As an infection preventionist in healthcare today, one of our biggest challenges is appropriately managing Clostridium Difficile - a colitis-causing bacteria that affects almost a half-million people in the U.S. annually.
Recent focus is now being given to the idea that not all of the increase in C.difficile rates stems solely from transmission in hospital settings but rather starts before patients reach the hospital doors.
I've focused my career on infection control and prevention since 1992. During many of those years the organizations in which I have worked, have implemented reusable sharps containers for handling and disposing of contaminated sharps. At first I was skeptical about bringing reusable sharps containers into a facility. I then visited the disposal site to observe the entire emptying and disinfection process. The level of automation assured me that disinfection processes are sufficient and minimize human exposure risks. The emptying process is performed robotically - no one manually dumps sharp objects. Once I understood the process, I supported it and embraced the benefits of keeping thousands of pounds of plastic out of landfills by choosing reusable containers.
A recent survey sponsored by a large manufacturer of single-use sharps containers indicated that use of reusable containers may be associated with increased C.difficile rates. However, the survey does not provide a description of how the sharps container would be implicated in the transmission and did not clearly describe how the transmission could occur. Because it is not considered to be a high-touch item, health care workers typically do not have extensive hand contact with the outside surface of sharps containers, only the sharps objects being disposed in them. For transmission to actually occur, someone would have to have hand contact with a sharps container contaminated with C.difficile and then, by not performing hand hygiene, transmit the organism in an infectious dose to the patient to ingest.
The author states several limitations in the study including the source of the data and the fact that only rates of C.difficile were assessed. In addition, the respondents referenced in the survey included mainly environmental safety professionals and only one third were infection preventionists, who typically have the highest level of awareness regarding an institution's C.difficile rates. Claims were made that most reusable containers are contaminated with microorganisms referenced as "environmental and skin contaminants." C.difficile is not typically considered a common environmental or skin contaminant, nor is it an organism that can "jump."
The results of this survey are not sufficient for me to suggest a change in practice. In my opinion, the survey made a large leap to suggest that reusable sharps containers are associated with increasing C.difficile transmission. I agree with the conclusion that the topic warrants further study.
If I were to study this topic more in depth, I would seek clarification on exactly what organisms were
cultured from the sharps containers in the referenced studies as well as to more fully understand how C. difficile is potentially transmitted from sharps containers to patients.
Stacy Martin, RN, BSN, CIC, is infection prevention manager at Moffitt Cancer Center in Tampa, Florida.
Disclaimer: Moffitt Cancer Center uses reusable sharps containers that are serviced by Stericycle, Inc.