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  3. Tuesday, 15 October 2002
POST 00510E : CONTAMINATION STUDY OF NEEDLE REMOVERS Follow-up on Post 00509E 14 October 2002 ______________________________________________________________ Mary Catlin (mailto:[log in to unmask]) from the University of Arizona Cancer Center shares sharp observations and comments on the contamination study of needle removers (previous posting). ______________________________________________________________ I am curious about the objectives of re-introducing needle-cutters and needle-removers that became illegal in the U.S. after it became undestood that needle removal increases workers' risks (re: ban see OHSA Regulations 29 CRF 1910.1030 (e) (2)(ii)(j). 1--If the objective is to reduce the volume of waste, it seems that it would be more cost-effective to reduce the unnecessary use of injections that form an enormous avoidable portion of the waste. 2--If the objective is to decrease disease transmission, then use of this type of device goes against known principles of redesigning tasks to make then safer. • a) It adds cost. The device would have to be provided at the point of care for every injectionist. Budgeting and supply-line failures are existing problems. • b) It adds complexity. Workers would have to voluntarily add a step so that after injection they turn to this device defang, then dispose of the syringe in a separate box (?), then turn back to the patient. If they have to set the used syringe down in between, or walk with the device the risk of needlestick goes up. Best solutions : decrease steps. It is one more thing to carry on mobile rounds and during outreach. • c) It creates a barrier to immediate disposal, which decreases needlesticks. If enough devices are not placed at the point of care, workers may be tempted to stockpile used syringes for later defanging. This increases manual handling and increases risk. • d) It increases manual handling of used equipment. To use it one handed means you need a surface. Injections are often given under a tree or when moving from patients bed to bed. To show that fewer needlesticks occur in use would require large studies and need controls. In general needle removal is dangerous - (see AJIC Risk of medical sharps injuries among Chinese nurses, W Phipps et al in August 2002 Vol 30 N.5 p 281.) Some 44% of injuries in Chinese nurses in this study occurred when separating the needle from the syringe, more than in recapping. So you are adding an inherently unsafe task and then trying to make it safe. • e) Would disposal create an additional waste stream? Do you bury the device full of solid needles? They seem hard to burn without additional fuel. Would the syringe be disposed of separately from the needle? If so how? If the syringe goes into the same waste stream, why separate them? Boxes of syringes and needles are likely to be easier to burn that cans of packed metal needles. If syringes, perhaps mangled syringes go into public waste sites, are you sure that they won't represent a source of exposure to the population? While hollow-borne needles have the greater risk of transmission of HIV, work with IV drug users has shown that even shared use of cottons can spread infections such as Hep C. Syringes in the trash are such useful items that they are likely to be scavenged and used. • f) When evaluating, please make sure they are in settings of intended use. If the intent is to protect workers, it would be helpful to have workers in the denominator, and measure the reduction in needlesticks per 100 annual productive hours, or 100 work years. Instead I think the very creative and talented engineers at PATH could make a great contribution by either designing a finger guard for use when opening glass ampoules, or make a pattern that people could use locally to make finger guards from available materials. Thanks for the opportunity to comment. Maybe you'll prove me wrong at SIGN! Best regards, Mary Catlin Research Specialist, Principal Young Women's Research Center University of Arizona Cancer Center _________________________________________________ - 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. 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