp injury cases are segregated into five major segments Interviewees were questioned on their potential referral of
based on the procedure timeline. Phase IV involves the sharp the Stericycle SMS using Bio Systems reusable containers to
device disposal and Phase V defines any actions in handling the their hospital peers. On a scale of 1 – 10, 90% responded in
sharps container as during replacement. The survey questions the top two categories (9 or 10) that they would highly
were directed at the impact of SMS using Bio Systems reusable recommend Stericycle’s Sharps Management Service using
containers on the Phase IV and Phase V injury rate. Bio Systems reusable containers to their peers at other
hospitals and plan to continue to use the service. Overall,
Overall, since implementing the SMS using Bio Systems 92% responded in the top of the scale that their overall
reusable containers, hospital customers indicated that experience with Stericycle’s SMS service was “excellent”.
needlesticks associated with the sharps disposal (Phases
IV and V) fell significantly: In closing, when asked what they would say to their peers
s 63% experienced a decline of needle sticks to 0 – 1 per year; at a healthcare facility using disposable sharps containers,
comments included:
s 40% eliminated all Phase 4/5 needle sticks – a 100% reduction.
s 52% saw a greater that 30% reduction in disposal needle “Recommend everyone investigate the reusable system”
sticks after SMS was implemented. See Table 3 on page 3. “It is a win/win”
s 100% felt that the unique design of the container combined “Save the landfills, environmentally safe, earth friendly”
with pro-active swap out of the Bio Systems reusable
“This is the wave of the future”
containers contributed to the decline in needle sticks.
“Benefit is employee safety – safer all around”
For hospital staff, safety and risk reduction were the primary “This is easy, a seamless system, one person accountable”
goals of the SMS implementation. Regarding safety outcomes,
“Just do it! Only way to go”
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 Stericycle’s Sharps Management Service using Bio Systems
reusable containers by Stericycle Service Specialists. By eliminating reusable containers provides a comprehensive process
the need for hospital staff to handle the container exchange, that reduces risk to healthcare workers while decreasing
it directly decreased the staff exposure to injury. Applying the waste in our landfills. By providing service specialists that
same measurement scale, 91% “strongly agreed/agreed” that are responsible for managing the monitoring and disposal
using the Sharps Management Service with Bio Systems reusable of sharps containers, your staff can focus on their primary
containers is a clinical best practice. responsibilities of patient care and environmental services.

1 Beekmann SE, Henderson DK. Protection of healthcare workers from bloodborne pathogens. Curr Opin Infect Dis. 2005:18:331-6
2 Occupational Safety and Health Administration, Department of Labor. 29CFR Part 1910.1030, Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991:56:64004-182.
3 OSHA, Department of Labor, Bloodborne Pathogens and Needlestick Prevention. April 2001. Available 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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