# Lean Six Sigma for Sharps Waste Management and Occupational Biosafety in Emergency Care Units

## TL;DR

This study uses Lean Six Sigma to improve sharps waste management and reduce occupational risks in Brazilian emergency care units.

## Contribution

Applies Lean Six Sigma (DMAIC) to structure low-cost interventions for biosafety governance in public healthcare.

## Key findings

- Recurrent nonconformities in labeling, documentation, and transport routes were identified in sharps waste management.
- DMAIC supported a low-cost action plan with checklists, standardized routes, and KPIs to improve biosafety traceability.
- Proposed actions aim to foster staff engagement and a culture of shared responsibility for safety practices.

## Abstract

What are the main findings?
Needlestick injuries represent a critical occupational risk in Emergency Care Units, with direct implications for healthcare workers’ safety and biosafety governance.The application of Lean Six Sigma (DMAIC) is significant in structuring low-cost managerial interventions aimed at process standardization, traceability, and risk control in public healthcare services.

Needlestick injuries represent a critical occupational risk in Emergency Care Units, with direct implications for healthcare workers’ safety and biosafety governance.

The application of Lean Six Sigma (DMAIC) is significant in structuring low-cost managerial interventions aimed at process standardization, traceability, and risk control in public healthcare services.

What are the implications of the main findings?
The proposed improvement plan offers a replicable approach to strengthening biosafety governance and reducing occupational risks in resource-limited emergency and urgent care settings.

The proposed improvement plan offers a replicable approach to strengthening biosafety governance and reducing occupational risks in resource-limited emergency and urgent care settings.

Occupational exposure to sharps waste represents a critical challenge for public health systems, directly affecting healthcare workers’ safety, institutional costs, and environmental sustainability. This study aimed to analyze sharps waste management practices and to structure improvement actions for biosafety governance in Brazilian Emergency Care Units (ECUs) through the application of the Lean Six Sigma (LSS) and DMAIC method (Define, Measure, Analyze, Improve, and Control). A single multiple-case study was conducted across three public units in different regions of Brazil, combining direct observation, regulatory checklists based on ANVISA Resolution No. 222/2018 (RDC), and cause–and–effect (5M) analysis. The diagnostic phase identified recurrent nonconformities in labeling, documentation, and internal transport routes, primarily due to managerial and behavioral gaps. Based on these findings, the DMAIC framework supported the development of a low-cost, evidence-based action plan that outlined proposed interventions, including visual checklists, standardized internal routes, and key performance indicators (KPIs), intended to strengthen biosafety traceability and occupational safety. The se proposed actions are expected to support continuous learning, staff engagement, and a culture of shared responsibility for safe practices. Overall, the study provides a structured basis for future implementation and empirical validation of continuous improvement initiatives, aimed at enhancing public health governance and occupational safety in resource-constrained healthcare environments.