January 8, 2012
By Christine M. Lederer
Unregulated disposal of household needles poses a serious threat to the safety of municipal solid waste workers. For example, a 44-year old trash collector stuck in the leg with a needle while on the job began having stomach pains a year later. His doctor told him that he had contracted Hepatitis C, probably from the needle stick the year prior. The doctors have been unable to help him and he is now in chronic liver failure, likely to die from the disease. As this case indicates, the threat of needle (also referred to as sharps) injuries to the municipal solid waste (MSW) occupation is a serious threat. Needle stick injuries are not only a threat to MSW collectors, but also to workers employed at material recovery facilities (MRFs) and transfer stations. Because MSW workers have direct contact with waste during all phases of MSW handling, from collection to recycling and ultimately to disposal in landfills, they have an alarmingly increased risk of accidental needle stick injuries.
Needle sticks subject MSW workers to potentially life-threatening diseases from contaminated needles. Needle sticks may also result in the transfer of external costs to the public or private waste management companies, the employees’ families and their communities. This article argues that it is imperative to regulate household sharps disposal. It further contends that the regulatory approach need not be complicated or expensive; the benefits of regulating household sharps will outweigh the costs.
I. The Municipal Solid Waste Process and the Danger to MSW Workers
During the years 1992 through 1997, the Bureau of Labor Statistics (BLS) identified municipal solid waste collection as one of the most dangerous U.S. professions. A study based on Florida MSW collectors from 1996 BLS data concluded that waste collectors were injured at a rate of 80 injuries per 100 collectors per year, and that MSW collection was the seventh riskiest occupation in the United States. There are various health and safety risks attributable to these injuries, one of which is created by the source of household waste: individuals who dispose of used needles. Because of changes in MSW processing, the number of MSW workers exposed to risk of injury is expected to rise.
Various sources indicate different figures for the number of MSW landfills in the 1990s and the number that are currently open. However, regardless of the data source, the result is the same: there have been a significant number of landfill closures in the past two decades. The U.S. Environmental Protection Agency (EPA) reports a decline in the number of operating landfills from 7,683 in 1986 to 5,345 in 1992. As a result of stringent federal and state regulations placed upon landfills, the number of operating municipal landfills has decreased to approximately 1,800 today. At the same time that MSW landfills are closing, the amount of waste produced by Americans is increasing. According to EPA figures, solid waste generation increased from 3.66 to 4.34 pounds per person per day between 1980 and 2009. In order for existing landfills to accommodate the increasing production of waste for as long as possible, there is an urgent need to reduce the amount of MSW reaching landfills. As a result, states have been establishing recycling goals ranging from as little as 25 percent to as much as nearly 80 percent. In order to meet these recycling goals, recycling efforts are on the rise, and workers come in contact with MSW beyond the typical collection process.
A. Materials Recovery Facilities and Transfer Stations
One way the MSW industry is dealing with the increased recycling is the use of materials recovery facilities (MRFs [pronounced “mərfs”]) and transfer stations. MRFs are similar to transfer stations in that each is designed to be an intermediary between collection and disposal. MRFs receive commingled recyclables and separate each type of recyclable (e.g., paper, plastic, glass) prior to recycling. Transfer stations receive MSW that will eventually be trucked to remote landfills. The efficiency of MRFs and transfer stations provide economic benefits; however, even with advanced technological processes, workers are still in direct contact with MSW and subject to accidental needle sticks with improperly discarded sharps.
B. Risks of Needle Sticks to MSW Workers
Improperly discarded needles pose serious health risks to workers who collect and sort waste. Gloves are not sufficient to protect MSW workers from accidental needle sticks, as needles are able to pierce the material. Even the smallest needles can pierce heavy garments and puncture skin. Accidental needle stick injuries can put the victim at risk for HIV, hepatitis or tetanus that could lead to life-threatening or long-term chronic disease.
Even if well-intentioned individuals dispose of needles in hard plastic containers, such as bleach or detergent bottles (pursuant to EPA’s previously recommended guidelines), there is still the danger of MSW workers being injured. Plastic containers containing sharps are likely to burst open when compressed in garbage trucks during collection, which then may injure workers either during the collection process or when delivered to MRFs and transfer stations.
Accidental needle stick injuries pose a considerable expense to the MSW employer as well. An employee stuck by a needle will most certainly require medical testing to ensure that he did not contract a disease from a contaminated needle. There may be an increase in missed days from work and lost time, in addition to an increase in workers’ compensation costs. Additionally, there are spillover costs related to the many externalities associated with the risk of injury to MSW workers. A governmental entity providing MSW services will need to pass on these external (or spillover) costs incurred to its citizens, either by an increase in taxes or a decrease in community services it offers.
Due to rising healthcare costs and the ability of individuals to provide their own injections, household use of needles is increasing. As of 2004, the Coalition for Safe Community Needle Disposal estimated that as many as 8 to 9 million Americans administered their own injections at home and that more than 3 billion syringes and lancets are disposed of in the household trash each year. It is expected that there will be a 165 percent increase in Americans diagnosed with diabetes over the next 50 years, which will only add to the needle disposal problem.
The increased household use and disposal of needles, coupled with the proliferation of MRFs and transfer stations, create an urgent need for the regulation of household sharps disposal in order to protect MSW workers from unnecessary contact with contaminated needles. Sharps pose the greatest danger to healthcare and waste disposal workers; however, the healthcare industry is regulated while households are not.
