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Post00297 DEFANGING? + JET INJECTORS? + INCINERATORS? + 7 November 2000 CONTENTS 1. NEEDLE DEFANGING? 2. DEVELOPMENT OF A HIGH-WORKLOAD JET INJECTOR 3. NO TO INCINERATORS!! ? 4. REGIONAL CENTRE ON HAZARDOUS WASTES OPENS IN SOUTH AFRICA 5. OTHER TECHNOLOGIES 1. NEEDLE DEFANGING? key issues in injection waste management are protection of health workers and public by assuring safe destruction as near as possible to point of use. This contribution by HealthTech safe medical waste disposal team to discussion follows up on the recommendations of Technet sub- committee meeting in Almaty, Kazakhstan, April 1999. * Replies to: Janet Vail [email=jvail@path.org]jvail@path.org[/email], [email=nmuller@path.org]nmuller@path.org[/email], [email=technet@acithn.uq.edu.au]technet@acithn.uq.edu.au[/email] From: "Muller, Nancy" To: [email=Technet@acithn.uq.edu.au]Technet@acithn.uq.edu.au[/email] Subject: posting Date: Fri, 27 Oct 2000 Hello Allan, HealthTech safe medical waste disposal team wanted to post attached rather long message on defanging to Technet. Thanks! Nancy Nancy Muller Program Officer PATH (Program Appropriate Technology in Health) 4 Nickerson Street, Seattle, WA USA 98109-1699 Tel: (206) 285-3500 Fax (206) 285-6619 nmuller@path.org http://www.path.org ___________________________________________________________________________ ***POSTING TO TECHNET *** Those of us working on HealthTech safe medical waste disposal team would like to generate a discussion on concept of "defanging"-using a device to safely remove needle ("sharp";) from syringe at point-of-use, and contain it securely until it can be disposed of safely. This approach was demonstrated by Medecins Sans Frontieres (MSF) at Technet sub-committee meeting in Almaty, Kazakhstan, in April 1999. PATH has been working on two different concepts removing needle: (1) a simple design use only with luer-slip needles (short development time, very low-cost, can be bundled with each box of syringes); and (2) a moderately more sophisticated design that can remove all needles (longer development time, higher cost, may not be a bundled commodity). We are interested in your thoughts and experiences with concept of defanging, as well as your views on best application and introduction strategies two specific approaches described within. Please view background below and keep these questions in mind as you read through rest of posting. *** QUESTIONS *** *> Needles (dangerous "sharps" component) constitute only a small percentage of total volume of injection devices. If a simple, low-cost device could safely segregate and contain needles at point-of-use (reducing volume of infectious sharps waste by more that 90%), would this substantially improve waste management in health centers? *> In all health center procedures involving injections, what percentage of needles you see are luer-slip (as opposed to luer-lock or fixed needles)? *> Does legislation in countries you are familiar with either require or prohibit removal of needle before disposal? *> What are barriers to health workers using a defanging device? *** CURRENT PRACTICE *** In current practice, syringe and needle are intended disposal as an assembled unit to avoid unnecessary handling of sharp. In best-case scenarios, syringe and needle unit will immediately be contained in a 5-liter WHO disposal box and then incinerated. In worst- case, loose syringes with needles attached are thrown out with health- facility trash, posing a risk to health workers and community. Best-case practices result in generation of 5 liters of infectious sharps waste every 100 syringes. Sharps waste volume is increasing dramatically with use of auto-disable (AD) syringes. *** BENEFITS OF DEFANGING *** We view two primary benefits of defanging as improving waste management by reducing volume of infectious waste that requires special handling and reducing needlestick accidents to clinic staff and community. It is also hoped that defanging will ultimately reduce disposable needle and syringe reuse. *** REDUCTION OF INFECTIOUS-WASTE VOLUME *** Defanging uses a basic solid-waste management principle-segregation. Segregation separates medical waste into categories of materials that require different handling. Defanged syringes can now be bagged ("yellow bag";) and disposed of with other infectious hospital waste. Separating needle from syringe reduces by 93% volume of sharps waste that requires special handling. *** REDUCTION OF NEEDLESTICK RISK *** Research shows that most needlestick accidents occur during, and immediately after, injection while injection device is still under control of user (Janine Jagger, University of Virginia). risk of pathogen transmission from infected persons to health care workers through injury with a sharp object have been estimated to be 6% to 30% HBV, 0.5% to 2% HCV, and 0.3% HIV. Point-of-use sharps-disposal strategies will impact a portion of accidents that occur after use and before disposal. Automatic needle sheathing or needle-free technologies are needed to address needlestick during use. needlestick accidents that occur during transfer, handling, disposal, or misuse of sharps waste can also be reduced or eliminated by good sharps management-starting immediately after injection. By using a simple, mechanical device that allows safe, one-handed removal of needle, clinic staff, waste handlers, and community are protected from needlestick transmission of blood-borne infections. small containers of needles can be incinerated or buried. Should needles find their way into general waste stream, they are safely contained and labeled as infectious waste. Like most practical and affordable solutions, this solution will not guarantee protection nor enforce good behavior. It can only enable compliance and facilitate good practices. It is not a substitute training and supervision. Please view defanging in this light. *** TWO DEFANGING CONCEPTS *** To improve injection safety, defanging must occur immediately, and at point of use. To enable wide availability, defanging devices should be small and inexpensive enough to be physically bundled with syringes, be produced locally, or be otherwise made available at a cost per syringe that is equal to or less than current disposal boxes. PATH is exploring two defanging approaches to safely remove and contain used needles-informally known to us as "Rocker" and "Puller." *** LUER-SLIP DEFANGER *** Rocker grew out of MSF's use of puncture-resistant drug boxes with a triangular cut in top to facilitate needle removal. We have used a puncture-proof can (imagine a soup or condensed milk can) with a small, indented hole in top. When any luer-slip needle is inserted up to hub and "rocked" once against sides of hole, needle drops into metal container. As with current burn box, safe disposal/destruction of these sharps depends upon motivation and training of responsible health worker. By radically reducing volume of most critical waste and containing it in a harder-to-open container, presumption is that waste management burden will be reduced and compliance with good practices encouraged. Rocker approach is ready field evaluation. If successful, Rocker could be ready production within next 12 to 18 months. *** PULLER-DEFANGS ALL SYRINGES *** Puller will extract entire length of sharp metal cannula from syringe, rendering needle non-reusable. It can be used with any type of needle fitting-fixed, luer-lock, and luer-slip-and any size or shape of syringe or needle. Working models have been developed this concept, but they require additional refinement before they will be ready field evaluations. This work is underway. Hope to hear from you all. *** CONTACT *** Janet Vail, Team Leader, Email: [email=jvail@path.org]jvail@path.org[/email] Fax: 206-285-6619 ____________________________________*______________________________________ 2. DEVELOPMENT OF A HIGH-WORKLOAD JET INJECTOR Linda D'Antonio, DCI, would like to find out about individuals in Technet group who might be interested in sharing with our design engineers their experiences with mass immunization campaigns? We can have these discussions by telephone, in person, or via email. Replies to Linda at: [email=LindaD1@twcny.rr.com]LindaD1@twcny.rr.com[/email], [email=Technet@acithn.uq.edu.au]Technet@acithn.uq.edu.au[/email] Contributions, comments and additions please: [email=Technet@acithn.uq.edu.au]Technet@acithn.uq.edu.au[/email] or use your reply button ___________________________________________________________________________ Date: Wed, 25 Oct 2000 To: [email=Technet@acithn.uq.edu.au]Technet@acithn.uq.edu.au[/email] From: "Linda D'Antonio" Subject: Technet Dear Allan, Our company, DCI, recently started work on a contract with National Immunization Program of Centers Disease Control and Prevention in Atlanta to complete our development of a High-workload Jet Injector (needlefree) designed specifically Mass Immunization Campaigns in developing and developed countries. We are currently establishing a complete list of requirements device. In addition to ensuring that device is safe and effective, it is also critically important us to consider "voice of customer" in design of system. Thus, we are interested in obtaining input from people who have been involved in mass campaign National