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Post0230 INJECTION SAFETY & WASTE DISPOSAL 9 March 2000 CONTENTS 1. SMALL SCALE INCINERATOR TRIALS - SOUTH AFRICA 2. LOW-COST MEDICAL WASTE INCINERATOR MANUAL AND PLANS ARE NOW AVAILABLE 3. SHARPS INCINERATION EMISSIONS CONTROL - NEW TECHNOLOGY DEVELOPMENT HELP? 4. COMMENT RE: POST0216 INJECTION SAFETY + REPORT 5. NEW ARTICLE: IMMUNIZATION INJECTION SAFETY IN AFRICA 6. POTENTIAL INTERIM APPROPRIATE TECHNOLOGY SOLUTION TO INJECTION SAFETY 7. NEW! SIGN HOME PAGE + SIGN RESOURCE CENTRE ON THE WEB 8. SUBSCRIPTION TO SIGNpost 9. CDC WEBSITE ON NEEDLE-FREE INJECTION TECHNOLOGY 10. NEWS ITEM: MACEDONIAN CAPITAL LITTERED WITH MEDICAL WASTE 1. SMALL SCALE INCINERATOR TRIALS - SOUTH AFRICA Ticky Raubenheimer, CCCCM, has kindly made available to TECHNET Subscribers, the long awaited results and findings of the very major trial of small scale incinerators for medical waste at health facilities. Contributions, comments and suggestions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ From: "Ticky Raubenheimer" To: "Moderator - TECHNET" Subject: Small Scale Incinerator Trials - South Africa Date: Thu, 17 Feb 2000 09:59:00 +0200 Organization: Collaborative Centre for Cold Chain Management Dear Allan, Finally we have completed the project in South Africa and all the documentation has been submitted to the Department of Health for further action. We wish to inform our colleagues in TECHNET accordingly and make the documentation available to all. The trials were very successful in many respects and showed us the way forward in this regard. The major indicators were: 1. Small scale incineration is a possible method to assist in medical waste management in rural primary health care clinics 2. Small scale incinerators can only be used under strictly controlled loading limits in respect of quality of waste and quantity of waste. 3. Small scale incinerators pose significant occupational health and safety hazards and strict compliance with operational requirements, including safety measures, must be adhered to 4. Operators of small scale incinerators must be trained adequately and monitored regularly for compliance 5. Small scale incinerators have limited use within the total system of medical waste management 6. The trials confirmed that if these small scale incinerators are used within the loading and geographical placement constraints, environmental impact assessment studies may not be necessary for licensing of individual units. 7. The loading capacities of these small scale incinerators will allow for the handling of medical waste during mass immunisation campaigns in South Africa. The documentation covering the total trial is quite extensive and some of the report files are very big in size. We have therefore loaded them onto an FTP server on the Internet in zipped format. To obtain the files: On the Internet, go to Here you will find various files in Winzip format for downloading. The titles are self explanatory. All these files are zipped with a password i.e. Geneva - in other words, to unzip them please enter the password Geneva when prompted by Winzip. The file sizes are as follows: 1. First Steering Committee Meeting minutes (winzip size:116KB) 2. Phase 2 - Laboratory trials report(winzip size:7,447KB) 3. Second Steering Committee Meeting minutes(winzip size:120KB) 4. Phase 3 - Field trials report(winzip size:2,838KB) 5. Third Steering Committee Meeting minutes(winzip size:119KB) 6. Phase 4 - Recommendations to the Dept. of Health on outcomes of trials(winzip size:146KB) 7. Final Combined Report Summary(winzip size:336KB) We hope and trust that this information can be of interest to your readers Best regards Tickly Raubenheimer Collaborative Centre for Cold Chain Management - South Africa ____________________________________*______________________________________ 2. LOW-COST MEDICAL WASTE INCINERATOR MANUAL AND PLANS ARE NOW AVAILABLE The incinerator described in the manual was developed by the Innovative Technology Group at De Montfort University, UK. Jim Picken at De Montford, has kindly posted the manual and plans to both TECHNET and to SIGNpost Forums. Thanks! Contributions, comments and suggestions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ * The file is available for download at: Click on the file: 2,347 KB This file contains these files: DeMontfordIncinerator.PDF 2381243 INCIN191099.dwg 322615 Karldraw3INCIN191099.TCW 304128 Note: The last 2 files are in TurboCAD and AutoCAD respectively and require those programs to open and view. If anyone in the TECHNET can help with conversions to other formats it would be appreciated. * You can also get the files via email. Send an email to: [[email protected]][email protected][/email] with the message: get technet ___________________________________________________________________________ Moderators note: You can only get files by email if you are a TECHNET subscriber. To subscribe to TECHNET Internet Forum. Send an email to: [[email protected]][email