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The importance of safe needle disposal in COVID vaccination programmes

Nearly three billion doses of COVID-19 vaccines had been given worldwide by the middle of June this year, in six months since vaccination programmes started. In the richer western countries, which secured the majority of available vaccine doses in the middle of last year, the vaccination rates are far higher than the rest of the world. The vaccination rates have reached over 60% in countries such as Israel and the UK.

Worldwide, however, the picture is completely different. Out of a global population of 7.79 billion, just over 20% have been given at least one dose and this is, obviously, heavily weighted towards developed countries. In the African region, only about 2.5% have received at least one dose and in Asia around 22% – the majority of those in China. With around 80% of the global population still to receive any dose, that leaves billions of doses to be distributed and injected and potentially a further 7.8 billion if a third booster dose is needed to protect against SARS-CoV-2 variants.

Vaccination safety

vaccine doses

While the media focus, understandably, is on giving people vaccines, there is a mass of other materials required to administer the doses and manage the vaccination programmes. For every vaccine dose given, there is a syringe and a needle, plus the glass vials that contain several doses each, which, although they are made of toughened glass, are a breakage risk if handled badly. In addition, there’s non-sharps medical waste – including the packaging for needles, syringes and vaccines – and the PPE worn by medical and other staff in the vaccination centres.

Before the pandemic, around 16 billion injections were given worldwide every year, according to WHO. In the US, with its advanced healthcare facilities, exposure to blood-borne pathogens from needle and other sharps injuries is a serious problem, resulting in 385,000 incidents a year.

A study by WHO and UNICEF found only 58% of healthcare facilities in 24 low- and middle-income countries had adequate systems in place for the safe disposal of medical waste. The risk of catching COVID-19 from a needlestick injury is so far unknown, but the risks of catching the most common infections from infected patients via sharps injuries range from 30% for hepatitis B (HBV) to 1.8% for hepatitis C (HCV) and 0.3% for HIV. Mass vaccination programmes set up to process many people quickly in often temporary facilities will have a higher risk of poor handling and disposal of sharps.

Sharps injuries can occur at several stages during medical procedures, according to the Royal College of Nursing:

  • during use
  • after use, before disposal
  • between steps in procedures
  • during disposal
  • while resheathing or recapping a needle
Some one getting vaccinated

There are additional risks in the handling of medical waste, especially in low- and middle-income countries. Manual sorting of hazardous medical waste and scavenging on waste disposal sites put people at risk from sharps injuries and exposure to toxic or infectious materials.

While the majority of sharps injuries don’t cause infections, they can cause unnecessary stress and fear while waiting for diagnosis, undergoing blood tests and taking any treatment, which can be debilitating for antiviral drugs.

There’s no evidence yet that SARS-CoV-2 (the virus that causes COVID-19) can be transmitted in blood. Therefore, the main risks from sharps injuries are HBV, HCV and HIV. There are lesser risks from several other viruses, including Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Parvovirus B19, transfusion-transmitted virus (TTV), West Nile virus (WNV) and also malarial parasites (Plasmodium species) and prion agents.

Safe disposal of sharps

According to WHO, the most common problem with the safe disposal of sharps and other medical waste is the lack of awareness of the health hazards, which results in:

  • inadequate training in proper waste management
  • absence of waste management and disposal systems
  • insufficient financial and human resources
  • low priority given to waste management

Even in the UK, there are reports of poor clinical waste-handling in the vaccination programme, with sharps placed in general waste bins and bags instead of the proper hard plastic and sealed containers. This highlights the importance of proper training for staff at vaccination centres, who may be volunteers from a variety of backgrounds to fulfil the wide range of tasks needed to operate them.

The US CDC has produced guidelines for protecting staff in vaccination centres from needlestick injury.

  • Place sharps disposal containers as close as possible to the vaccinator or within arm’s reach. When a wall mount is not possible, set the container on a table or a cart in an upright position (preferably secured). Do not place sharps disposal containers on the floor or the ground.
  • Immediately after using a sharp, engage any safety feature, and place it in a sharps disposal container that is closable, puncture-resistant, leakproof on the sides and bottom, and biohazard-labeled or colour-coded.
  • Do not remove, recap, break, or bend contaminated needles or separate contaminated needles from syringes before discarding them into a sharps disposal container. Best practice is to immediately place the connected needle and syringe into the sharps disposal container.
  • Use sharps containers to dispose of needles and other sharps contaminated with blood or other potentially infectious material.
  • Close the container when it is filled to the clearly marked fill line or when it is ¾ full if it has no fill line.
  • Do not overfill sharps disposal containers – even during supply shortages – as this increases the risk of a needlestick injury and a blood-borne pathogen exposure.

Containers for sharps disposal

disposal bin

Containers certified to recognised standards for handling sharps waste (BS EN ISO 23907 and UN3291) are essential safety elements for vaccination centres. These standards ensure containers are resistant to puncture, do not leak and can be sealed properly.

There’s a range of sharps bins, trays and trolleys for handling, storing and disposing of sharps waste for differing sizes of vaccination centres. It’s important to have sufficient bins of the right capacity available to avoid overfilling and to make sure the sharps can be stored safely.

Sharps bins are colour-coded to show which type of waste they should contain.

Yellow-lidded Sharps Bins
For the storage and disposal of sharps containing or contaminated with medicinal products and their residues, such as needles used to give injections.

Orange-lidded Sharps Bins
For the storage and disposal of sharps that are not containing or contaminated with medicinal products or their residues, such as sharps used for blood samples.

Purple-lidded Sharps Bins
For the disposal of sharps, including those contaminated with cytotoxic or cytostatic medicinal products.

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