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  2. Vaccines and delivery technologies
  3. Monday, 18 March 2002
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:jaap.dominicus@amsterdam.msf.org) and Menno Goedhart (mailto:menno.goedhart@amsterdam.msf.org) 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. ----------------------------------------------------------------------------- CONTRIBUTIONS Contributions to or use your reply button! The TechNet21 e-Forum welcomes new subscribers who are involved in immunization services. SUBCRIBE To subscribe, send an e-mail to Leave the SUBJECT area BLANK, do not type anything. In the body text, just write : Subscribe TECHNET21E Surname Name Do not use any accents in your name and surname. UNSUBSCRIBE To unsubscribe, send an e-mail to Leave the SUBJECT area BLANK, do not type anything. In the body text, just write : Unsubscribe TECHNET21E ------------------------------------------------------------------------------ ARCHIVES New archives of posted messages starting with 1 November 2001 is accessible to all TechNet21 subscribers. To view the archives http://listes.ulaval.ca/listserv/archives/technet21e.html Archives for postings between 17 August 1998 and 31 October 2001 can be found at the following web site for download starting 1 December 2001. http//http://www.who.int/vaccines-access/Vaccines/Vaccine_Cold_Chain/Technet Archives for files (documents) are under revision to clean old documents and drafts that are already replaced with new ones, and will be made available soon at the same site. http//http://www.who.int/vaccines-access/Vaccines/Vaccine_Cold_Chain/Technet ----------------------------------------------------------------------------- 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.


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