Immunization Days. Because conditions, environment, personnel availability, etc., are different in different parts of world, we would like to have contact with individuals from various places. How would I find out about individuals in Technet group who might be interested in sharing with our design engineers their experiences with mass immunization campaigns? We can have these discussions by telephone, in person, or via email. Thank you in advance any assistance you can provide. I look forward to hearing back from you soon. Best Regards, Linda D'Antonio DCI, Inc. 6308 Fly Road E. Syracuse, NY 13057 Phone: (315)463-4999 FAX: (315)463-5267 E-mail: [email=LindaD1@twcny.rr.com]LindaD1@twcny.rr.com[/email] _____________________________________*_____________________________________ 3. NO TO INCINERATORS!! The Current recommendation for safe destruction of injection waste is that incineration above 800'C is preferred. The current trend in environmental politics is to stop incineration because of its role in environmental pollution. Below are to recent news events reflecting these trends. 1. Mozambique Environmentalists Defeat Incinerator Plan 2. London Mayor Joins Fight Against Incinerator Contributions, comments and additions please: [email=Technet@acithn.uq.edu.au]Technet@acithn.uq.edu.au[/email] or use your reply button ___________________________________________________________________________ Environment Mozambique Environmentalists Defeat Incinerator Plan MAPUTO, Mozambique, October 13, 2000 (ENS) - Mozambique's first environmental group is claiming victory on issue it was created to fight. Livaningo formed two years ago in protest at a plan to turn a local cement kiln into a hazardous waste incinerator. incinerator, proposed by Danish International Development Agency, would have burned stockpiled obsolete pesticides and other toxic wastes. Disposing of pesticides can be a hazardous business. (Photo by Tim McCabe, courtesy U.S. Department of Agriculture) But last week, Mozambique's environment ministry rejected plan. Incineration of hazardous wastes in cement kilns produces most toxic persistent organic pollutants (POPs) known - dioxins and furans. These dangerous substances, along with heavy metal contaminants, find their way into both cement product, known as clinker, and into cement kiln dusts. Danish agency, known as Danida, had pointed out that incineration at high temperatures present in cement kilns is a disposal method recommended by United Nations Food and Agriculture Organization, because it ensures total destruction of all compounds. Danida had planned a monitoring program to ensure emissions of dioxins and furans would be within European regulations on incineration of hazardous waste. plan failed to convince Mozambique government, which announced it plans to export 300 tons of obsolete and unidentifiable pesticide waste for destruction in a developed country. "While we appreciate Danida's efforts to stop immediate threat posed by pesticides by collecting and cleaning up sites around country, we have all along been demanding that incineration part of project be stopped," said Jacob Hartmann of Greenpeace, one of groups that helped create Livaningo. name means "all that sheds light." Basel Action Network, Environmental Justice Network Forum, and Essential Action which co-founded GAIA Global Anti-Incineration Alliance were involved in setting up Livaningo. groups sponsored a visit to Mozambique by Dr. Paul Connett, a professor of chemistry at St. Lawrence University in Canton, New York, and critic of hazardous waste incineration. visit was arranged after it appeared that there had been no public consultations and environmental assessment of project had been written in English. Mozambique is a Portuguese speaking country. For two years, Livaningo took its campaign to residents and businesses in town of Matola, where cement factory is based. group warned people of toxic hazards of pollution from incineration, and held some of first civil demonstrations known in post-revolution Mozambique, engaging government officials and local media. Livaningo representatives even travelled to Denmark to plead their case before Danida and Danish Parliament. "We just decided that we would not fail, although there were many times when it looked as if all hope was lost," said Anabela Lemos of Livaningo. "In course of struggle, our people have awoken to problems of pesticides, incineration, and toxic wastes, and have learned that ultimate solution is to avoid use of toxic materials in first place. It has been a great education for all of us here in Mozambique," Lemos said. Mozambique is a poor country slowly rebuilding