Project Needle Smart

State: NY Type: Model Practice Year: 2014

Greene County Public Health Department (GCPHD) is located in Catskill, New York. The public health issue began with Greene County Solid Waste Department (GCSW)staff being exposed to large amount of "home" sharps at a GCSW transfer station. This was a large spill of insulin syringes that put many employees at risk for a bloodborne pathogen exposure. Due to this incident, the GCSW department brought this issue to GCPHD and the County Bloodborne Pathogen Committee. The committees' objective was to evaluate those at risk and find solutions to reduce or eliminate risk of bloodborne pathogen exposure if possible. This began with GCPH examining the protocol for disposal of home sharps and how can home sharps be removed from transfer stations and landfills and still be safely disposed of. The solution would involve community stakeholders, ie., local pharmacies, local long-term care facilities, GCSW staff, County union representation, local urgent care facilities, New York State Department of Health, local sanitation haulers, and 2 nursing homes (Kaaterskill and The Pines) run by Columbia Memorial Hospital. Project Needle Smart was officially implemented in June 2011, after extensive work on policies and procedures, community education planning, collaborating with the NYS DOH Expanded Syringe Access Program (ESAP) and all the stakeholders as well as obtaining county leadership buy in. GCPHD utilized a Master's in Public Health student intern from the State University of New York at Albany to initiate the application process with NYSDOH,collaborate on policies and procedures with NYS DOH ESAP staff, Centro Civico INC. and those in the community willing to accept a kiosk at their site. One of the biggest challenges was getting corporate approval from CVS Pharmacy. The student intern was able to follow the appropriate steps necessary to secure their corporate approval. This is the first needle disposal contract in the county for CVS Pharmacy. GCSW department would be responsible for accepting and mounting the kiosk's at their predetermined sites as well as emptying them monthly. Two local pharmacies, Emurgent Care, and the County Office Building accepted a kiosk a their site. The long-term care facilities worked with GCSW on accepting the kiosk contents at their facilities to be transported for incineration. GCPHD would manage the program by ordering supplies and tracking paperwork for reports to the NYS DOH. Once the infrastructure for the program was intact, community education began. The results of Project Needle Smart in Greene County have been remarkable. Since the program was initiated, there have been no other reports of sharps at the transfer stations in the county. This project has offered proper disposal of home sharps which has prevented injury, illness, and pollution. The success of this program has increased the demand for additional kiosks. In January 2012, a new kiosk was placed in another locally owned pharmacy. The strategically located kiosks have assisted those utilizing the program, making it more convenient to dispose of their sharps. The primary objective of reducing the risk of exposure to County Solid Waste employees has been met. Although it is impossible to eliminate the risk of exposure to staff, Project Needle Smart has removed hundreds of pounds of home sharps from the transfer stations and landfills. The biggest factor that led to the success of Project Needle Smart was the buy in by all of the stakeholders. Each Discipline saw the need in the proper and safe disposal of home sharps in our community. The main public health impact of Project Needle Smart in Greene County is the removal of home sharps from our transfer stations and landfills. Through Community education, the residents of Greene County have learned and taken advantage of an alternative way to dispose of sharps safely, reducing injury and illness to others.