II. Current Regulatory Structure for Sharps Disposal
The federal regulation of medical waste has focused its efforts on typical generators of medical waste, such as hospitals, and has overlooked small generators of sharps, such as in-home healthcare patients, which dispose of a considerable amount of needles each year. Because hospitals generate the majority of medical waste, medical waste management regulation and guidelines target this industry. Other targeted generators include nursing homes, clinics and physicians’ offices, dental practices, laboratories, and, to a lesser degree, funeral homes, medical/nursing schools, veterinarians, hospices and emergency medical services. While much literature discusses the overwhelming confusion surrounding the range of definitions of medical waste, it is well established that infectious waste is a subset of medical waste, and that sharps are considered infectious waste.
Even though there has been a noticeable movement toward increased home healthcare, most states provide regulatory exemptions for household generators of medical waste – and more specifically, sharps. The incentive to “cheat” by improperly disposing of needles is generally one of convenience. However, because an increase in regulation often leads to an increased expense for those being regulated, the incentive to cheat may also be related to individuals weighing the risk of being caught for improperly disposing of needles versus paying for proper disposal.
The unnecessary risk to MSW workers of improperly disposed household sharps has not been addressed for various reasons. To date, the focus of accidental needle sticks has been more on the healthcare industry and protecting its workers. Understandably so, because healthcare workers are in direct contact with needles all day, every day. However, with the change in MSW processes and the increase in home healthcare, the risks for MSW workers are increasing and the industry is faced with a new problem.
Improper disposal of household needles has not been brought to the public’s attention because the amount of this waste pales in comparison to that of healthcare facilities. Therefore, the focus has been on healthcare workers, and the risk to MSW workers has not been widely addressed. Below are some suggested solutions to the problem of improper disposal of household needles.
III. Proposed Regulation
A major obstacle regulating the disposal of household sharps is the ability to enforce the regulation. How does the government enforce a regulation when detection of non-compliance at the source is almost impossible? A waste collector who gets an accidental needle stick, in most instances, may be able to identify the household from which the refuse originated. However, with the increased use of MRFs and transfer stations, workers who come in contact with improperly disposed needles will have no way or determining from whose home the sharps originated. The government cannot simply employ trash police to filter through each household’s garbage. A proposed solution will need to take into account the difficulty of enforcement.
Solutions to combat the improper disposal of household needles should start with regulation on the state level. The only way to ensure compliance is to educate household users and make compliance of proper needle disposal as easy as possible. A 2005 literature review titled “Vaccinations for Waste-Handling Workers; A Review of the Literature” reported that needle stick injuries and sightings are rare in communities that have introduced sharps disposal programs. Implementing state regulation, as has been done in California, would at least require local governments to provide the means for achieving the goal.
Beyond the obvious approach of educating household needle users about proper disposal, the procedure for proper needle disposal needs streamlining. There should be as little burden imposed upon the individual as possible in order to ensure compliance. One way of achieving this goal is to provide proper disposal containers free of charge to individuals at the time of needle purchase. Just as necessary as ensuring accessibility to proper disposal containers, household users of needles should have convenient disposal locations. Ideally, at least pharmacies, drug stores and hospitals that sell needles to consumers should be required to accept sharps containers for disposal. Other facilities that would increase convenience are doctors’ offices, clinics and nursing facilities. However, simply requiring institutions that sell needles to take them back would be a sufficient start, as individuals could easily drop off filled sharps containers when they return to purchase additional needles.
Another option for proper disposal are state-of-the-art kiosks. Communities that use these kiosks typically place them in safe locations (such as police or fire stations) that are accessible 24 hours a day. Kiosks range in size from containing 8- to 28-gallon buckets, and range in price from $1,000 to $2,500, depending on the size of the bucket in the kiosk and the number of kiosks purchased. A couple of companies that sell the kiosks, in addition to providing the disposal services, are Stericycle and Johnson Environmental Products. One benefit of kiosks (versus returning used needles to pharmacies or drug stores) is privacy.
Reducing the burden on household users of needles is the best way to ensure compliance. This means imposing the cost of compliance on someone other than the individual. Therein lies the dilemma: Who is going to pay the cost for compliance with regulation of household needle disposal? Pharmaceutical and device manufacturers, pharmacies, and doctors wield considerable power financially and through lobbying. Pinning the responsibility for compliance on any one industry would result in failure. In these stressful economic times, the local, state and federal governments are strapped for cash and cannot carry the financial burden. Various stakeholders should share the cost and responsibility for compliance. Because MSW managers bear the bulk of the costs if improperly disposed needles injure workers, there is an incentive for MSW managers to assist in the funding of specific collection options. The costs of kiosks pales in comparison to the medical and social costs associated with accidental needle sticks.
Municipal solid waste collection has been identified as one of the most dangerous professions in the United States, and more MSW workers are coming in direct contact with improperly disposed household needles. Add to the mix the fact that there is an expected increase in the number of diabetics and that more Americans are opting for home healthcare, and MSW workers are increasingly being subjected to accidental needle sticks. Accidental needle sticks not only result in additional expense to the MSW employer for medical testing of an employee, but there are numerous external costs to the employee, his family and the community.
Regulating the disposal of household needles does not need to be complicated or expensive. The costs of regulating disposal outweigh the risks to the MSW workers and society. The smaller the burden on the individual, the greater the likelihood of compliance. Providing information to needle users about proper disposal options, supplying the users with approved disposal containers and offering sufficient locations for disposal of containers full of used needles would invite participation and reduce the risk of accidental needle sticks to MSW workers. No one stakeholder will solve the problem; there needs to be a combined effort from all involved in order to prevent injuries among MSW workers from accidental needle sticks caused by improperly disposed household needles.
Christine Lederer earned her JD from Cleveland-Marshall College of Law and M.A. in Environmental Studies from Cleveland State University in 2011. She interned with the City of Houston and a private remediation company, participated in an environmental clinic with the City of Cleveland and was a 2010 Cleveland-Metropolitan Bar Association, Environmental Law Section, award recipient. You can contact her at 216-789-8382 or [email protected].