POST 00897E : NEEDLE REMOVERS REVIEW
Follow-up on Post 00891E
12 March 2006
_______________________________
NOTE : There has been problems with transferring files of the two Uganda
documents mentioned in Post 00893E. It’s now been repaired and they are
now accessible.
Satish B. Kaipilyawar (mailto:
[email protected] ) from PATH/India
contributes the following challenging comments on the Needle Removers
Review published in Post 00891E
_______________________________
Dear Yves,
We have gone through the report "Review of studies conducted on the use of
needle removal devices", posted on the TechNet. We were hoping for a more
comprehensive review that took into consideration advantages of
elimination of syringe reuse which is what needle and hub cutters are best at.
During your visit to the trial site in Andhra Pradesh you appreciated
these issues and provided us with your valuable suggestions to consider
making the puncture proof containers out of the recycled plastics. We also
discussed the issue of reuse of syringes, repacking of used syringes and
the failure of most staff to use the safety boxes as they were neither
practical nor safe to burn in the open air.
The risk to the community caused by untreated injection waste getting
accumulated at the health center or in the municipal garbage collection
bins were all eliminated by the simple intervention of needle removal (hub
cutting eliminates reuse of syringes and needles, a huge problem in
India). If you leave the plastic intact there is a strong chance that the
syringe finds it way onto the open market for re-use. I shared with you
our experience of syringes being sold in front of the hospital gate at a
cost of two rupees, (about 3 US cents) and you can imagine the health
impact of this. The project in Andhra Pradesh has monitored data related
to occurrence of needle stick injuries and following more than 50,000
(fifty thousand) destroyed syringes in 200 centers over a period of 6
months we have not seen a single needle stick injury due to the use of the
hub cutters. We can be sure that without the cutters many of these 50,000
syringes would have been reused.
The report I feel lacks this component which are clear benefits for
recommending hub cutters. The field view seems to be absent in the WHO
review. Why are we so biased about the use of needle removers when they
are so successful in addressing the issue of eliminating re-use of
infected syringes and needle sticks in the community?
I believe there is a need to have a fresh look at the broader benefits of
needle and hub cutters. All the issues need to be considered before making
a recommendation. Remaining neutral doesn’t provide any guidance to the
implementing countries, (which is already a recommendation in itself to
the implementing countries), rather it creates confusion and in the
process we contribute to accumulating hazardous, infectious waste.
Finally, while WHO sits on the fence, the world is starting to use needle
cutters – just to my knowledge more than 30,000 thousand are already in
routine use in India and a further 500,000 are currently being procured by
the Government of India, trials are going on in Viet Nam and elsewhere,
and there may be many more that I don’t know about. Also, because of
WHO’s hesitation there seems to be little progress on establishing a
minimum performance standard for needle and hub cutters. In the meantime
countries are buying needle and hub cutters that are almost certainly a
low standard and may be doing even more harm.
We are concerned that WHO not making a decision on needle and hub cutters
is a decision in itself and this is allowing dangerous practices to
continue and poor quality devises being purchased for use in immunization
programmes and more broadly for all injections.
Satish
______________________________________________________________________________
Visit the TECHNET21 Website at
http://www.technet21.org
You will find instructions to subscribe, a direct access to archives, links to reference documents and other features.
______________________________________________________________________________
To UNSUBSCRIBE, send a message to : mailto:
[email protected]
Leave the subject area BLANK
In the message body, write unsubscribe TECHNET21E
______________________________________________________________________________
The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (
http://www.ccisd.org)
______________________________________________________________________________