Disposal of pre-filled glass syringes?

Dear all,

I am not sure if this discussion is still on as it seems to be an older one. However, I received an inquiry outlining the same problem asking if WHO has a standard procedure for glass PFS. I asked around but it seems as if there is no standard. One contact told me that PFSs are not used in WHO Euro because of the "cold chain volume requirements" as the difference in cold chain volume seem to be huge - 30-50 fold. 

I did a quick research on the web, and there are PFS with stacked needles and some with luer locks. Which one are we talking about? 

In general, I think the standard WHO procedure can still be used, by throwing the complete syringe in the sharp box and sending it either for autoclaving or incineration (will the glass syringes explode in the incineration chamber (tight barrel) like it is common with glass vials - or just melt?). 

if the needle is attached with a screw luer-lock , a safety box with a specific opening to separate the needle from the barrel (strip off device: see example video: https://www.propraxis-shop.de/dispo-kanueleneimer-1500-ml-803.html). Depending on the kind of vaccine and it is not considered as potentially infectious, the barrel might be crushed or just disposed of for landfilling (if safe). 

If not - a needle cutter cannot be used and the needle is potentially infectious and the complete syringe need to be disposed of as hazardous waste. 

#Ruanda: this is an interesting example. Why is the glass sharp waste (red bin) treated differently than the other sharp waste?

Would be great to learn more - or if there are new standards - more experiences in the field. 

Best from Berlin,

ute

Thank you Hart. Very informative. Regards, Nagaraj

Hi Patrick, There are indeed many glass crushers, some of which are specialized for medical waste glass. Examples of the classic MSF and a commercial clinic level vial crusher are attached for reference. I do maintain though that if considering use of these devices, it's best to incinerate syringes prior to compaction to neutralize the biohazard and maximally strip the syringes of non-glass components; needle removal would also most likely facilitate compaction in these devices but testing would need to be systematically undertaken to confirm this approach as feasible and appropriate. Secondary use of the glass is indeed a possibility if the value added product made with them is sold for a very high premium to justify the economics of collection and processing (melting and filtering to remove metal residue). Do you know of any active programs that make use of such glass in commercial products?Regards, Tory_________ Toryalaihart, There are glass crushers that reduce the volume of glass. The glass can then be used by companies that make terrazo for the kitchen or disposed off in a health care waste pit. Patrick ##text## ##text##

Hello, Thanks for the message related to this issue. As you know, Rwanda just completed the PCV7 post introduction evaluation. Here is the update from the evaluation. The approved disposal policy for glass pre-filled syringes was defined as follow: a) Collect used glass pre-filled syringes and AD syringes in two different safety boxes ("red" safety boxes" for glass PFS and "yellow" or "white" safety boxes for AD syringes). b) Filled yellow or white safety boxes with AD syringes are disposed using the standard incinerators at the health center. Filled "red" safety boxes with glass syringes are stored at the health center in a safe place and are taken to the district hospital once every month when the health worker comes to collect vaccines and other medical supplies c) When the number of red safety boxes increases at the district hospital (once every two or three months), a truck goes and collects them and transports them to the high temperature incinerator located at the Kanombe Military district hospital (in Kigali). Findings from the evaluation showed the following: a) Health workers were aware of the policy of collecting used syringes in two different safety boxes b) Both red and yellow safety boxes were available at each health center we visited c) During the immunization, health workers deposited, in a systematic way, used syringes in the appropriate safety box d) The filled red safety boxes were stored in a safe place, waiting to be shipped to Kigali for final disposal When we asked if they had experienced any major problems in implementing the policy, they said: "NO". We can conclude that the guidelines for final disposal of glass pre-filled syringes and AD syringes were known and well implemented by the health workers. Regards, Michel Othepa Immunization Technical Officer USAID/MCHIP Project

Dear Hart, Anne, Depending on the quantities of such bottles and syringes, a high temperature high-tech incinerator with air pollution control devices can be fabricated with the expertise we have developed at the University of Dar es Salaam. This can incinerate most of the syringes and all plastic materials leaving the glass ready for crushing. The crusher will then handle only glass. Note that I concur with Hart that we have to sterilize the bottles to remove all biologicals, before crushing or encapsulation. Hart suggested temperatures around 650°C, but currently our incinerators are running at 950+, with temperature control systems in place. I will appreciate if the person in need will arrange some sort of meeting and discuss this on the table. As I indicated earlier, I am in a position to undertake this exercise. Prof. S.V. Manyele Department of Chemical and Mining Engineering College of Engineering and Technology University of Dar es Salaam P.O. Box 35131,Dar es Salaam Tanzania Mobile: +255 716 941 061

