Less GHG with reusables over long-haul

Reusables reduce GHG 65% when long-haul transport is required.

Two Californian colleagues and I had our Lifecycle Carbon Footprint study published today confirming a significant 65% reduction in greenhouse gases when disposable sharps bins were replaced with reusables and long transport distances impacted both systems.

The study was conducted over a two-year period at a large five-hospital system in Loma Linda CA.

An earlier GHG Chicago study found reusables reduced sharps waste stream GHG by 84%. However the study’s sensitivity analysis found transport distances impacted results significantly and suggested the study be repeated in a scenario where transport distances between manufacturer and hospital were large.

In the Loma Linda study, mfg-hospital distances were several thousand km and hospital-plant distances were several hundred km. Under these conditions the study concluded:

  • Such distances lessen GHG differential between the systems
  • Reusable achieved significant GHG reductions
  • Transport & electricity cleanliness are key factors.
  • Lifespan of reusables has minimal effect on carbon footprint.
  • Procurement can significantly contribute to GHG strategies.
  • Reusables reduced GHG with minimal staff behavior-change.

Click here for Loma Linda study

EXPO-STOP 2015 Blood-exposure Survey – Sneak Preview

AOHP EXPO-STOP blood-exposure survey is too large for one post – but here’s a sneak preview

The 2015 EXPO-STOP blood exposure survey of the Association of Occupational Health Professionals in Healthcare (AOHP) will take several publications to convey all the data to readers – so Linda Good and I wanted to share the presentation we delivered at the Sept 2016 AOHP Conference in Myrtle Beach SC, USA.

In this 5th annual EXPO-STOP survey, 182 hospitals from 38 states participated  – making it USA’s largest.

The PowerPoint covers: the 2015 EXPO-STOP national blood exposure incidence; proven strategies to reduce sharps injury (SI) incidence; and url’s of many resources

Take Home Messages

  • USA SI incidence is 2.1 per 100 FTE hospital staff – a significant decrease from 2.7 in 2001
  • Nurses at 3.2 SI/100 FTE represent 46% of all reported SI (Drs 32%)
  • Surgical SI = 38% of all SI reported
  • But… this incidence means 320,000 HCW sustain SI annually – almost 1,000/day.
  • Renewed focus on prevention strategies is needed
  • Best practices include more effective Safety Devices, Competency training, Communication to all, Investigation, Engagement – particularly in OR.

Click here for download of PPT presentation

Watch this Space! – the top proven SI prevention strategies will be published in JAOHP Winter Issue in March 2017

Too many sharps injuries from punctured containers – why?

“Finer needles, higher temps, and thinner walls, all make container penetration easier.”

500 healthcare professionals in USA and 200 in UK sustain sharps injuries (SI) from needles puncturing containers each year. Not high numbers but they CAN be markedly reduced with tougher sharps containers (and tougher Standards)?

In my recent paper, I researched this question by examining 3 parameters affecting needle penetration – needle gauge, temperature, and container wall thickness.

Under controlled standard conditions I conducted 288 tests comparing 6 needle gauges (21G – 30G), 3 temperatures (130C, 230C, 430C) and 3 wall thicknesses (1.9mm, 2.4mm, 2.8mm).

Would 30G penetrate more easily than 21G? Many say 21G …but the answer is 30G – by far. A 30G needle penetrates a wall at 1/3rd the force needed for 21G! At 430C it is 1/7th.

So… finer needles, higher temps, and thinner walls are why sharps injuries from container-penetration are occurring – ‘container abuse’ is rare.

46% of U.S. needles are finer than 21G (31% in UK) so it is surprising Standards still use 21G to test containers. And USA Standard F2132 still uses a low 12.5N as the Pass for “force necessary to penetrate”. However, Canada’s healthcare workers lobbied successfully to raise their Standard’s requirement for wall toughness to 20N – 60% higher than older Standards. Go Canada!

True, tougher containers cost more. So too do needle safety devices. If we pay more for safety devices, then we need pay more for safer, tougher containers. There’s always a cost for safety.

In our quest for zero Sharps Injuries, needles penetrating through sharps containers is one cause of injury we can readily eliminate.

Publications (since 2003 – click link)


  • Grimmond T. Sharps Injuries – why aren’t we at zero? Webber Teleclass June 17, 2020. https://webbertraining.com/schedulep1.php?command=viewClass&ID=1485. Author copy (non-audio)Available.


  • McPherson B, Sharip M, Grimmond T. 2019. The impact on life cycle carbon footprint of converting from disposable to reusable sharps containers in a large US hospital geographically distant from manufacturing and processing facilities. PeerJ 2019;7:e6204. doi.org/10.7717/peerj.6204
  • Grimmond T, Good L. EXPO-S.T.O.P. 2016 and 2017 blood exposure surveys: An alarming rise. Am J Infect Control 2019 Dec;47(12):1465-1470. doi: 10.1016/j.ajic.2019.07.004.  Author copy available.
  • Grimmond T. UK safety-engineered device use: changes since the 2013 sharps regulations. Occupational Medicine 2019;69:352–358. doi:10.1093/OCCMED/kqz087. Author copy available.
  • Grimmond T, Good L. EXPO-S.T.O.P. 2016-17 Report. J Assoc Occup Hlth Prof, Winter 2019;39(1):9-11. Author copy available.