itself after decades of misrule by Portugal, a coup in 1974 and civil war in years that followed. Since United Nations forces left in 1995, country has been at relative peace. "Had civil society only been consulted at an earlier stage, Danida and Mozambique authorities could have saved themselves a lot of trouble and even benefited with a cutting edge approach of dealing with obsolete pesticides such as holding pesticide producers responsible and destroying pesticides using non-incineration and non-polluting destruction technology," said Lemos. Thomas Schjerbeck, Danish ambassador in Maputo, addressed this issue in an editorial written in South African newspaper "Mail and Guardian" last year. "Danida agrees that as many of obsolete pesticides as possible should be returned to producers. But it cannot be assured that producers will take everything back and, in a best case scenario, we are still left with up to 500 tons of pesticides, for which it is not possible to identify producers." Livaningo is calling for pesticides to be rendered non-toxic using alternative non-incineration destruction technology. It wants costs borne by companies that originally exported pesticides to Mozambique, with Denmark as co-sponsor. ? Environment News Service (ENS) 2000. All Rights Reserved. --- Environment London Mayor Joins Fight Against Incinerator LONDON, United Kingdom, October 17, 2000 (ENS) - Greenpeace volunteers have come down to Earth after four days spent sitting atop a 100 meter incinerator chimney in North London. Their protest against expansion plans at Edmonton incinerator convinced Mayor of London Ken Livingstone to support calls for plans to be halted while health impacts of waste incinerators are looked into. Edmonton incinerator is operated by LondonWaste, a joint public-private company set up to dispose of North London's waste. Last year company burned 535,000 tonnes of mainly household waste, producing energy for electricity for 24,000 homes. company has applied to UK Environment Agency to build another incinerator to increase capacity by 60 percent to 800,000 tonnes a year. agency is legal regulator for incineration and releases to environment from industrial processes. LondonWaste's application illustrates a trend towards incinerators as a solution for UK's growing mountain of municipal solid waste. There are currently 15 solid waste incinerators in UK. government has awarded another 62 contracts. A further 10 incinerators are in planning or under construction, bringing total to 87. Groups like Greenpeace contend that even most sophisticated modern incinerators release toxic substances into air and produce toxic ashes. This can lead to contamination of air, water, soil, and in some cases, plants, animals and humans. Greenpeace argues that incinerators undermine efforts to promote recycling, too. most notorious of incineration byproducts is dioxin, which forms when chlorinated substances in waste, such as polyvinyl chloride (PVC) plastic, are burned. Dioxins are persistent, toxic, and accumulate in food chain. Because they are transported for long distances on air currents they are now a global contaminant. Sixty-five Greenpeace volunteers occupied Edmonton incinerator for four days last week, shutting down operations. "Our occupation of Edmonton incinerator has galvanized public opinion against incineration and started a political process which we hope will end incineration and massively boost recycling in London," said Greenpeace campaigns manager Matthew Spencer. "We have protected residents of Edmonton from eight tonnes of acid gases and showed that they are not alone in their fight against incinerator." Greenpeace shut down LondonWaste's Edmonton plant for four days. group also won an important political ally in Livingstone. "Before anyone rushes into increasing incinerators and incinerator output we should actually look at evidence about risks to human health and environment by energy from waste incinerators," said Livingstone. "Until that time I am opposed to any new incinerators or expansions." "If there is evidence available about health impacts of energy from waste incinerators I want to hear it," he added. "seven local authorities feeding Edmonton with waste have very low recycling rates. Irrespective of any information Greenpeace may have on health impacts, waste incineration crowds out an increase in recycling, affects overall air quality and adds to level of heavy vehicle traffic. For these reasons large scale expansion proposed for Edmonton incinerator should not go ahead," mayor said. Livingstone said he had written to Environment Agency, and to Food Standards Agency about possible effects