protected][/email] with the message: subscribe ___________________________________________________________________________ From: "Jim Picken" To: technet moderator Intermediate Technology Development Group Ltd., Company Reg No. 871954, England, Charity No. 247257. ___________________________________________________________________________ Extract: Page 1 " The medical waste incinerator is a simple two-chamber natural-draught incinerator designed to be operated at temperatures of 800'C and higher. The performance of the incinerator will vary depending on the moisture content of the medical waste but a throughput of up to 15kg/hour can be achieved. The incinerator has been designed so that it can be built on site, using standard building bricks or blocks and lined with refractory bricks. All the steel components, such as the loading door, the ash removal door and air inlet apertures can be made using basic workshop equipment. Wood, wood and dry waste soaked in kerosene or diesel is required initially to start the combustion process. Once the correct temperature is reached, the medical waste is loaded into the incinerator. Much of the medical waste will have value as a fuel and will contribute towards combustion but additional wood or kerosene may be required to ensure that adequate combustion temperatures are maintained. The initial combustion occurs in the primary chamber and then the hot gases pass into the secondary chamber where the combustion process is completed. The two-chamber design helps to ensure that the combustion time is sufficient to destroy the products of combustion and minimise any harmful emissions. The incinerator should be situated under a simple open-sided roofed structure, such as a lean-to, away from tall buildings and in an area free from air turbulence. Although it can be operated in the open, a roof will help to protect the incinerator from rain and provides shelter for the operator. The incinerator is capable of incinerating most types of medical waste including textiles, plastics and packaging. It can also incinerate most types of drugs, medicines, vaccines and sharps ? as long as they are mixed with other wastes. However, as grease-based products, such as ointments, creams and Vaseline create large quantities of dense black smoke when burned , they are best disposed of by other means." ____________________________________*______________________________________ 3. SHARPS INCINERATION EMISSIONS CONTROL - NEW TECHNOLOGY DEVELOPMENT HELP? In the posting below, Janine Jagger, International Health Care Worker Safety Center at the University of Virginia Medical School, provides a hint of the new technologies for incineration construction and the control of emissions that the group is working on. * Janine is looking for funding for a fellowship to enable the further development of the technology by the inventor of a brick kiln with a novel emissions filter made from clay. Replies to Janine at: Contributions, comments and suggestions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ TECHNET Forum subscribers will recall that Janine posted an update on the activities in safe injection carried out at the Center in TECHNET Post0050, 2 October 1998. Technet postings are available on the web at: ___________________________________________________________________________ From: "Jagger, Janine" To: Technet Moderator Subject: Sharps Incineration Emissions Control Development Request Date: Fri, 21 Jan 2000 12:56:39 -0500 To the TECHNET moderator: For the past two years our group has been working on injection safety issues focusing on the areas that have received less attention than injection equipment use and reuse; namely the secure containment of injection waste at the point of use, and the destruction or elimination of injection waste (by incineration or other means). We have been looking for new technologies or existing technologies that have yet to be applied to this problem. We have identified a very interesting technology that might be used for the incineration of injection/medical waste, but needs to be tested for that purpose. The raw materials needed to build this incinerator are free, it has no moving parts, it filters 90% to 99% of particulate emissions and it produces a salable product. It is a brick kiln with a novel emissions filter made from clay and invented by Robert O. Marquez a graduate student at New Mexico State University. Robert is more than just a graduate student; he worked as an engineer for Hewlett Packard for ten years. He is now devoted to developing technologies to improve the lives of the poorest people. We are recruiting Robert to the University of Virginia for a two-year post-doctoral fellowship to do further research on the application of this technology to medical waste incineration. He will be working with Professor James Smith, an international expert in the properties of clays in the Engineering School at U.Va. Upon completion of his fellowship at U.Va., Robert will return to New Mexico State