Dear Anne and Prof. Manyele, Current best practice as per the means available in most countries is to incinerate the glass syringes at 650+ Deg C, and then preferably compact them. Compaction prior to treatment is unwise since crushing could release pathogens and endanger health workers. Burial without sterilization poses risks as well unless the encapsulation pit is professionally made, and sure to be un-compromised for at least 20 years after the last syringe is placed in it. Autoclaving is also an option, but is technologically unfeasible at most locations due to the need for electrical power. Putting them through an MSF vial crusher after incineration or autoclaving is cumbersome since the needles tend to get caught and jam the slammer arm. Removing the needle with a cutter, and then incinerating (to remove plastics/rubber and sterilize) could adequately prepare a glass syringe to be run through an MSF vial crusher but systematic testing hasn't been undertaken as far as I know -- needles would then go into a needle pit. There are some new appropriate technology auto-combustion incineration systems out there being piloted in the field. One has a built-in crusher, and the other processes them in a separate chamber as a step in a low tech recycling chain, with eventual conversion to marketable products. The effectiveness of these technologies hasn't been field verified at this time, but is certainly a start. Glass syringe safety boxes are typically about 20% heavier than plastic syringe safety boxes, but packed less full. The countries in which I have seen glass syringes (pneumo) are for the most part stockpiling them while building capacity to process them. The overall physical volumes from routine immunization programs are minimal relative to the general medical waste stream (only about 5% by weight of a sampled african country's national hospital waste stream), and storage at a dry locked facility isn't unthinkable. Indications from experts in vaccine delivery indicate that the glass syringe technology won't be commonplace in the future, and is just a transitory delivery mechanism for some of the newer vaccines. It is a shame though that more funding and effort was not invested in R&D prior to dissemination of vaccines in this form since countries now appear to be faced with the dilemma of glass syringe disposal. Prof. Manyele -- If you have an alternative solution that addresses both the biohazard and the compaction of the syringes, I for one, would be delighted to hear of it. Kind regards, Tory Hart ______________________________________________________________________

Disposal of pre-filled glass syringes - RESPONSE? Posted: Mon Jul 06, 2009 6:54 am -------------------------------------------------------------------------------- Another response: Dear Marcia and Tory Regarding the issue of disposal of pre-filled glass syringes, I remember to respond to the call fopr disposal proposal, but I did not get any response. If you are still open to finding the solution, I have one for you. Let me know what you want done. Prof. S.V. Manyele Department of Chemical and Process Engineering College of Engineering and Technology University of Dar es Salaam P.O. Box 35131,Dar es Salaam Tanzania Mobile: +255 716 941 061

Anyone have any updates on disposal of glass syringes and vials by any chance? I read in one recommendation that you need to crush and bury...somewhere else said that you can use high-temperature incineration. What's the latest? Thanks! anne

Waste of Glass Syringes is also not easy because when glass burns their might be some little blast and in result this makes injuries. Plastic is cheaper then glass it cut cost also. 

Use of glass syringes especially pre-filled may break during transportation and if not properly disposed could result in injuries so it has to be discouraged. Pre-loaded polysterene or pvc syringes are much better in transportation and storage. It could cut cost also. Plastic could be recycled after proper disinfection as recommended by health waste management. Nagaraj

Dear Marcia and Tory Regarding the issue of disposal of pre-filled glass syringes, I remember to respond to the call fopr disposal proposal, but I did not get any response. If you are still open to finding the solution, I have one for you. Let me know what you want done. Prof. S.V. Manyele Department of Chemical and Process Engineering College of Engineering and Technology University of Dar es Salaam P.O. Box 35131,Dar es Salaam Tanzania Mobile: +255 716 941 061

Hi Marcia, Unfortunately, there were no public responses regarding this question.  A contact in Rwanda did privately confirm that the problem there is serious and shared photographs of incineration facilities in Kigali overloaded with hundreds of kilos of glass syringes from the Pneumo vaccine.  If JSI has anything to share, such stories might be key to preventing other countries from hurrying into wanting these vaccines without first putting in place the required infrastructure to process this waste. Cheers, Tory

Hi Tory, JSI is working with the MOH on this in Rwanda through its ImmunizationBASICS and MMIS projects. To date, the introduction of the Pneumo 7 vaccine remains an issue both for injection safety and HCWM. Have you had any response to this query to inform the discussion? Thanks, best, Marcia.