#tech note

TECH Note #71 - Model Exposure Control Plan for Syringe Pick-Up

Background In 2015, several municipal and state facilities have noticed an increase of occurrences where used syringes are found discarded in public parks, lobbies, or bathrooms.   Used syringes can be contaminated with blood that may be infectious for Hepatitis, HIV or other bloodborne pathogens.  Municipal and state employees who are assigned to clean up discarded syringes must be protected from unprotected contact with discarded syringes.

Purpose This Exposure Control Plan is developed to provide minimum procedures for protecting employees from contacting illness when handling used syringes.  

This sample plan is specifically designed for public works, parks, library, transportation and water department employees whose job descriptions do not include providing healthcare, dental services.

Fire/EMS should reference “Exposure Control Plan for Healthcare Providers”

Schools may reference the “Exposure Control Plan for Schools”

A copy of the Exposure Control Plan can be downloaded by visiting http://www.mass.gov/lwd/labor-standards/massachusetts-workplace-safety-and-health-program/public-sector-employee-health-and-safety/services-available.html

What to Do when a Used Syringe is Observed

There are designated staff who will be delegated responsibility for cleaning up used syringes that have been left behind by the public. These staff will be provided with gloves, tools and a puncture-proof sharps container, and will be offered the Hepatitis-B vaccine.

All discarded syringes should be assumed to be contaminated with blood that could contain Hepatitis, HIV or other bloodborne disease. This is called “Universal Precautions” when all blood-contaminated items are considered infectious. How to Pick Up Discarded Syringes

• Bring gloves, pliers and a sharps container to the location of litter.

• Put on puncture resistant gloves, such as a leather glove. The purpose of the leather glove is to reduce the risk of skin puncture.  

• In outdoor, library, or office settings, the leather gloves can be re-used.

• In manhole and sewage treatment settings, the gloves should be discarded if they become contaminated with sewage.  Gloves can be discarded in regular trash.

• Do not touch the syringe with your hands.

• Use pliers to pick up the syringe, or • Use a dustpan and broom.

• Put the syringe immediately into a Sharps Disposal Container. Place the syringe needle-first into the container.

• Do not recap the needle.  If a syringe was already capped, keep the cap on, and still discard in a Sharps Disposal Container.

• Bring the Sharps Disposal Container with you to location of syringe. Do not walk across park or down a hallway to get to the sharps container, bring the container with you.

• Do not hand the syringe to another person. If a member of the public wants to hand you a syringe that they found, ask them to: 1) place the syringe directly into a sharps disposal container; or 2) if a container is not available, ask them to put the syringe on a table so you can pick the syringe up from a stationary surface when the container is obtained.

• Remove your gloves.  Leather gloves can be reused.

• Wash hands, or use alcohol gel to clean your hands as soon as possible.

• Keep the sharps disposal container in a secure location. This must be disposed as biohazard waste.

What to Do if You Experience a Needlestick

If you experience a needlestick, get medical treatment within the first 24 hours.

Report the injury immediately the injury coordinator at your workplace.

If you are punctured or get a laceration by a used syringe, lancet, razor or other medical “sharp,” getting medical treatment within the same day is required.  Studies have shown that receiving medical treatment for a needlestick within the first 24 hours is able to prevent transmission of HIV and Hepatitis.

Employees may not decline going to a healthcare provider for evaluation.  (The employee may decline the advice or treatment offered by a healthcare provider, but they must obtain the evaluation.)  The medical exam is confidential – the employer should not receive medical test results or other medical information regarding the employee.

Instructions after a Needlestick:

• Discard the syringe into the Sharps Disposal Container. • Do not bring the syringe to the doctor – the blood in the syringe is not tested for HIV or Hepatitis.

• Wash the puncture area with soap and water.

• Do not disinfect your skin with bleach or disinfectant – this can damage the skin and make transmission of Hepatitis or HIV easier.

Be prepared to tell the healthcare provider about: • Location of  puncture on your skin • How deep the puncture/laceration • Whether or not there was visible blood inside the syringe tube • Whether or not there was visible blood on the needle

Requirements for Tools and Equipment

Sharps Disposal Container • Must be puncture-proof and leak-proof.

• Should have a cap that allows the container to be carried to different locations without spilling.

• Should be replaced when 3/4th full.

• Never pour out contents of a smaller sharps container into a larger container.

• Must be labeled with a Biohazard label.

• Vendors are available on the state vendor list.

Tools: • Use pliers, long-handled picker tool,  or a dustpan and broom to pickup syringe so that hand contact is not required.

• Dispose syringe directly into sharps container without hand contact.

Gloves • Should be puncture resistant.

• Look for ANSI-rated puncture resistant glove when cleaning areas with a high density of syringes.

• Do not use healthcare latex/nitrile gloves – these are too thin to resist a needle.

• The puncture-resistant glove can be re-used.  

Shoes • Closed-toe shoes are required.

• Leather shoes with sturdy sole required for Public Works.

• Rubber overboots may be required for areas with high-density of syringes in debris.

Handwashing

• Handwashing with soap and water is required after handling a used syringe.

• Alcohol hand-sanitizer can be used when a sink is not available. 

Hepatitis B Vaccine

• The Hepatitis-B vaccine must be offered to employees who are given the job duty to pick up discarded syringes.