Greene County Public Health Department (GCPHD) is a partial service health department that consists of a Diagnostic and Treatment Center, Early Intervention program, Preschool program, Public Health preparedness, Public Health Education and Family Planning. Greene County's 48,992 residents are spread out over 648 square miles (77 person/sq. mi.) and live in 15 towns and 5 villages throughout Greene County. Towns include: Ashland, Athens, Cairo, Catskill, Coxsackie, Durham, Greenville, Halcott,Hunter, Jewett, Lexington, New Baltimore, Prattsville, Tannersville, and Windham. Villages include Athens, Catskill, Coxsackie, Hunter, and Tannersville. Catskill is the most populated town with close to 11,900 residents, followed by Coxsackie with close to 9,000 residents. Greene County is situated between the mile wide Hudson River on the east and the Catskill Mountains at the southern and western ends. Greene County is bordered by Albany County to the north, Rensselaer County to the northeast, Columbia County to the east, Ulster County to the south, Delaware County to the west, and Schoharie County to the northwest. The county is located just two hours north of the major metropolitan areas of New York City, New York's Tech Valley region, and a half-hour south of New York State's Albany's Capital District and is easily accessible to the NYS Thruway and nearby air, rail, and bus lines.Greene County's population is racially homogeneous, with 90% of residents being white and approximately 6% of residents are black. The median estimated income for Greene County in '08 was $44,966 with 20% of household earning between $50,000 - $74,999. Greene County's median household income is less than the median income for both NYS($53,448) and the USA households ($50,740). Close to 40% of Greene county residents are low income and moderate income, earning 80% or less of the area median income. In addition, close to 13% of Greene County's residents are below the poverty level. About two thirds of Greene County's population is between ages 5-54. The two age groups that have seen the largest increase in population since 2000 are 15-24 and 55-64. In 2008 Greene County Solid Waste Department (GCSW)reported a needle spill at the local transfer station in Catskill. This consisted of a fair number of home sharps (insulin syringes) disposed improperly in the garbage, potentially exposing employees working at the facility. Another, much larger needle spill was reported two months later to the GCPHD requesting assistance with proper clean up. GCSW brought this potential public health hazard before the county's Bloodborne Pathogen Committee, which GCPHD chairs. Due to the Severity of the spill, especially the second spill in November 2008, both the Health Department and the Committee at large needed to examine a way that would reduce the risk of exposure to others. This particular scenario noted thousands of home sharps (insulin syringes) that were properly disposed of in a puncture resistant containers and taped up. However, at the transfer station, once a dump trailer is full, county employees need to tamp the contents of the full trailer down with a front loader and staff then walk on the trailer top to attach the top netting to secure the contents for transfer to an out of county dump site. During this process, the home sharps in their plastic coffee containers broke open and thousands of syringes were on top and spilled over the side of the trailer with staff, potentially exposed. Although proper personal protective equipment was used by staff, the potential for exposure was evident.The target population initially was to reduce the risk of bloodborne pathogen exposure to those working in sanitation. Even commercial sanitation haulers bear the risk of exposure, along with staff working at the transfer stations and dump facilities. However,the community at large can be a target group as well; care givers for those needing home injections are at risk, as well as the population that engages in illegal drug activity.Proper anonymous disposal of needles could potentially reduce the numbers sharing contaminated needles. As this project has evolved, the statistical information on the amount of sharps being processed is growing. In order to be accessible to the entire rural county, the kiosks were strategically placed throughout the county to accommodate the mountaintop area, the valley towns as well as the northern portion of the county. Due to the anonymity of the program, actual percentage of the population utilizing the kiosk is hard to determine. However, statistically the number in pounds of home sharps being collected has increased over the last 2.5 years as seen in the attached chart. This is a significant amount of potentially infected sharps removed from transfer stations and landfills, reducing exposure and illness. Previously, there were no official reports of home sharp spillage in the past at the transfer stations or landfill noted. Those needing to dispose of home sharps could take them to the local long-term care facilities in the county; however, both of them are located in Catskill, and the timeframe specified by these facilities to bring home sharps was very limited. Through research conducted with the long-term care stakeholders, such disposal facilities were underutilized. Since the early 1990's however with reporting the increases in HIV/AIDS, the community at large became more sensitive regarding bloodborne pathogens and exposure risk, especially occupationally. The Occupational Safety and Health Administration (OSHA) instituted the Bloodborne Pathogen Standard.It also targets those occupations at the highest risk for exposure to blood and other potentially infectious material while performing their work duties. This kiosk program assists in reducing the number of sharps at our transfer stations and landfills and essentially serves as an engineering control to reduce potential exposure. The kiosk program is an alternative for residents to dispose of home sharps at their convenience as well. Long-term care facilities have a limited timeframe each week that they can accept home sharps and per the long-term stakeholders, it was under utilized by the community. As more and more residents with home sharps begin to take advantage of the kiosk program, less sharps will make it to transfer stations and landfills.Education