POST 00826E : NEEDLE-REMOVER STUDY
Follow-up on Post 00818E
23 August 2005
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This posting contains two contributions. The first is from Mary Catlin
(mailto:
[email protected]) from The United States, followed by that of
Ville Lehto (mailto:
[email protected]) from Finland.
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The creative minds at PATH have presented an interesting approach for
sharps disposal that used a needle remover, and imported a specially
designed funnel into a large plastic drum. This approach does lessen some
of the issues of spilling sharps during disposal, and avoids the need to
dig pits. The sites using these devices spend less money on needle disposal
containers. The funnel design and barrel do offer advantages for sites
where staff manually empty boxes of removed needles. It is a new idea in an
area where we need all the approaches we can get.
However despite the conclusions in Technet blurb, it is not yet known if
the process is cost effective or safe. The process was determined to be
safe, because staff felt it was safe. No data was presented or gathered on
safety. Safety is not determined from perceptions, but from measured
defined outcomes. The study noted that the use of needle removal had
created unsafe conditions: batching of used syringes in busy settings
because staff did not remove the needle but just put them in a pile, and
staff were no longer putting scalpel blades, introducers and other sharps
into sharps containers.
It will also be important to know more about the costs. In actual use, some
needle remover devices, which can cost about US$40+ each, were lasting 2
years and would need replacement. The study decided that preventive
maintenance of the needle removers would also be necessary, which involves
purchasing supplies, labor, supervision, and training. The barrels were not
available in rural areas and were transported, and the funnels would need
to be prepared by metal workers to a custom design. It would be helpful to
know how the savings in safety boxes compare to the total costs of this
alternate method. They did not talk about other sharps, which will continue
to need safety boxes for safe disposal.
While I welcome all new thoughts on waste disposal, and do appreciate the
improvement that both the new funnel and barrel represent, it is important
to base purchasing decision on reality, not impressions. Health workers
often scoff at other measures of unquestionable proven efficacy  use of
seat belts, use of hepatitis B vaccine for themselves, use of motorcycle
helmets, getting tested for HIV and getting on treatment. We health care
workers are not always rational in our perceptions, and I prefer that
safety be determined on data not our whims.
Thank you to PATH for a new idea and for the taking the effort to collect
their useful observations.
Mary Catlin
Public Health Consultant
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Hi Everyone,
I read the message of Carib Nelson about the needle remover study in Senegal.
For me it was interesting to find out that the healthcare workers found it
safer to remove the needle. When we needed some authentic test material, we
introduced the safety boxes in Oulu University Hospital. We also conducted
a survey on the opinions of the healthcare workers. They preferred the
safety boxes to the former practice (needle removing, separate disposal of
needle and syringe), and the reason they cited was the improved safety as
one step was reduced.
From the environment point of view I support separating the metal from the
incinerated material. It is possible to prevent harmful components by
controlling the process well, but there is no way to make the (heavy)
metals disappear. In the same way, e.g. mercury will be in the output of
every disposal method (not just incineration).The majority of the metal in
needles and surgical knifes/blades is not heavy metals, but small amounts
exist. The heavy metal contents of our ash are low enough to meet the
requirements for sludge that is used for fields (though, adapting to the
precautionary principle we strongly discourage that). Anyway, less metal is
a step to the right direction, and I think needle removers add
environmental value in the waste management chain. Combined with more
efficient use of safety boxes it will probably also cut some of the costs.
Considering the solution for needles the barrel seems to be more
sustainable solution. The purpose of waste management is either to get the
material back to the industrial system or put it into the ecosystem in a
form that it can easily handle. It would take ages for the metal in a pit
to be part of ecosystem again. With barrels I guess some kind of
collection, sterilization and re-use of material should be possible. If the
answer is not there today, at least the barrels are easier to empty once it
is found.
I’m looking forward to the comments! Should you have any questions, please
feel free to contact me!
With kind regards,
Ville Lehto
Marketing Manager,
Mediburner Ltd
Oulu , FINLAND
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