University where he has been offered a faculty position. We are searching for financial support for Robert's two-year post-doctoral fellowship. Since this research falls outside of my area of expertise, I need to be directed to the appropriate resources. Robert is a Native American of the Navaho Tribe, which should qualify him for programs targeting minorities in the U.S. Any advice that TECHNET members could provide would be greatly appreciated. Thank you for any help you can provide, Janine Jagger, M.P.H., Ph.D. Director, International Health Care Worker Safety Center University of Virginia School of Medicine [email protected] --- From: "Jagger, Janine" To: Sign Moderator , Technet Moderator Subject: RE: posting Date: Sun, 23 Jan 2000 14:01:51 -0500 Allan, Thank you for posting the message. Robert Marquez is a very special person and if I can play a small role in helping his work come to fruition I will be very pleased. When I first heard about his work with the brick makers of Mexico (I heard about it on a national radio program) I immediately thought about its application to the incineration of medical waste. I "hunted him down" to find out if he had considered this application of his technology. He said he had not and that he was looking for additional applications. So my phone call was of great interest to him. He is finishing his Ph.D. this Spring and then is required to work "somewhere else" for 2 years before accepting a faculty position at NMSU. It's a rule in American universities that faculty cannot be hired directly out of one's own academic program. So I thought it would be ideal if we could get Robert to U.Va. for a 2-year post-doc. After some searching I found out that we had this major clay expert right here at U.Va. I put Robert in touch with him and the two immediately fell deeply into "clay love." Robert is convinced that this is the place for him to continue his research, so he made a leap of faith, committing to do his post-doc here, in the belief that somehow financial support will follow. So that is the point we are at now. I didn't know much about clay before, and I still don't know much. But what I have learned is that the simple combination of dirt and water can yield amazing results; and it is abundant and it is cheap. So I am hoping that through the network of SIGN and TECHNET colleagues we can help Robert to do the necessary research to test the application of clay filters to the incineration of medical waste in developing countries. Yes, please put me on the SIGN list - I thought I was on it! Best regards, Janine _____________________________________*_____________________________________ 4. COMMENT RE: POST0216 INJECTION SAFETY + REPORT Hala Azzam, USAID/E&E/EEUD/HRHA, comments on the problem of medical waste disposal with reference to TECHNET Post0216 Injection Safety on 12 January 2000. Hala also provides a web link to a think report analysing the effects associated with activities undertaken and influenced by the health care service sector. "Environmental Implications of the Health Care Service Sector" ___________________________________________________________________________ Date: Tue, 18 Jan 2000 13:51:38 EST To: From: "Hala Azzam" Subject: re: Post0216 INJECTION SAFETY Dear Allan, I hope the issue of preserving vaccines at low temperature will be kept alive this time[after Technet'99]. I read Posts0217 and 0218 and see that there is some effort in this direction. I have finally been able to locate one article in the US that has looked at the impact of medical waste on the environment in a comprehensive manner! It was published in October 1999, by RFF (Resource For the Future), a think tank. It is more of a reconnaissance document, since the authors are basically saying that there wasn't sufficient data in this area and that more needs to be done. I thought it very telling however, that the authors chose medical waste as their case study. The thrust of the article was to look at the impact of the service sector on the environment, an area that has fallen through the cracks. The topics covered range from infection control and needle-stick injuries, to dioxin emissions and ground water contamination. The article also talks about about the vision for the future and mention that health is a sector that has considerable influence both "upstream" on its suppliers, and "downstream" on its end-users, and therefore alternatives with less impact on the environment must be encouraged. I have attached the reference for this article below: Sincerely Hala Hala Azzam, PhD AAAS Fellow USAID/E&E/EEUD/HRHA tel 202- 712 1585 fax 202- 216 3409 email: [[email protected]][email protected][/email] _____________________________________*_____________________________________ 5. NEW ARTICLE: IMMUNIZATION INJECTION SAFETY IN AFRICA [Crossposted from SIGNpost] Modibo Dicko, WHO/AFRO, and colleagues have recently published an article, in the Bulletin of WHO, looking at the problem of injection safety in selected national immunization programs in Africa, in the context of a recent logistics project. Safety of immunization injections in Africa: not simply a problem of logistics by M. Dicko, A.