IN THE TRASH BIN: A CROSS-COLLABORATION EFFORT
TO REDUCE THE NEGATIVE IMPACT OF MEDICAL INJECTION DEVICE WASTE
We, as a society, have turned to sustainability in order to reverse our way of negative thinking and actions towards the environment. It has emerged as a result of significant concerns about the social, environmental, and economic consequences of rapid population growth, economic growth, and consumption of our natural resources. Sustainability is based on a simple principle: everything we need for our survival and well-being depends either directly or indirectly on our natural environment. It ensures that we have and we will continue to have water, materials, and resources to protect human health and our environment (“Sustainability,” EPA). There are two methods of reducing negative human impact and enhancing ecosystem services, one being environmental management and the other being human consumption of resources.
Intertwined with this practice is waste produced by consumers, businesses, technologies and so forth. Some waste production is inevitable, such as a patient using a product to alleviate their illnesses. If a patient in a medical facility uses a product that creates medical waste, it is then properly disposed by medical and waste staff. However, if the consumer uses the medical device at home, the waste is improperly ‘thrown away.’ As there is no current regulation of home-generated medical waste in the United States, patients are disposing of their used medical injection devices in household trash, risking those who are exposed. A social, environmental, and economic solution is necessary, which is achieved through the collaboration and combination of problem-solving techniques and methods of graphic design and its disciplines, and the medical, pharmaceutical, and waste industries. With this unified response to the current situation, social awareness and safety regulations will be greatly improved for medical staff, sanitation workers, consumers, and the community.
During the past 150 years, the basic design, mechanics, and manual operation of the medical injection device has not changed much. Its purpose is to administer injections into the bloodstream, which diagnose, prevent, and treat diseases or other conditions. These ailments include allergies, migraines, diabetes, infertility, arthritis, IV, hepatitis, multiple sclerosis, osteoporosis, psoriasis, and others. Patients include humans and animals, males and females, and ages ranging from newborns to the elderly. Examples of medical injection devices used to administer medicine are syringes, lancets, needles, insulin pump tubing, continuous glucose monitor tubing, and insertion devices. Insulin pumps are used by approximately 375,000 Americans. Approximately 25 million Americans have diabetes, and it is estimated that about 26% (6.5 million Americans) are taking 1–4 insulin injections per day using over 13 million needles and syringes per day (Gold 848). 7.5 billion needles and syringes are used outside the healthcare system yearly in households, and this number does not reflect the number of lancets used by the previously mentioned 25 million diabetic patients. It is estimated that 1 in 12 households in the United States use a syringe for treatment (Gold 849).
The FDA (U.S. Food and Drug Administration) strongly suggests to never place loose needles and other sharps in household or public trashcans or recycling bins, and to never flush them down the toilet. This places trash and sewage workers, janitors, housekeepers, household members, and children at risk of being harmed. If placed in public receptacles, those dependent on illegal drug abuse have the opportunity to use the already contaminated needles for the injection of illegal substances. But, the waste these medical injection devices produce is not currently regulated in the United States, and therefore, consumers are placing their needles and syringes in household and curbside trash, against the FDA’s suggestion. However, an individual does have the option of buying a container and finding a way to properly dispose of their used medical injection devices themselves, but this requires additional money, gas, mileage, and time. Therefore, placing this waste in household trash is more convenient for the patient, even if it does have harmful repercussions.
Curbside trash is taken to a materials recover facility (MRF), which begins a sorting process to separate designed recyclable material (different from voluntary recycling in which households participate) from the solid waste. Materials are then sorted either manually or through a mechanical sorting process; what is not recyclable is transported to a landfill. It is at this point in the process where sanitation workers are exposed to needle-stick injuries. These types of injuries are one of the top three injuries reported at MRFS (according to data tracked by waste management companies). Custodial staffs are also at risk at public venues (including hotels, airports, train stations, and large entertainment centers), but presently there are no data-tracking systems for these professions.
Currently, a limited number of regions in the United States offer a safe community disposal system for these devices. In 2004, the Environmental Protection Agency published Community Options for Safe Needle Disposal outlining the dangers of improper needle disposal and offering a variety of program options, none of which are mandatory:
- Drop-off collection sites
- Syringe exchange programs
- Mail-back programs
- Home needle destruction devices
- Household hazardous waste collection sites
- Residential waste special pick-up programs
State governments, municipalities, and companies are beginning to research and enforce their own policies to offer safer alternatives. For example, Senate Bill 486 (Pharmaceutical Manufacturer Sharps Disposal Plans), signed into law October 2009 in the state of California, requires a pharmaceutical manufacturer that sells and distributes medications in California, that are self-injected at home, to submit a plan describing how the manufacturer supports the safe collection and disposal of sharps and needles. The required plans must include a description of the actions, if any, to:
- Provide for safe collection and disposal of sharps
- Educate consumers about safe management and collection opportunities
- Support efforts by other organizations to promote the safe management of sharps
Because of this, Waste Management, a waste management, comprehensive waste, and environmental services company in North America, voluntarily submitted their own current plan describing the companies on-going efforts to: education the public on safe needle disposal; work cooperatively with public agencies to expand the infrastructure for the safe management of sharps waste; and provide each of their California employees and their families with a free, safe and convenient program for the collection and disposal of sharps wastes. It is of interest that Becton, Dickinson, and Company and Waste Management announced in April 2011 an agreement to recycle medical sharps waste from hospitals and other health care facilities. The companies are jointly launching the BD ecoFinity™ Life Cycle Solution, an innovative service that will recycle medical sharps waste and utilize the material to manufacture new products (Gold 849).
