POST 00437E : NEEDLE-FREE INJECTORS FOR MASS IMMUNIZATION
Follow-up on Posts 00405E, 00408E, 00411E, 00147E, 00420E, 00426E and 00429E.
18 March 2002
________________________________________________________________________
Jaap Dominicus (mailto:
[email protected]) and Menno Goedhart
(mailto:
[email protected]) from the MSF-Holland Field
Support Unit further contribute to the discussion on the needle-free injector
________________________________________________________________________
The 'clean hands' approachthe jet injector is indeed not 100% safe, we
agree. Michel states that the 'Demonstrated absence of risk of cross
contamination because the use of an inherently dangerous device cannot be
ethically justified'. Then we are talking about an ethical question, not a
technical one. There is a risk, and there'll always be an intrinsic risk of
cross contamination using the jet injector.
We can be blamed for using such a device. We cannot be blamed for any cross
contamination if AD syringes are used. Because such contamination will be
due to bad management, poor training and the like. Although we have no
access to data (if they exist at all) on cross contamination in a AD
environment (including the risk of needle stick accidents and improper
handling and/or disposal of syringes); we are sure that this (ethically 0%)
risk is the same or of even higher compared to the risk of jet-injection.
Here we are stuck with the ethical or 'clean hands' approach. Practical
advantages and disadvantages remaining. Having worked extensively with
Im-O-Jets and Ped-O-Jets, we agree with Hans'comment that sterilisation
after repair at field level (especially for the Ped-O-Jet) was often poor.
The Im-O-Jet is easier in that aspect.
An option could be to have some spare sterilised injection tips (including
the delivery valve), or some complete injection heads (expensive) available
at vaccination sites. As far as we recall these options are only valid for
the Im-O-Jet, as the Ped-O-jet is not assembled in this modular way.
Advantages are speedas stated, a good AD team can meet the speed of a
jet-injector. In a mass campaign it can be difficult to have enough good
teams to cover the required area. In these circumstances you can send out
more teams with jet-injectors (well trained on its use).
Speed can be essential in saving lives, another factor that is beyond our
calculation possibilities. It is an important ethical factor though. If an
improved jet injector will become available, even the better! we wonder
however if the design as suggested (with a space of a couple of millimeters
between the protective film and the skin) would not increase the risk of
bleeding and thus cross contamination, as the pressurised liquid stream
will take a cone like shape immediately after it left the nozzle, before
piercing the skin? As we know from experience, when you did not press the
nozzle of the jet firmly to the skin, an injection could result in
considerable bleeding.
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