Current practicesBased on discussions with NSP coordinators, there are a variety of practices employed and/or recommended for the disposal of N&S. These variations in practice have resulted largely from a lack of clarity of State and Territory legislative requirements for the management of N&S deposited at a NSP or community sharps container for disposal. While legislative requirements for management of similar wastes from a healthcare centre are quite clear, most jurisdictions have elected to "administratively" exempt NSP services from these requirements – in essence this is not documented so may not provide the relief necessary should an adverse incident occur. Miller (2001), also makes comment on the unpredictable manner in which many of the "waste laws" are enforced in Australia.
However, each jurisdiction and local government has legislation that could be used to prosecute a NSP under broad "pollution", "litter", "public health" and "nuisance" provisions. Again it is unclear as to how and when these provisions could be used.
Essentially, used N&S deposited at a NSP or into a sharps container located in public areas are disposed of in accord with requirements imposed on healthcare facilities. That is, use of a waste contractor to transport the sharps containers to a treatment facility. In some jurisdictions, landfilling of untreated clinical waste is allowed and the N&S may be disposed of via this process.
While IDU are generally encouraged to return used N&S when obtaining new supplies, this is not an absolute requirement. Given that that NSP program was established on the principles of "harm minimisation" for the spread of bloodborne pathogens, not supplying new equipment should used N&S not be returned would compromise these initial aims of the NSP program.
As a consequence, used N&S from IDU in many States are often disposed of in domestic waste/recycling systems. In some jurisdictions such as Western Australia, this is actively promoted. Others allow it but do not promote it, with the remaining jurisdictions generally providing some guidance as to how it is to occur. Olowokure (2003), reports that disposal of N&S into domestic waste streams has the potential to:
- Create concern in the community over this waste in domestic waste containers
- Containers used are often punctured during landfill compacting processes
- Containers with N&S are placed into the recycling stream posing risks to recycling contractor staff (eg., at material recovery facilities)
Best practiceBest practice management of needles and syringes is predicated on the hazards associated with these waste products. It must be noted that the hazards exist to human health (with those at risk ranging from IDU, NSP staff, waste management staff and the wider community), generally via exposure to needles. In addition, there could be environmental hazards (eg., from the content of syringes), but this is probably quite minimal. It should also be noted that in risk management, perceived risks should be just as actively managed as identified risks.
Therefore, management of N&S needs to be based on all risks (as identified further on within this literature review).
It is also essential that in evaluating waste disposal methodologies, full costings of all aspects of the various methods be conducted. This includes costs of providing training to staff (Drain 2003). Some current disposal strategies rely on "in kind" support from NSP sites, particularly those located within healthcare facilities and so the costs associated with waste management are not understood. Given the recommendations of several Australian and international authors in regards to development of community N&S disposal systems, it is not only the costs of the service that needs to be determined, but also the savings resulting from the protocols implemented post-needlestick injury to a member of the community (Drain 2003, Law 2003, Ekwueme 2002, Macalino 1998, Gold 1997).
Best practice management of N&S requires (ANZCWMIG 2004):
- Containerisation of the N&S at source (ie., where the N&S becomes a waste product);
- Use of containers that meet relevant Australian Standards (ie., colour coded, signed and strength);
- Use of containers that are sufficiently sized for the expected waste volumes;
- Containers are secured to prevent removal as well as access to contents;
- Regular replacement of containers at locations;
- No manual emptying of contents;
- Managed in accord with the philosophy specified by State and Territory government agencies for N&S generated within healthcare facilities;
- Disposal of container contents via a recognised treatment process (eg., those that are approved by State and Territory environmental agencies for N&S generated within healthcare facilities);
- No landfilling of untreated N&S;
- No disposal of N&S into domestic waste/recycling streams (ie., due to risk of needlestick injuries to waste contractor staff).
In addition, Kelsall (2002) discusses the concept of "safe disposal" as perceived by Australian IDU and what could be construed as altruistic attempts to prevent reuse of the N&S by other IDU. Surveys of IDU have clearly demonstrated that there is a clear intent by the vast majority to ensure safe disposal of used N&S – what is of concern is that there are different concepts of what is safe. It must also be noted that good intents can be undermined by the fear of Police enforcement activity.