The Relationship Between Different Types of Sharps Conainers and C. difficile Infection Rates in Acute Care Hospitals: Chart

By Monika Pogorzelska-Maziarz, PhD, MPH, College of Nursing, Thomas Jefferson University, Philadelphia, PA



  • Sharps disposal containers are ubiquitous in healthcare facilities.
  • However, there is paucity of data on the potential for environmental contamination of these containers and their role in transmission of pathogens.
  • The potential for sharps containers to become a source of pathogen transmission within the healthcare setting is an issue that has been raised1,2 but not systematically studied.
  • This is especially important given that contamination of the hospital environment has been shown to be an important component of pathogen transmission.


  • To describe the use of different types of sharps containers in a national sample of hospitals.
  • To assess the relationship between the use of reusable vs. single-use sharps containers and rates of C. difficile infections.


  • Cross-sectional survey of 2,056 hospitals with ≥100 beds conducted in December 2013 to collect data on the use of sharps disposal containers.
  • Survey linked to 2012 Medicare Provider Analysis and Review (MedPAR) dataset containing facility characteristics and C. difficile infection rates as identified by ICD-9 codes.
  • Differences in C. difficile infection rates between hospitals using reusable vs. single-use sharps containers examined using bivariate and multivariable negative binomial regression models.


Support for this study was provided by Becton, Dickinson and Company. MPM served as a consultant to Becton, Dickinson and Company on this project


  • Completed surveys received from 604 hospitals (30% response rate).
  • 539 hospitals provided data on the type of sharps containers used in Fiscal Year 2012 (27% response rate).
  • Participating hospitals were predominantly non-for-profit (67%) and non-teaching (63%).
  • The majority of respondents reported their primary role was in environmental safety (56%); a third were infection preventionists (31%).
  • The majority of hospital utilized reusable sharps containers (72%) in FY 2012.
  • Use of single-use vs. reusable sharps containers differed significantly by region, bedsize, ownership, annual discharges and urbanicity (p-values <0.05).
  • In bivariate regression, hospitals using single use sharps containers had significantly lower rates of C. difficile infections vs. hospitals using reusable sharps containers (Incidence Rate Ratio [IRR] = 0.846, p-value = 0.001).
  • This relationship persisted in multivariable regression (IRR = 0.870, p-value = 0.003] after controlling for other hospital characteristics.


  • This is the first study to show a link between the use of single-use sharps containers and lower C. difficile infection rates and further work is needed to replicate this finding.
  • Future studies should investigate the potential for environmental contamination of reusable sharps disposal containers with C. difficile and other micro-organisms and the role that sharps containers may play in pathogen transmission.


1.Neely AN, Maley MP, Taylor GL. Investigation of single-use versus reusable infectious waste containers as potential sources of microbial contamination. Am J Infect Control 2003; 31:12-7.

2.Runner JC. Bacterial and viral contamination of reusable sharps containers in a community hospital setting. Am J Infect Control 2007; 35:527-30.