-Q. O. Oni, S. Ganivet, S. Kone, L. Pierre, & B. Jacquet: vol.78, no.2, 163-169. The article is available at: Or on the SIGN website at: Or get the file by email: Send a message to: [[email protected]][email protected][/email] with the message: get technet Bul78-2-2000-Dicko.pdf Additional Bulletin articles discuss immunization safety. Please see the Table of Contents below. * Kay Bond, WHO/ V&B, kindly posted the announcement of the publication of the article and has drawn our attention to the Immunization Safety Priority Project (Department of Vaccines and Biologicals, WHO Geneva). For more information please contact Kay at: [[email protected]][email protected][/email] Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ From: [[email protected]][email protected][/email] Date: Mon, 06 Mar 2000 13:53:04 +0100 To: Subject: New Article: Injection Safety In Africa The Immunization Safety Priority Project of the WHO Dept. of Vaccines and Biologicals is pleased to inform SIGNpost readers that the theme of the February 2000 issue of the WHO Bulletin is "Immunization Safety". One article by M. Dicko et al. looks specifically at the safety of immunization injections in Africa. On-line version: Do not hesitate to contact us with any questions or further information on the Immunization Safety Priority Project. Thanks and regards. Kay Bond Administrative Officer Immunization Safety Priority Project Department of Vaccines and Biologicals WHO, Geneva Tel: +41 22 791 2262 Fax: +41 22 791 4210 E-mail: [[email protected]][email protected][/email] ___________________________________________________________________________ All articles in this Special Theme issue of the Bulletin of the World Health Organization are available from this website: ___________________________________________________________________________ TABLE OF CONTENTS Bulletin of the World Health Organization The International Journal of Public Health Volume 78, Number 2, Bulletin 2000, 153-280. SPECIAL THEME - IMMUNIZATION SAFETY EDITORIAL Immunization safety: a global priority by M. Scholtz & P. Duclos: vol.78, no.2, 153-154. [Full text] [Full text PDF] THEME PAPERS New challenges in assuring vaccine quality by N. Dellepiane, E. Griffiths, & J.B. Milstien: vol.78, no.2, 155-162. [Full text PDF] Safety of immunization injections in Africa: not simply a problem of logistics by M. Dicko, A.-Q. O. Oni, S. Ganivet, S. Kone, L. Pierre, & B. Jacquet: vol.78, no.2, 163-169. [Full text PDF] Developing a national system for dealing with adverse events following immunization by U. Mehta, J.B. Milstien, P. Duclos, & P.I. Folb: vol.78, no.2, 170-177. [Full text PDF] Monitoring signals for vaccine safety: the assessment of individual adverse event reports by an expert advisory committee by J.-P. Collet, N. MacDonald, N. Cashman, R. Pless, & the Advisory Committee on Causality Assessment: vol.78, no.2, 178-185. [Full text PDF] The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA by R. T. Chen, F. DeStefano, R.L. Davis, L.A. Jackson, R.S. Thompson, J.P. Mullooly, S.B. Black, H.R. Shinefield, C.M. Vadheim, J.I. Ward, S.M. Marcy, & the Vaccine Safety Datalink Team: vol.78, no.2, 186-194. [Full text PDF] Simian virus 40, poliovirus vaccines, and human cancer: research progress versus media and public interests by J.S. Butel: vol.78, no.2, 195-198. [Full text PDF] Clinical safety issues of measles, mumps and rubella vaccines by M.A. Afzal, P.D. Minor, & G.C. Schild: vol.78, no.2, 199-204. [Full text PDF] ROUND TABLE Vaccine adverse events in the new millennium: is there reason for concern? by B. J. Ward: vol.78, no.2, 205-215. [Full text PDF] Discussion by Ahmed A. Darwish; Phyllida Brown; John Clemens; Robert Pless; Alan R. Hinman; Adrian J. Ivinson: vol.78, no.2, 216-223. [Full text PDF] BULLETIN 2000 FEEDBACK Health inequalities and social inequalities in health by Paula Braveman, Nancy Krieger, & John Lynch: vol.78, no.2, 232-233. [Full text PDF] Response to P. Braveman et al. by C.J.L. Murray, E.E. Gakidou, & J. Frenk: vol.78, no.2, 234-235. [Full text PDF] EDITORIAL Reducing HIV/AIDS risk, impact and vulnerability by D. Tarantola: vol.78, no.2, 236-237. [Full text] [Full text PDF] CRITICAL REFLECTION Directly observed treatment, short-course strategy and multidrug-resistant tuberculosis: are any modifications required? by I. Bastian, L. Rigouts, A. Van Deun, & F. Portaels: vol.78, no.2, 238-251. [Full text PDF] RESEARCH Prevalence of use of complementary/alternative medicine: a systematic review by E. Ernst: vol.78, no.2, 252-257. [Full text PDF] Preventing trachoma through environmental sanitation: a review of the evidence base by A. Pr?mp; S.P. Mariotti: vol.78, no.2, 258-266. [Full text PDF] POLICY AND PRACTICE Biomedical and development paradigms in AIDS prevention by I. Wolffers: vol.78, no.2, 267-273. [Full text PDF] BOOKS & ELECTRONIC MEDIA: [SIGN