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  3. Sunday, 12 March 2006
POST 00897E : NEEDLE REMOVERS REVIEW Follow-up on Post 00891E 12 March 2006 _______________________________ NOTE : There has been problems with transferring files of the two Uganda documents mentioned in Post 00893E. It’s now been repaired and they are now accessible. Satish B. Kaipilyawar (mailto:satish@path.org ) from PATH/India contributes the following challenging comments on the Needle Removers Review published in Post 00891E _______________________________ Dear Yves, We have gone through the report "Review of studies conducted on the use of needle removal devices", posted on the TechNet. We were hoping for a more comprehensive review that took into consideration advantages of elimination of syringe reuse which is what needle and hub cutters are best at. During your visit to the trial site in Andhra Pradesh you appreciated these issues and provided us with your valuable suggestions to consider making the puncture proof containers out of the recycled plastics. We also discussed the issue of reuse of syringes, repacking of used syringes and the failure of most staff to use the safety boxes as they were neither practical nor safe to burn in the open air. The risk to the community caused by untreated injection waste getting accumulated at the health center or in the municipal garbage collection bins were all eliminated by the simple intervention of needle removal (hub cutting eliminates reuse of syringes and needles, a huge problem in India). If you leave the plastic intact there is a strong chance that the syringe finds it way onto the open market for re-use. I shared with you our experience of syringes being sold in front of the hospital gate at a cost of two rupees, (about 3 US cents) and you can imagine the health impact of this. The project in Andhra Pradesh has monitored data related to occurrence of needle stick injuries and following more than 50,000 (fifty thousand) destroyed syringes in 200 centers over a period of 6 months we have not seen a single needle stick injury due to the use of the hub cutters. We can be sure that without the cutters many of these 50,000 syringes would have been reused. The report I feel lacks this component which are clear benefits for recommending hub cutters. The field view seems to be absent in the WHO review. Why are we so biased about the use of needle removers when they are so successful in addressing the issue of eliminating re-use of infected syringes and needle sticks in the community? I believe there is a need to have a fresh look at the broader benefits of needle and hub cutters. All the issues need to be considered before making a recommendation. Remaining neutral doesn’t provide any guidance to the implementing countries, (which is already a recommendation in itself to the implementing countries), rather it creates confusion and in the process we contribute to accumulating hazardous, infectious waste. Finally, while WHO sits on the fence, the world is starting to use needle cutters – just to my knowledge more than 30,000 thousand are already in routine use in India and a further 500,000 are currently being procured by the Government of India, trials are going on in Viet Nam and elsewhere, and there may be many more that I don’t know about. Also, because of WHO’s hesitation there seems to be little progress on establishing a minimum performance standard for needle and hub cutters. In the meantime countries are buying needle and hub cutters that are almost certainly a low standard and may be doing even more harm. We are concerned that WHO not making a decision on needle and hub cutters is a decision in itself and this is allowing dangerous practices to continue and poor quality devises being purchased for use in immunization programmes and more broadly for all injections. Satish ______________________________________________________________________________ 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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