Model Practice Title
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Please provide the name or title of your practice
Sharps Collection Program
Practice Categories
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Model and Promising Practices are stored in an online searchable database. Applications may align with more than one practice category. Please select all the practice areas that apply.
- Access to Care
- Advocacy and Policy Making
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- Cultural Competence
- Emergency Preparedness
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- HIV/STI
- Immunization
- Infectious Disease
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- Injury and Violence Prevention
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- Organizational Practices
- Other Infrastructure and Systems
- Organizational Practices
- Primary Care
- Quality Improvement
- Research and Evaluation
- Tobacco
- Vector Control
- Water Quality
- Workforce
- Conference Theme: Bridging Clinical Medicine and Population Health
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Other:
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Is this practice evidence based, if so please explain.
Winnable Battles
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To keep pace with emerging public health challenges and to address the leading causes of death and disability, CDC initiated an effort called Winnable Battles to achieve measurable impact quickly.Winnable Battles are public health priorities with large-scale impact on health and known effective strategies to address them. Does this practice address any CDC's seven Winnable Battles? If so, please choose from the following:
- Food Safety
- HIV in the U.S.
- Nutrition, Physical Activity, and Obesity
- Tobacco
- Healthcare-associated Infections
- Motor Vehicle Injuries
- Teen Pregnancy
- None
Overview: Provide a brief summary of the practice in this section (750 Word Maximum)
Your summary must address all the questions below:
- Brief description of LHD- location, demographics of population served in your community
- Describe public health issue
- Goals and objectives of the proposed practice
- How was the practice implemented/activities
- Results/Outcomes (list process milestones and intended/actual outcomes and impacts.
- Were all of the objectives met?
- What specific factors led to the success of this practice?
- Public Health impact of practice
- Website for your program, or LHD.
750 Word Maximum
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Please use this portion to respond to the questions in the overview section.
Brief Description
The Florida Department of Health in Duval County’s (DOH-Duval) Sharps Disposal Program was first implemented in April 2016. The program was created to provide the residents of Duval County a safe and free means to dispose of their home generated sharps, such as needles and lancets. The goal of the program is to protect the public and sanitation workers from the exposure to untreated medical waste in the solid waste stream. This was the first sharps collection program to exist in Duval County. Residents and visitors of Duval County can bring their sharps containers to any one of the seven participating site locations for proper disposal and to receive a free sharps container in return.
Overview
Duval County is located in the northeast region of Florida. It covers 918 square miles including all land and water, is home to 913,010 people, and contains two of the largest Naval Bases in the southeast U.S. The 2015 U.S. Census reports that the population of Duval County is 61.8% White, 30.1% Black, and 8.9% Hispanic. The median household income in Duval County is $47,582 and 18.2% of the population is below the poverty line. The median age in Duval County is 35 years old.
Local health departments work tirelessly to prevent the spread of infectious disease through surveillance, immunizations, screening, outbreak response, and treatment. Preventing the spread of infectious disease often depends on understanding the identifying causes, such as accidental needle sticks. People use sharps to treat a variety of medical conditions in the home, and the number of conditions treated at home with injectable medicines continues to rise. Each year, 8 million people across the country use more than 3 billion sharps to manage medical conditions in the home. Many sharps users throw their needles in the trash or flush them down the sewer system. Disposing untreated medical waste in the solid waste stream poses a serious risk of exposure to infectious diseases not only to sanitation workers but to the general public as well. Discarded needles may expose solid waste workers to potential needle stick injuries and possible infection when containers break open inside garbage trucks or needles are mistakenly sent to recycling facilities.
Currently, 12.1% of the adult population in Duval County has been diagnosed with diabetes and may have the need to dispose of lancets or needles generated in the home as a result of this chronic disease. Prior to 2016, residents of Duval County had no alternative other than to dispose of their sharps in the solid waste stream, pay to have their sharps containers removed by a licensed medical waste transporter, or utilize a mail back program. In April 2016, DOH-Duval implemented a free needle collection program at seven locations throughout the greater Jacksonville area. The program assists residents by offering a free and safe means of disposing their home generated sharps while also providing a replacement sharps container in return.
Although this program has only been operational for the past seven months, DOH-Duval has seen positive interest in the use of this program. The ultimate objective of this program is to reduce the risk of exposure to infectious disease to sanitation workers, recycling personnel, and the general public. In this short period of time, DOH-Duval has collected 24 sharps containers from the community that would have otherwise been disposed of through the solid waste stream. Each collection site keeps track of the number of containers collected via a log that is submitted quarterly to DOH-Duval’s Environmental Health Division. Success of the program will be determined as we see an increase in the number of containers collected and a reduction in the number of needle sticks reported by our local sanitation and recycling companies. The main public health impact of DOH-Duval’s needle collection program is to educate the public on how they can safely and properly dispose of their home generated sharps at no cost, which will ultimately result in reduced exposure to infectious disease via needle sticks to everyone in the community.