and SIGNpost reviews] vol.78, no.2, 276-277. [Full text PDF] Letters: vol.78, no.2, 278. [Full text PDF] ? World Health Organization / Organisation mondiale de la Santé¬ 2000 _____________________________________*_____________________________________ 6. POTENTIAL INTERIM APPROPRIATE TECHNOLOGY SOLUTION TO INJECTION SAFETY Bob Chen, CDC/Atlanta, contributed these thoughts on an appropriate needle technology to the TECHNET Forum. Bob proposes fiber reinforced plastic needles - as more appropriate for the usual purpose of needles and to simplify safe disposal. Bob challenges needle designers and manufacturers to make this a reality! Action, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ Moderators Notes: The thermal processing of sharps was discussed in TECHNET Post0125, Alternatives To Incineration, on 17 March 1999. Go to the website for the file: Post0125-AltIncineration.txt ___________________________________________________________________________ The UK Consumers Association reported some success on using low level heat (~200'C) to turn used syringes and needles into an apparently low risk, disinfected plastic cake which successfully trapped all sharps. The method the UK Consumers Association was working with was proposed by Dr Imam Zagloul Imam, formerly Director general of VACSERA, Egypt, uses an adapted domestic oven for the reduction and decontamination of injection waste. This was described and discussed in TECHNET Post0125, along with other methods of thermal processing of sharps. ___________________________________________________________________________ From: "Chen, Robert (Bob) (NIP)" To: "'Technet Moderator'" Subject: RE: Post0216 INJECTION SAFETY Date: Thu, 13 Jan 2000 13:53:54 -0500 Dear Allan, With the new millennium, I'd like to initiate/stimulate some discussion on one potential interim(appropriate technology) solution to injection safety: 1) developing and substituting plastic needles for steel needles as a first step in helping to solve the waste disposal problem. 2) combining a plastic needle with autodisabling pouch and needle delivery system (e.g., an improved Uniject) as the second step. Rationale: - While alternative methods for administering medicines and vaccines are under development, parenteral injections will still be the principal delivery method in developed and developing countries for a long time. - The main solution for unsafe injections developed to date by the "developed" world is the single use disposable plastic syringe & needle. The use of this "solution" requires 1) constant adequate supply at points of use, and 2) adequate medical waste disposal system. Both of which are clearly not available in much of the less developed world - highlighting the need for an alternative solution. - Pondering the uses of needle and syringe, one quickly realizes how "overengineered" the typical plastic syringe and metal needle is for its mission: a low pressure medical procedure that takes a few seconds to complete. The resulting waste has a large bulk of plastic and a metal needle that requires thousands of degree to adequately incinerate (i.e., not doable in most outlying clinics at point of use). The current syringe and needle is always available for the tasks where such bulk of plastic and needle is needed. The question is to come up with a simpler alternative for the main mission of injections. - Further reflection on the history of syringe and needle since its invention in the 1800's, suggest that the major change is in the material (from metal, to glass, and now plastic), rather than how the design can be optimized to meet our current needs (until some of the recent autodisabling/sheathing features). - Plastic can be melted down into relatively less harmful and more easily managed blocks at hundreds of degrees - something doable at almost all outlying clinics. Therefore the current proposal to explore developing plastic needles as a substitute for current metal needles, and then to decrease volume of waste, link such needles to autodisabling pouch and needle systems. - While a plastic needle may not be able to be made as sharp as a metal needle (perhaps plastic technology has now advanced to the point where this is now debatable), since it is designed to be used just once, the advantages of ease of disposal may outweigh a slight increase in pain. In fact dulling after use without the ability to be resharpend may be a good deterrent to reuse. - Similarly, the plastic required to provide the necessary strength may be more expensive than stainless steel initially, but the other benefits and hopefully the market will make price less of an issue. - While plastic may be more likely to break than metal, again, it would seem to me that some simple weaving of plastic fibers would make this a non-issue in routine use. - While the above proposed solution(s) may not be the final or even a good answer, I'd like to challenge the syringe and needle designers and manufacturers, as well as others to critique and improve on this