of incineration on food. He has also written to local health authorities to ask if there is any medical evidence to support claims of health risks. Greenpeace claims to have UK government figures showing that emissions from Edmonton incinerator are responsible for 15 premature deaths a year, a figure that would rise to 22 if expansion went ahead, group says. _____________________________________*_____________________________________ 4. REGIONAL CENTRE ON HAZARDOUS WASTES OPENS IN SOUTH AFRICA ___________________________________________________________________________ Geneva/Nairobi, 2 October 2000 - United Nations Environment Programme (UNEP)/Secretariat of Basel Convention is organizing first workshop on national reporting and national inventories of hazardous wastes in Vista University, Pretoria, South Africa from 2-6 October 2000. Basel Convention Regional Centre for Training and Technology Transfer will also be inaugurated. This training workshop is organized to stimulate and assist countries in greater response to national reporting as well as to set up national inventories on their hazardous waste situation. Representatives from English-speaking African countries will participate in workshop. following countries will be represented: Botswana, Congo, Ethiopia, Gambia, Malawi, Mauritius, Mozambique, Namibia, Nigeria, Seychelles, South Africa, Tanzania, Uganda, Zambia. following non- Parties to Basel Convention are invited: Ghana, Kenya, Lesotho, Swaziland. fifth meeting of Conference of Parties (COP-5) which met in December 1999 highlighted need to put more emphasis in regions through regional centres. Basel Convention regional centres raise awareness and build capacities in developing countries for management, disposal and minimization of hazardous wastes. Since their inception, regional centres are strongly enhancing legal, technical and institutional capabilities in regions to manage hazardous wastes in an environmentally sound way. "Basel Convention Regional Centres for Training and Technology Transfer will play a key role in implementing Convention," said Mr. Per Bakken, Officer-in-Charge of Secretariat. Secretariat of Basel Convention will assist South African regional centre in development of hazardous waste training programmes, raising larger awareness on hazardous wastes in Africa and assist in mobilization of support for it to reach self- sustainablity. Danish Agency for Development Assistance (DANIDA) is financing first years of operation of South African centre. Basel Convention was signed in 1989 and entered into force in 1992. It has 136 Parties (as of October 2000). Convention is concerned with annual worldwide production of hundreds of millions of tonnes of hazardous wastes. These wastes are considered hazardous to people or environment if they are toxic, poisonous, explosive, corrosive, flammable, eco-toxic, or infectious. Convention regulates movement of these wastes and obliges its members to ensure that such wastes are managed and disposed of in an environmentally sound manner. Governments are expected to minimize quantities that are transported, to treat and dispose of wastes as close as possible to location where they were generated, and to minimize generation of hazardous waste at source. Note to journalists: For more information please contact: Mr. Per Bakken on (+41- 22) 917 8213/18, fax: (+41-22) 797 3454, email: [email=per.bakken@unep.ch]per.bakken@unep.ch[/email] or Mr. H.J van der Linde on (+2712) 337 6000/6104, fax: (+2712) 322 2905, email: VDLND- [email=HJ@acaleph.vista.ac.za]HJ@acaleph.vista.ac.za[/email] (Official documents and other information on Basel Convention are available on the Internet at http://www.basel.int/ In Nairobi, please contact: Tore J. Brevik, UNEP Spokesman. Tel: 254-2- 623292, Fax: 623927; email: [email=cpiinfo@unep.org]cpiinfo@unep.org[/email] UNEP News Release 00/102 _____________________________________*_____________________________________ 5. OTHER TECHNOLOGIES These are press releases and should be considered as such. They are posted to acquaint non-specialists among us with other approaches in other settings. ___________________________________________________________________________ WR2 Acquires STI July 3, 2000 INDIANAPOLIS--(BUSINESS WIRE)--June 30, 2000 via NewsEdge Corporation - Two Companies Will Offer Hospitals Low-Cost Solutions for On-Site Elimination of Red Bag and Path Waste Without Incineration Waste Reduction by Waste Reduction, Inc. (WR2), world's leading manufacturer of equipment for environmentally responsible elimination of pathologic and animal tissue waste, has acquired Sterile Technology Industries, Inc. (STI), a leader in