With examples of communities, states, and companies enacting their own solutions, why is the nation not correcting this problem as a whole? The most popular answer seems to be money. The disposal of medical waste is expensive, so who is going to bear this burden? The patient who already has high expenses? The local municipalities that will have to develop, implement, publicize, and enforce regulations? Waste management companies? Or should the manufacturers and pharmaceutical companies provide a solution? Some of these questions are being answered by communities, state governments, and companies, and are already spending their own money as they see this issue as one of their top priorities. However, these are questions and discussion points that need to be addressed in a cross-collaboration involving various fields and different backgrounds, including graphic design and its many disciplines, and the medical, pharmaceutical, and waste industries. The solution must be one that improves the current situation, while meeting the standards and goals of all the industries currently involved. Depending on the solution proposed, another industry such as mailing services might also become a collaborator due to its involvement in mail-back programs. Local, state, and federal governments might become involved at some point if they deem this situation needs to be mandated by law.
Every day, consumers make decisions that either have a huge impact on the environment, or of negligible importance. To those who care about their quality of life and what is currently happening, this can be a vastly important decision. The publication, The Consumer’s Guide to Effective Environment Choices: Practical Advice from The Union of Concerned Scientists, identifies the 4 most significant consumer-related environmental problems, the 7 most damaging spending categories, 11 priority actions, and the 7 rules for responsible consumption. All these are to help inform consumers about their everyday decisions that significantly affect the environment, which in turn connects to how sustainability came to fruition. The cross-collaboration must consider the consumer and their perspective as a part of their research, as it will provide insight of what the consumer contemplates when it comes to decisions that affect the environment, and if they even truly think sustainability is steering society on the correct path. During this perspective exploration, the psychology behind America’s complex relationship with the medical industry will reveal a deeper understanding of the damaging and dangerous oversights in current medical design.
While we have well-developed tools for tackling social issues based on thoughtful analysis and technological inventiveness, we have yet to apply design thinking to the exploration of new choices and alternative solutions. In his article, “Why Social Innovators Need Design Thinking,” Tim Brown explains design thinking is scalable and can be applied to improve existing ideas, or it can be applied to create disruptive solutions that meet the needs of people in new ways, which this current situation disparately requires. As design thinking is centered on innovating through the eyes of the end user, it can be applied by people from a broad range of backgrounds to problems ranging from creating new products and services to redesigning existing ones, such as this current problem.
As medical device manufacturers and pharmaceutical firms have begun to focus on company sustainable practices such as material selection and facility management, a product solution itself is not seen in the immediate future due to testing and approval processes. While pain-free, low cost, and easily transportable prototypes are being developed, waste disposal is still an afterthought. As for this cross-collaboration, current design solutions will include re-designing of packaging and creating awareness through web and print design. These, of course, will need to also go through the prototyping phase; however, this is more of feasible solution to the current situation.
One challenge the graphic design field will face is re-envisioning solutions as a less environmentally destructive practice, specifically package design. Designers will need to examine an array of techniques and methodologies for creating an innovative and sustainable package design, and one that keeps consumers from tossing used medical injection devices in the trash, and keeping them out of the hands of substance abusers. The cross-collaboration will have to consider if possible solutions will create more waste, and if there is a more sustainable material for the package design. In a way, the solution(s) will not reduce the amount of used medical injection devices, as that is still being investigated by product designers, but it will control the placement and safety of this waste.
As evidenced, the current situation is a social, economic, and environmental issue that must be solved. Even though the product design is something beyond reach at this point, graphic design and its disciplines, and the medical, pharmaceutical, and waste industries together can find a solution which will alleviate the issue of medical injection devices being placed in household and curbside trash. This collaboration will need to consider the best problem-solving techniques and methods in order to implement an effective solution, which will combine graphic design goals with those of the involved industries. This unified solution will create social awareness and improve safety for medical staff, sanitation workers, consumers, and communities. It will enable patients to participate and take action (even if it’s small step), as the process will be more environment-friendly convenient, unlike the current situation.
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