starting point for discussion - and hopefully some solutions. Best regards, Bob Robert T. Chen, MD MA Chief, MS-E61 Vaccine Safety and Development Branch National Immunization Program CDC, Atlanta, GA 30333 _____________________________________*_____________________________________ 7. NEW! SIGN HOME PAGE + SIGN RESOURCE CENTRE ON THE WEB The Safe Injection Global Network has a home page: Set your bookmark! The Safe Injection Global Network website has been updated. New features include a resource centre and a photo gallery. A list of documents available on the site is posted below. Our thanks and congratulations to the EpiConcept Team for designing and maintaining the site! ___________________________________________________________________________ From: [[email protected]][email protected][/email] Date: Tue, 01 Feb 2000 18:50:23 +0100 To: "SIGNpost" Subject: SIGN Home Page SIGN now has its WEB page at . For the moment, we have just the fact sheets up there, but I would welcome comments and suggestions regarding how we could make use of this extraordinary communication tool. Regards, Yvan Hutin SIGN coordination/WHO E-mail: [[email protected]][email protected][/email] --- From: "Etienne" To: "SIGN Moderator" Date: Fri, 03 Mar 2000 21:19:14 +0100 Subject: the SIGN web site was updated on 03/02/2000 New in the SIGN site: a resource center + a photo gallery regards, EpiConcept Team ___________________________________________________________________________ SIGN RESOURCE CENTRE The documents below can all be downloaded directly from this Internet site. Alternatively, hardcopies can be ordered from the SIGN secretariat by email or by writing or faxing the SIGN Secretariate at: SIGN Secretariat Department of Blood Safety and Clinical Technology World Health Organisation 20 Avenue Appia CH-1211, Geneva 27 Switzerland E-mail: [[email protected]][email protected][/email] Fax: +41 22 791 4836 The documents available on 03 March 2000 are. * Aide-memoire for a national strategy for the safe and appropriate use of injections This two-page document designed for policy makers at country level summarises the key elements of a national strategy for the safe and appropriate use of injections. *SIGN slide presentation This powerpoint presentation reviews the evidence documenting the public health problem associated with unsafe injections and presents the safe injection global network. * SIGN Initial meeting report The report of the SIGN initial meeting summarises the proceedings of the initial SIGN meeting on October 4-5th, 1999, at the World Health Organisation Headquarters in Geneva, Switzerland. It contains the SIGN terms of association and the proposed SIGN strategic framework. * Consensus statement on use of auto-disable syringes for immunisation This consensus statement signed by the World Health Organisation (WHO), the United Nations Children Fund (UNICEF), the International Federation of Red Cross and Red Crescent Societies (IFRCS), and the United Nations Population Fund (UNFPA) addresses the need to generalise the use of auto-disable syringes for immunisation by the end of 2003. ARTICLES FROM THE BULLETIN OF THE WORLD HEALTH ORGANISATION ON INJECTION SAFETY * Injection safety: a global challenge This editorial summarises key injection safety issues and announces the launch of SIGN * Unsafe injection in the developing world and transmission of bloodborne pathogens: A review This literature review summarises studies that assessed injection safety and injection frequency, as well as studies estimating the strength of the association between unsafe injections and infections with bloodborne pathogens. It concludes that in many countries, unsafe injections are a major source of infections with bloodborne pathogens. * Transmission of hepatitis B, hepatitis C, and HIV through unsafe injections in the developing world: Model-based regional estimates This mathematical model provides an estimate of the incidence of injection-associated infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). It suggests that each year, in the world, overuse of injections and unsafe injection practices combine to cause an estimated 8 to 16 million HBV infections, 2.3- 4.7 million HCV infections, and 80,000 to 160,000 HIV infections. * The cost of unsafe injections This article provides an estimation of the cost of unsafe injections annually world-wide. * Sterilisable syringes: Excessive risk or cost-effective option? This article reviews reasons that would support the choice of sterilisable syringes to administer injections. * Auto-disable syringes for immunisation: Issues in technology transfer This article reviews issues in technology transfer for the use of auto-disable syringes for immunisation. * Safety of immunisation injections in Africa: Not simply a problem of logistics This article reviews difficulties in reaching immunisation injection safety in Africa and proposes a holistic approach to injection safety that goes beyond the problem of logistics. * Anthropological