regarding this program was essential to receiving buy in by our stakeholders. Project Needle Smart in conjunction with ESAP personnel put together a comprehensive training day for all those that would be involved in the overall implementation and success of the program. Members of the GCSW department were trained using the actual equipment on how to remove sharps from the kiosks as they were going to be the group responsible for the pick up on a monthly basis. The long-term care stakeholders were able to meet and discuss how and when the kiosks sharps could be taken to their facility for eventual incineration. Both long-term care facilities were enthusiastic to participate in any way to assure a streamline process for the GCSW employees upon delivery. Local pharmacies were also involved in the education training on what the kiosks look like, how they will be secured at their facilities and the free sharp containers that can be given to anyone utilizing the kiosks. County union representatives were invited to view this training to assure that county personnel were receptive and safe with the new task they would be responsible for. Public Health would administratively manage the program with relation to organizing the delivery of the kiosks, setting up the contracts with those agreeing to have a kiosk on or in their facility, developing policies and procedures for the program, as well as ordering supplies, such as kiosk sharp bins,tongs, special gloves, and sharps containers. Public Health would also be responsible for compiling the statistics monthly and reporting out to the stakeholders. The program has been operational for 2.5 years now and appears to be well received by the community. Home sharps have been identified as a public health hazard occupationally and the kiosk program has been an innovative way to remove the threat of exposure to sanitation staff and others. Residents throughout the county appreciate the convenience of the kiosks as well as the easy accessibility of the kiosks.
HIV in the U.S.
The goals and objectives of the project were initially to reduce or eliminate exposure to bloodborne pathogens for county solid waste employees and those working in sanitation,by removing as many home sharps from our transfer stations and landfills possible. This required an alternative way to dispose of home sharps safely.The Greene County Bloodborne Pathogen Committee decided to explore other ways for residents to dispose of their home sharps by evaluating what other counties were doing to address this problem. NYS DOH Expanded Syringes Access Program (ESAP) was addressing the need for safe disposal of home sharps through their Kiosk program. Centro Civico, Inc. manages the ESAP program in Montgomery and Albany counties and were excited for ESAP expanding south of the Capital Region area. This group was vital in assisting Greene County through this process. GCPH in conjunctions with the County bloodborne Pathogen Committee, brought all the potential stakeholders together, Pharmacies, Emurgent Care facilities,Solid waste personnel, union representatives, Long-term care facilities, County Attorney and Public Health personnel to present the Kiosk program and provide time for questions and answers. Centro Civico Inc. staff had a power point presentation for the stakeholders to view as well as a scaled down version of an actual Kiosk and all the supplies used in emptying it. It prompted great discussion amongst all those who attended and they were able to answer many questions and give interesting examples of situations that had arisen in Albany and Montgomery counties. After the initial presentation, all of the stakeholders had buy in and wanted to do their part in initiating this program. The Kiosk program was an ideal project for a Master's in Public Health student intern. She acted as the project manager and worked on the project for over 4 months. She was able to complete the application process and secure 2 pharmacies, and Emurgent Care facility and the County Office Building for Kiosk sites. CVS Pharmacy in Cairo New York is the only CVS in the country to initiate a needle disposal program. The corporate approval process was time intensive but the location for this part of the county was crucial. The project manager met with GCSW staff and the Long-term care staff to discuss their roles in emptying the Kiosks and delivering the content to the Long-term care facilities to be shipped out for incineration. Bringing these two partners together allowed them to set up schedules, gain access to drop off contents , review paperwork and trouble shoot different scenarios. Public Health staff also had meetings with the Kiosk site managers, to review necessary paperwork, storage of sharps containers, and the ordering protocol. Whenm the Kiosks were delivered there was publicity in local print and radio media for residents. A strong education push regarding the Kiosk program was initiated with PSA's, newsletters and Kiosk flyers to all pharmacies, provider offices and community based events.The Greene County Legislative Health Committee had previously approved the application process, but the project manager prior to completing her internship, did a full presentation to the committee. The Committee appreciated the innovative approach to reduce illness and injury. From the onset of the significant needle spill in November 2008 until the project was up and running for the public, was approximately 2.5 years of collaborating and planning. A time line has been attached for review. The program has been running in Greene County for 2.5 years and has noted an increase each year in the pounds of sharps collected. In 2011, from June until December, 546 pounds of home sharps were collected. In 2012, 1,257 pounds of home sharps were collected and thus far in 2013 1,025 pounds collected via the Kiosk program. The Mobilization for Action through Planning and Partnerships Committee acted as a vital resource to introduce the program to the community stakeholders as well. The Greene County MAPP committee meets monthly and the Kiosk program was part of their agenda throughout the planning process. When the program was complete, the full MAPP committee received an overview and each stakeholder was versed in the benefits of using the Kiosk program for home sharps disposal for their particular discipline.
