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  2. Vaccines and delivery technologies
  3. Tuesday, 23 August 2005
POST 00826E : NEEDLE-REMOVER STUDY Follow-up on Post 00818E 23 August 2005 _____________________________________ This posting contains two contributions. The first is from Mary Catlin (mailto:marycatlin@hotmail.com) from The United States, followed by that of Ville Lehto (mailto:ville.lehto@mediburner.com) from Finland. _____________________________________ 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 ------------------------------- 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 ______________________________________________________________________________ ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:LISTSERV@listes.ulaval.ca Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ 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. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________


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