perspectives on injections: A review This article reviews anthropological studies conducted on the social and individual determinants of poor injection practices. _____________________________________*_____________________________________ 8. SUBSCRIPTION TO SIGNpost [Crosspost from SIGNpost] Are you subscribed? Send an email to: [[email protected]][email protected][/email] or to: [[email protected]][email protected][/email] ___________________________________________________________________________ From: [[email protected]][email protected][/email] Sent: Tuesday, February 08, 2000 9:59 AM To: Sign Moderator Subject: !! SUBSCRIPTION to SIGNpost !! I have come to realize that a number of persons are not subscribed to SIGNpost, the weekly, moderated injection safety email forum run by Allan Bass, while they think they are. In addition, some people have not subscribed thinking that SIGN and technet have similar injection safety posting, which is not exactly true. In order not to send unsolicited emails, we have NOT subscribed people automatically but we sent an invitation to which A REPLY WAS NECESSARY to be SIGNposted. If you wish to be signposted and receive weekly injection safety news, you can 1- Reply to this email 2- Send an email to [[email protected]][email protected][/email] 3- Send an email to Allan Bass (Disregard this email if you are in fact already SIGNposted) Best regards Yvan Hutin SIGN coordination/WHO E-mail: [[email protected]][email protected][/email] _____________________________________*_____________________________________ 9. CDC WEBSITE ON NEEDLE-FREE INJECTION TECHNOLOGY In case you missed it elsewhere! [Crosspost from SIGNpost] ___________________________________________________________________________ From: "Damon, Scott" To: "'SIGN Moderator'" Subject: RE: Post0012 TOOLS + ARTICLE + SYMPOSIUM + INCINERATOR + Date: Wed, 9 Feb 2000 12:38:46 -0500 The Centers for Disease Control and Prevention (CDC) has developed a website on needle-free injection technology. The site includes a bibliography of related scientific literature; a listing of the needle-free injection policies of the World Health Organization (WHO), CDC, and the U.S. Department of Defense; and information about manufacturers and devices. To visit CDC's website on needle-free injection technology, go to: _____________________________________*_____________________________________ 10. NEWS ITEM: MACEDONIAN CAPITAL LITTERED WITH MEDICAL WASTE Contributions, comments and suggestions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ Macedonian Capital Littered with Medical Waste By Natasa Dokovska SKOPJE, Macedonia, March 6, 2000 (ENS) - One month after a brand new medical waste incinerator was placed in the Drisla waste collection facility, medical waste is still scattered in the streets of Skopje. The incinerator was donated to the former Yugoslav Republic of Macedonia by the United Kingdom. On Friday, the center of the Macedonian capital city of Skopje was littered with the medical waste. Near the Town's Hospital, blood soaked materials, syringes, dirty gauze and bandages were in plain view. Street dogs are prowling amongst the waste, feeding and scattering the litter. The UK government decided to donate the medical waste incinerator to the Macedonian government after an incident six months ago when United Nations peacekeepers, KFOR soldiers, left bags containing body parts from Kosovo in the center of Skopje. Skopje, Macedonia (Photo courtesy City of Skopje) But now that the incinerator is in Skopje, nobody is interested in using it. The hospital staff has been through extensive training in the use of the incinerator, but they cannot using the instructions they received because the incinerator remains closed. Boris Zmejkovski, director of the Drisla waste collection depot, says he cannot get the incinerator started for the lack of 100,000 German marks. He must find a solution for financing of the work on the incinerator, because it will be too expensive for the depot to cover alone. Zmejkovski says another problem is that he does not yet have agreement from all hospitals in Skopje to use the incinerator. And in addition, Zmejkovski says once agreement is reached they must find trucks to transport the waste. During this period, the World Health Organization has been financing a project to provide 250,000 plastic bags for medical waste for the period of three months. They have asked the medical stuff to separate the waste in three parts, but now nobody wants to do this work. Environmentalists in Macedonia are worried that the new incinerator will not be used and medical waste will continue to contaminate Skopje. ? Environment News Service (ENS) 2000. All Rights Reserved. Copyright ? 2000 Lycos, Inc. All Rights Reserved. Lycos? is a registered trademark of Carnegie Mellon University. ____________________________________*______________________________________ ____________________________________*________________________

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