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  3. Sunday, 15 August 2004
POST 00706E : ACCIDENTAL NEEDLESTICK Follow-up on Post 00701E 15 August 2004 _______________________________ Two replies were received following Vladimir's Petrovic's posting (00701E). The first is from Steve Wiersma (mailto:wiersmas@who.int) from WHO who discusses the issue. The second came from Tina Norgard (mailto:tnorgard@emunio.dk) from Denmark who tells us about a new generation of syringes, the retractable syringe. _______________________________ Vladimir Petrovic describes an unfortunate means of exposure to blood-borne pathogens. Similar exposures occur in occupational settings and among injection drug sharing populations among other groups. Unfortunately, exposures such as this present multipe risks to blood-borne pathogens including HIV, HBV and HCV, as well as other pathogens. The public health approach towards a needle-stick injury should include a complete risk assessment, referral for management of the injured person (medical, psycho-social, etc), as well as implementation of prevention strategies. The WHO "Aide Memoire for the health care worker protection" (available at http://www.injectionsafety.org ) covers many of these issues but is addressed to a specific audience. The checklist contained in this document covers 1) universal precautions (includes proper waste management), 2) hepatitis B immunization, 3) Personal protection, and 4) post-exposure management. Each of these topics is relevant for the child who is injured by a medical device in the situation described by Mr. Petrovic although specific advice may be different for these cases (e.g. serological testing following routine infant immunization is not recommended). In addition, post-exposure options will vary depending the pathogen and resources available. Possible options include provision of immunoglobin vaccine and antivirals. Decisions may be improved by determination of source and victim serostatus for the various pathogens, however, that is often difficult when exposure comes from mixed medical waste. In conclusion, most blood exposures are preventable and we need to continue our efforts to make these events rare. Steve Wiersma, Medical Officer/Hepatitis Focal Point Expanded Programme on Immunization World Health Organization _________________________________ Mr Petrovic raises the issue of thrown away IDU syringes, which can then be found at playgrounds, in parks etc. We would like to draw your attention to a new generation of safety syringes, the socalled Retractable Syringes, where the needles disappear into the barrel after use, thus preventing re-use and preventing the fatal accidents referred to. In the past such syringes were extremely expensive, with prices up to 50 US cents a piece. However, the development of simpler manually retractable syringes, has made it possible to put these on the market for around 8 - 10 cents a piece. Admittedly a price higher than a regular syringe, but taken the costs of screening for and treatment of hepatitis and HIV, this may prove to be a very viable investment. Safety Syringes are recommended by WHO (see Guiding Principles to Ensure Injection Device Safety), and WHO will have additional information about the cost effectiveness of implemeting safety syringes. If any members of TechNet are interested in receiving evaluation samples, please do not hesitate to contact me, and please feel free to visit our website http://www.emunio.dk for further information. Tina Norgard Emunio ApS ______________________________________________________________________________ __________________ 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:LISTSERV@listes.ulaval.ca 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) ______________________________________________________________________________


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