The Kiosk program has been underway in Greene County for 2.5 years. The success of the program is gauged by the pounds of sharps being collected on a monthly basis from each Kiosk site. In addition, noting no reporting of home sharps being dumped at the transfer stations in the county as well as no reports of employee exposure to potentially infectious material at the sanitation facilities.The original objectives were to evaluate the current disposal of home sharps and to reduce or eliminate potential exposure to employees to bloodborne pathogens at the county solid waste transfer stations and landfills due to a large needle spill at a county facility. The Kiosk program has served as a safe alternative method for residents to dispose of home sharps; keeping these out of our sanitation facilities that can pose a risk to all who work there. The increased numbers, in pounds of home sharps collected, continue to increase each year. This increase notes the effectiveness of the education and outreach done by all our stakeholders. In addition there have been no exposure incidents at any of the transfer stations in the county. Solid Waste officials have noted very few residents bringing identified home sharps to their facilities. Those who do identify home sharps, are instructed to bring them to the many kiosks sites in the county. Each transfer station has signage clearly displayed on the proper disposal of home sharps and the locations of all the County kiosk sites. As part of this program, the GCPHD will continue to track usage at each Kiosk facility. GCSW may have to alter their scheduled pick ups at certain facilities based on trends noted at kiosk sites. The evaluation process is outcome driven. The higher number of pounds of sharps collected at these kiosk results in the lower number of home sharps being disposed of improperly at the sanitation facilities posing the risk of injury and illness.
There have been lessons learned through Project Needle smart. Initially,residents unfamiliar with the program used the kiosks for disposing of trash at times, loose syringes were deposited, containers too large to fit through the kiosk opening were left and clogged the container, preventing others from accessing it. However, with continued community education, through provider newsletters, PSA's, and outreach by public health and family planning health educators, residents have familiarized themselves on what is acceptable for the kiosk. Partner collaboration was the most significant part of this project since its inception. Some of the lessons learned with partner collaboration dealt with communication among stakeholders. For instance, some pharmacy staff were unaware of what to do if a kiosk is clogged, or full. Education was needed on where to obtain additional sharps containers, and who can sign for a kiosk pick up. These issues were handled by putting together literature for all pharmacy staff to review in the event that the kiosk manager was unavailable. Another example would be signage on the kiosk to advise residents where to go if that particular kiosk is full. Long-term care facilities admitted that, in the past, the home sharps program at their facilities were underutilized. The stringent time frames that residents could drop off their home sharps were inconvenient and very limited. As for sharps at the transfer stations, there were no documented incidents prior to 2008, however that large spill and potential exposure was significant enough to demand changes. Project Needle Smart could address both needs. There is no cost analysis available for this new practice. The only cost to the county was the initial manpower to mount to kiosks at each site and the manpower to empty each kiosk monthly by the GCSW department. However,GCSW administrators were able to schedule these pickups for their staff while they were scheduled to be in that particular town. This prevented overtime issues, additional travel costs, and made it sustainable for the County. Supplies for the kiosks are free to the program and there are limited printing costs for the health department to incur. This program, through the assistance of the NYS DOH ESAP makes it very sustainable for GCPHD. The stakeholders involved are committed to the success of this program for the long term. As long as NYS DOH ESAP is able to provide the needed supplies,GCSW and GCPHD will continue to earmark the operational staff as well as the managerial staff necessary to effectively run the program.
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