The website for the organization is www.duval.floridahealth.gov/
Responsiveness and Innovation
A Model Practice must be responsive to a particular local public health problem or concern. An innovative practice must be (1) new to the field of public health (and not just new to your health department) OR (2) a creative use of an existing tool or practice, including but not limited to use of an Advanced Practice Centers (APC) development tool, The Guide to Community Preventive Services, Healthy People 2020 (HP 2020), Mobilizing for Action through Planning and Partnerships (MAPP), Protocol for Assessing Community Excellence in Environmental Health (PACE EH). Examples of an inventive use of an existing tool or practice are: tailoring to meet the needs of a specific population, adapting from a different discipline, or improving the content.
- Statement of the problem/public health issue
- What target population is affected by problem (please include relevant demographics)
- What is the target population size?
- What percentage did you reach?
- What has been done in the past to address the problem?
- Why is the current/proposed practice better?
- Is current practice innovative? How so/explain?
- Is it new to the field of public health
OR
- Is it a creative use of existing tool or practice:
What tool or practice did you use in an original way to create your practice? (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, a tool from NACCHO’s Toolbox etc.)
- Is the current practice evidence-based? If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.)
2000 Word Maximum
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Please state the Responsiveness and Innovation of your practice (2000 Word Maximum)
The Florida Department of Health in Duval County (DOH-Duval) is one of the largest health departments in the state of Florida. It serves more than 900,000 residents which is comprised of 22.7% minors, 13.1% seniors over the age of 65, and 64.2% between the ages of 19 and 64.
Thousands of people every day need to use sharps in the home to treat a variety of chronic conditions and, as such, need a way to dispose of their used needles and lancets. Prior to April 2016, the primary way a resident of Duval County had to dispose of their home generated sharps was in the solid waste stream. Residents were instructed to place their used sharps in a plastic container and dispose of it with the rest of their solid waste in their trash receptacles. The problem with this method is that garbage trucks often compact their waste at intervals which can cause the plastic containers to rupture causing the needles to become exposed. These loose sharps become a serious occupational hazard to sanitation workers, as well as the general public, as garbage can often escape the confines of the truck while in route. Sorters at recycling plants may be at greatest risk of exposure since they have to handle all items disposed of as recyclables by hand during the sorting process. Alternatively, residents can pay to have their sharps containers removed by a licensed medical waste transporter. This option is safer, but places the financial burden on the residents of Duval County.
Since April 2016, DOH-Duval has provided a free and safe alternative to the residents of Duval County for the disposal of home generated sharps other than disposing of them directly into the solid waste stream. Residents then obtain a free replacement sharps container from any one of our participating locations. This program is the first in Duval County to provide a free and safe alternative to disposing of sharps in the solid waste stream.
As mentioned in the CDC’s Guide to Community Preventive Services, health communication campaigns that use multiple channels, one of which must be mass media, combined with the distribution of free or reduced-price health-related products are most effective in producing intended behavior changes.
https://www.thecommunityguide.org/findings/health-communication-and-social-marketing-campaigns-include-mass-media-and-health-related
In this case, the program’s intent is to replace the previous behavior of discarding home generated sharps into the solid waste stream with use of DOH-Duval’s needle collection program. Public service announcements or news releases are being developed to market to radio and newsprint media; Facebook and Twitter will also be used as alternative forms of public outreach. Distribution of brochures has occurred at clinic locations, as well as during Diabetes Education classes. DOH-Duval’s webpage is used to promote the program and to distribute a downloadable version of the brochure. The health related product in this case is the distribution of a free sharps container that can be returned when full in exchange for another sharps container. Although the concept of a sharps disposal program is not new, many programs charge a fee for this service and most are not managed by a local health department.
LHD and Community Collaboration
The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broad-based involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
- Goal(s) and objectives of practice
- What did you do to achieve the goals and objectives?
- Steps taken to implement the program
- Any criteria for who was selected to receive the practice (if applicable)?
- What was the timeframe for the practice
- Were other stakeholders involved? What was their role in the planning and implementation process?
- What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s)
- Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown.