Background STOP signs are traffic control devices that drivers come across regularly. The function of a STOP sign is to improve the safety and operation of intersections by defining who has the right of way. Since STOP signs have considerable control over traffic, they should be installed only where necessary. The Manual on Uniform Traffic Control Devices (MUTCD) provides guidelines for the installation of STOP signs through the development of warrants. Unwarranted STOP signs may create problems either at the intersection or along the roadway itself by: • Encouraging motorists to drive faster between intersections in order to save the time lost by stopping. • Encouraging violation of traffic laws. For example, if STOP signs are installed at a location where the driver does not perceive a need for them, the rate of STOP sign violations tends to increase at that and other locations. • Encouraging the use of alternate, often more local, routes by drivers trying to get around the STOP sign. • Increasing the chance that drivers will disregard conflicting vehicle and pedestrian traffic, thus increasing the risk of collisions and injuries.

STOP Sign Regulations In accordance with the MUTCD, a STOP sign shall be an octagon with white legends and border on a red background, and include only the word STOP. An “ALL WAY” supplemental plaque may be necessary when more than two directions are controlled by STOP signs. STOP signs shall be located on the right side of the roadway, however a secondary STOP sign can be installed on medians or on the left side of the road to supplement the sign on the right side if the road is very wide. The STOP sign shall be installed as close as practical to the intersection and should be visible to the driver as soon as possible. A STOP line or the word STOP on the pavement may be used along with a STOP sign. STOP signs and YIELD signs shall not be mounted on the same post. In addition, no sign should be mounted to the back of a STOP sign other than a DO NOT ENTER sign so the octagon shape of the STOP sign is always visible. Where two roads intersect at an angle, the sign should be placed out of view to the other roadway. A STOP sign in rural areas should be located 6 feet from the shoulder, or if there is no shoulder 12 feet, and the height from the roadway to the bottom of the sign shall be a minimum of 5 feet. In urban areas, a lesser lateral clearance is permissible as necessary (i.e., 2 foot clearance from the curb is allowable), and the height shall be a minimum of 7 feet from the ground to the bottom of the sign.

Technical Information The MUTCD provides technical information and guidelines for the usage of STOP signs. The sections on the next page highlight some of the more critical guidelines from the MUTCD.

For two way stop control, the MUTCD indicates that STOP signs should be used if engineering judgment justifies that one or more of the following exist: A. An intersection of a less important road with a main road where application of the normal right-of-way rule would not be expected to provide reasonable compliance with the law;

B. A street entering a designated through highway or street; and/or

C. An un-signalized intersection in a signalized area.

D. High volume, restricted view, or crash records indicate a need for control by the STOP sign.

A different application of the STOP sign is multiway control, which is limited to intersecting roads of relatively equal volume and characteristics. In accordance with the MUTCD, the following criteria should be considered in an engineering study for a multiway STOP sign installation:

A. Where traffic control signals are justified, the multi-way stop is an interim measure that can be installed quickly to control traffic while arrangements are being made for the installation of the traffic control signal.

B. Five or more reported crashes in a 12-month period that are susceptible to correction by a multi-way stop installation. Such crashes include right-turn and left-turn collisions as well as right-angle collisions

C. Minimum volumes: 1. The vehicular volume entering the intersection from the major street approaches (total of both approaches) averages at least 300 vehicles per hour for any 8 hours of an average day; and

2. The combined vehicular, pedestrian, and bicycle volume entering the intersection from the minor street approaches (total of both approaches) averages at least 200 units per hour for the same 8 hours, with an average delay to minor-street vehicular traffic of at least 30 seconds per vehicle during the highest hour; but

3. If the 85th-percentile approach speed of the major-street traffic exceeds 40 mph, the minimum vehicular volume warrants are 70 percent of the values provided in Items 1 and

D. Where no single criterion is satisfied, but where Criteria B, C.1, and C.2 are all satisfied to 80 percent of the minimum values. Criterion C.3 is excluded from this condition.

Additional criteria that may be considered in an engineering study related to installation of multi-way stop control is available in MUTCD Section 2B.07. Once the decision has been made to install a stop sign, there are several critical elements to consider regarding the placement of the sign. Specifically, the MUTCD list three standards governing the placement of a STOP sign as follows: • The STOP sign shall be installed on the right side of the approach to which it applies. When the STOP sign is installed at this required location and the sign visibility is restricted, a Stop Ahead sign shall be installed in advance of the STOP sign. • The STOP sign shall be located as close as practical to the intersection it regulates, while optimizing its visibility to the road user it is intended to regulate. • STOP signs and YIELD signs shall not be mounted on the same post.

Additional Considerations Many traffic safety problems are complex and cannot be resolved by installing a STOP sign. For example, STOP signs should not be used to reduce speed or cut-through traffic. In fact, the improper use of STOP signs in these instances may have unintended and adverse impacts which may be opposite of the original intent. In addition, another consideration may be cost. Although the physical installation of a STOP sign is relatively inexpensive, other costs that need to be considered relate to its maintenance, and to extra fuel consumption, increased air and noise pollution and lost driver time. If a STOP sign is not necessary, other countermeasures may be considered. For example, trees and bushes can be trimmed or parking restrictions can be installed to increase visibility at the intersection. YIELD or warning signs, police enforcement, or traffic calming measures may also be effective strategies for consideration.