biohazardous waste sterilization and destruction equipment, companies announced today. Randall G. McKee will continue to serve as president and CEO of STI from company's current headquarters in West Chester, Pa. "I am pleased and proud that all STI employees will play an important role in this new phase of rapid growth with our company," said McKee, who founded STI five years ago. WR2 and STI will offer hospitals two products that provide a complete, low- cost system for eliminating all biomedical waste at point of generation -- without incineration. STI Chem-Clav(R) and STI Path-Clav(R) will handle red bag, pathologic and research animal carcasses and tissue -- including radioactively contaminated tissue. products will enable hospitals to comply with Environmental Protection Agency Clean Air Act's requirement that all medical waste disposal and treatment processes meet stringent new air emissions standards by year 2002. new EPA regulations will make on-site incineration impractical for most hospitals. "In addition to their reliability, safety, and environmental compliance, STI Chem-Clav and STI Path-Clav feature very low operating and acquisition costs," said Joseph H. Wilson, president and CEO, WR2. "This combination of state-of-the-art technology and low cost will make both products compelling choices for hospital facilities directors, financial officers and safety officials. "These two products will save healthcare industry and its funders tens of millions of dollars annually in waste disposal costs," Wilson added. "STI has given healthcare industry first truly desirable destruction/sterilization system for treatment of medical waste," said Gordon Kaye, chairman of board, WR2. "Combining STI's capabilities with those of WR2 is exciting," McKee added. "It provides significant opportunities for expanding success of each company's technologies, products and people in serving healthcare industry." WR2 and STI plan to unveil STI Chem-Clav and STI Path-Clav system at American Society of Healthcare Engineering (ASHE) trade show in Seattle, July 10-12. About WR2 Headquartered in Indianapolis, Ind., with research laboratories located in Rensselaer, New York, WR2 manufactures equipment -- including STI Path- Clav -- that employs heat and alkali to totally eliminate path waste, tissues and carcasses. equipment is ideal for destroying Transmissible Spongiform Encephalopathy (TSE) agents, which cause (among others) Creutzfeldt-Jakob disease, "mad cow" disease, chronic wasting disease and scrapie. It reduces volume and weight by 98 percent -- equal to that of incineration -- and converts animal and microbial tissue into a sterile, neutral, aqueous solution that is suitable for disposal into a sanitary sewer. In addition to pharmaceutical companies in U.S. and Europe, WR2 equipment is currently installed in medical centers, veterinary facilities and government research facilities in U.S., Canada and U.K. WR2's European subsidiary, Waste Reduction Europe, Ltd. (WRE) is based in Glasgow, Scotland. About STI Based in West Chester, Pa., STI was founded in 1995 to develop a rugged, more cost effective way to treat medical waste. Premier, Inc., one of nation's leading healthcare group purchasing organizations, has named STI sole-source provider for infectious and regulated waste treatment equipment. three-year agreement involves STI Chem-Clav Series 2000 continuous-feed steam sterilization equipment, related ancillary products, installation and services. contract was awarded after an extensive, two-year review process of competitive systems. Since installation of first commercial STI ChemClav in August 1995, it has processed more than 45 million pounds of waste. hospital unit is built to same level of durability as STI's commercial systems, establishing a new level of reliability for on-site biohazardous waste processing equipment. In addition to placing STI Chem-Clav units in a number of U.S. hospitals and in commercial waste processing facilities, STI has placed three commercial Chem-Clav systems -- two in Northern Ireland's Antrim Hospital, and one centralized unit in Dublin -- to replace 11 large incineration plants throughout Ireland. CONTACT: Media Contacts: | Joseph H. Wilson, President and CEO | WR2 | 317/484-4200 | [email=jwilson@WR2.net]jwilson@WR2.net[/email] | or | Andrea Taft | Saphar & Associates (for WR2 and STI) | 716/325-7624, ext. 41 | [email=taft@saphar.com]taft@saphar.com[/email] ____________________________________*______________________________________ Selected news item reprinted under fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html


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