POST 00510E : CONTAMINATION STUDY OF NEEDLE REMOVERS
Follow-up on Post 00509E
14 October 2002
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Mary Catlin (mailto:[log in to unmask]) from the University of
Arizona Cancer Center shares sharp observations and comments on the
contamination study of needle removers (previous posting).
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I am curious about the objectives of re-introducing needle-cutters and
needle-removers that became illegal in the U.S. after it became undestood
that needle removal increases workers' risks (re: ban see OHSA Regulations
29 CRF 1910.1030 (e) (2)(ii)(j).
1--If the objective is to reduce the volume of waste, it seems that it
would be more cost-effective to reduce the unnecessary use of injections
that form an enormous avoidable portion of the waste.
2--If the objective is to decrease disease transmission, then use of this
type of device goes against known principles of redesigning tasks to make
then safer.
• a) It adds cost. The device would have to be provided at the point of
care for every injectionist. Budgeting and supply-line failures are
existing problems.
• b) It adds complexity. Workers would have to voluntarily add a step so
that after injection they turn to this device defang, then dispose of the
syringe in a separate box (?), then turn back to the patient. If they have
to set the used syringe down in between, or walk with the device the risk
of needlestick goes up. Best solutions : decrease steps. It is one more
thing to carry on mobile rounds and during outreach.
• c) It creates a barrier to immediate disposal, which decreases
needlesticks. If enough devices are not placed at the point of care,
workers may be tempted to stockpile used syringes for later defanging. This
increases manual handling and increases risk.
• d) It increases manual handling of used equipment. To use it one
handed means you need a surface. Injections are often given under a tree or
when moving from patients bed to bed.
To show that fewer needlesticks occur in use would require large studies
and need controls. In general needle removal is dangerous - (see AJIC Risk
of medical sharps injuries among Chinese nurses, W Phipps et al in August
2002 Vol 30 N.5 p 281.) Some 44% of injuries in Chinese nurses in this
study occurred when separating the needle from the syringe, more than in
recapping.
So you are adding an inherently unsafe task and then trying to make it safe.
• e) Would disposal create an additional waste stream? Do you bury the
device full of solid needles? They seem hard to burn without additional
fuel. Would the syringe be disposed of separately from the needle? If so
how? If the syringe goes into the same waste stream, why separate them?
Boxes of syringes and needles are likely to be easier to burn that cans of
packed metal needles. If syringes, perhaps mangled syringes go into public
waste sites, are you sure that they won't represent a source of exposure to
the population? While hollow-borne needles have the greater risk of
transmission of HIV, work with IV drug users has shown that even shared use
of cottons can spread infections such as Hep C. Syringes in the trash are
such useful items that they are likely to be scavenged and used.
• f) When evaluating, please make sure they are in settings of intended
use. If the intent is to protect workers, it would be helpful to have
workers in the denominator, and measure the reduction in needlesticks per
100 annual productive hours, or 100 work years.
Instead I think the very creative and talented engineers at PATH could make
a great contribution by either designing a finger guard for use when
opening glass ampoules, or make a pattern that people could use locally to
make finger guards from available materials.
Thanks for the opportunity to comment. Maybe you'll prove me wrong at SIGN!
Best regards, Mary Catlin
Research Specialist, Principal
Young Women's Research Center
University of Arizona Cancer Center
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