  • Grimmond T, Neelakanta A, Miller M, Saiyed A, Gill P, Jennifer Cadnum J, Olmsted R, Donskey C, Pate K, Miller K. A microbiological study to investigate the carriage and transmission potential of Clostridium difficile spores on single-use and reusable sharps containers. Am J Infect Control. 2018;46:1154-9. doi.org/10.1016/j.ajic.2018.04.206. Author copy available.
  • Good L, Grimmond T. Burnson J, et al. Exposure Injury Reduction Strategies: Results that Protect Lives. J Assoc Occ Hlth Prof. Fall,2018;38(4):10-13. (Copy courtesy AOHP).
  • Grimmond T. Safety Engineered Device Usage and Activation in Six Western U.S. Hospitals. J Assoc Occup Hlth Prof 2018;38(4):14-8. Author copy available.


  • Grimmond T, Good L. Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015: A national survey of sharps injuries and mucocutaneous blood exposures among health care workers in US hospitals.  Am J Infect Control 2017;45(11):1218–1223. doi.org/10.1016/j.ajic.2017.05.023. Author copy available.
  • Good L, Grimmond T. Proven Strategies to Prevent Bloodborne Pathogen Exposure in EXPO-S.T.O.P. Hospitals. J Assoc Occup Hlth Prof 2017:36(1);1-5. (Copy courtesy AOHP).


  • Brown C, Dally M, Grimmond T, Good L. Exposure Study of Occupational Practice (EXPO-S.T.O.P.): An update of a national survey of sharps injuries and mucocutaneous blood exposures among HCW in US hospitals. J Assoc Occup Hlth 2016;36(1):37-42. Author copy available.
  • Grimmond T. Sharps Injury Prevention: Challenges and Effective Strategies. Webber Teleclass June 29, 2016. Mp3 avail https://webbertraining.com/recordingslibraryc4.php.  Author copy (non-audio) available.


  • Grimmond T, Good L. EXPO-S.T.O.P. 2012: Year two of a national survey of sharps injuries and mucocutaneous blood exposures among healthcare workers in USA hospitals. J Assoc Occup Hlth Prof 2015;35(2):52-57. Author copy available.


  • Grimmond T, Naisoro W. Sharps injury reduction: A 6-year, 3-phase study comparing use of a small patient-room sharps disposal container with a larger engineered container. J Infect Prev 2014;15 (5):170-174. https://doi.org/10.1177/1757177414543088. Author copy available.
  • Grimmond T. Frequency of use and activation of safety-engineered sharps devices: a sharps container audit in five Australian capital cities. Healthcare infection 2014;19(3):95-100. http://dx.doi.org/10.1071/HI14009. Author copy available.
  • Grimmond T. The Effect of Temperature, Needle Gauge and Wall Thickness on the Force Required for Needles to Puncture Sharps Containers. J Clin Engin 2014;39(2):71-5. Author copy available.
  • Grimmond T. Use and activation of safety engineered sharps devices in a sample of 5 Florida healthcare facilities. J Assoc Occup Hlth Prof 2014;34(1):13-15. Author copy available.
  • De Sousa F, Martin D, Grimmond T. The impact of a liner-less reusable clinical waste bin system on costs, waste volumes and infection risk in an Australian acute-care hospital. Healthcare Infection, 2014, 19, 76–80. http://dx.doi.org/10.1071/HI13048. Author copy available.


  • Grimmond T, Good L. EXPO-S.T.O.P.: A national survey and estimate of sharps injuries and mucocutaneous blood exposures among healthcare workers in USA. J Assoc Occup Hlth Prof 2013;33(4):31-36. Author copy available.
  • Grimmond T. Using reusable containers for hospital waste – is there an infection risk? South Afr J Epidemiol Infect 2013;28(4):197-201.


  • Grimmond T, Reiner S. Impact on Carbon Footprint: An LCA of Disposable vs Reusable Sharps Containers in a Large US Hospital. Waste Management & Research 2012;30:639-642. Author copy available.


  • Grimmond T. Conducting Research – It’s Your Everyday Work. J Assoc Occup Hlth Prof Spring 2010;30(2):12-14. Author copy available.
  • Grimmond T. Trends in Sharps Injury Prevention. Webber Teleclass, Feb 2010. MP3 avail https://webbertraining.com/recordingslibraryc4.php.  Author copy (n0n-audio) available.
  • Grimmond T, Bylund S, Anglea C, at al. Sharps injury reduction using a sharps container with enhanced engineering: A 28 hospital non-randomized intervention and cohort study. Am J Infect Control 2010;38:799-805. Author copy available.


  • Grimmond T, Rings T, Taylor C, Creech R, R. Kampen R, W. Kable W, et al. Sharps Injury Reduction Using Sharpsmart – A Reusable Sharps Management System. J Hosp Infect 2003;54(3):232-238. Author copy available.