5000 words maximum
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Enter the LHD and Community Collaboration related to your practice (5000 words maximum)
The primary goal and objective of DOH-Duval’s Sharps Disposal Program is to provide a safe and free means of disposal of home generated sharps for residents of Duval County that will reduce the potential exposure of needle stick injuries to sanitation workers and the general public. In order to accomplish this, DOH-Duval’s Environmental Health Division conducted extensive research into other programs around the state and created a plan to initiate a Sharps Disposal Program for the residents of Duval County. This plan was presented to and approved by the Executive Leadership Team at DOH-Duval. Once the Sharps Disposal Program was approved, a formal policy and procedure was written. Meetings were conducted with clinic supervisors and personnel that would be participating directly in the program and sharps containers were purchased and delivered to participating DOH-Duval clinics for distribution. To promote the program, marketing materials, such as brochures and signs, were created. Each collection site was provided with a copy of the DOH-Duval’s written policy and procedure, which details the purpose and the protocols of the program. Each collection site also received a site visit from an Environmental Health employee that explained the procedures involved with the collection, handling, and proper logging of information for each individual that utilized the program. The DOH-Duval website was updated to include information about the Sharps Disposal Program, including a downloadable version of the brochure and a list of participating DOH-Duval clinic sites. In less than a year, the Sharps Disposal Program went from proposal to implementation; in the seven months it has been functioning, 24 containers of sharps have been kept out of the solid waste stream.
Upon initiation of the Sharps Disposal Program, only a small media campaign was launched. Now that the Sharps Disposal Program has been operating for seven months, and has shown positive results, DOH-Duval has released information about the program to the media. Community stakeholders like the City of Jacksonville-Solid Waste Division, local garbage/recycling companies, Diabetes Prevention and Education organizations have all been contacted and are educating their customers and clients about the program. Community stakeholders are also referring their customers to DOH-Duval’s website to view the downloadable brochure. The Department’s social media outlets such as Facebook and Twitter will soon be updated to include information about the program. In the future, as participation increases, community partners could play a role in the distribution of free sharps containers to those who are in financial need and are limited in their transportation.
Evaluation
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improve practice. Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
- What did you find out? To what extent were your objectives achieved? Please re-state your objectives.
- Did you evaluate your practice?
- List any primary data sources, who collected the data, and how (if applicable)
- List any secondary data sources used (if applicable)
- List performance measures used. Include process and outcome measures as appropriate.
- Describe how results were analyzed
- Were any modifications made to the practice as a result of the data findings?
2000 Words Maximum
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Please enter the evaluation results of your practice (2000 Words Maximum)
DOH-Duval’s Environmental Health Division will continue to track the number of containers returned to selected collection sites and monitor the use of the program via the log sheets kept at each site which track the number of containers that are brought in for disposal. Environmental Health contacts each collection site quarterly to obtain a copy of the log sheets and to inquire if there are any issues or challenges that need to be addressed concerning the program. By increasing program awareness, it is anticipated that a higher number of containers will be collected which immediately translates into a reduced number of sharps in the solid waste stream that can cause potential danger to the public.
Sustainability
Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that the stakeholders are invested in its maintenance and to ensure it is sustained after initial development (NACCHO acknowledges that fiscal challenges may limit the feasibility of a practice's continuation.)
- Lessons learned in relation to practice
- Lessons learned in relation to partner collaboration (if applicable)
- Did you do a cost/benefit analysis? If so, describe.
- Is there sufficient stakeholder commitment to sustain the practice?
- Describe sustainability plans
1500 Words Maximum
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Please enter the sustainability of your practice (2000 Words Maximum)
One of the biggest lessons learned is the need for additional marketing of the Sharps Disposal Program to increase participation. To date, DOH-Duval’s marketing of the Sharps Disposal Program has only been able to reach a small portion of the population. A more widespread approach is being developed to reach more of Duval County’s population with information on the program. This marketing approach will include the use of social media and greater involvement from community partners in increasing public awareness of the program.
Increased participation will create an increased need for resources. The primary need for this program is sharps containers that the disposal locations can give out when residents return their used containers. The cost is approximately $98.00 per case (80 containers). Funds were available within the Environmental Health budget to purchase an initial 20 cases (1,600 containers) to pilot the program. As the program grows, additional funding may be sought to assist with cost of containers.
The sustainability of the program is extremely likely since the participating collection sites in the Sharps Disposal Program are existing locations that are maintained by DOH-Duval. The sites are already equipped to properly dispose of sharps and other biomedical waste. The additional costs to sustain this program are relatively inexpensive.
Additional Information
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How did you hear about the Model Practices Program:
- I am a previous Model Practices applicant
- At a Conference
- NACCHO Website
- Public Health Dispatch
- Colleague in my LHD
- Model Practices brochure
- NACCHO Exhibit Booth
- NACCHO Connect
- Colleague from another public health agency
- E-Mail from NACCHO
- NACCHO Exchange
