FIRST%20EXPERIENCE%20OF%20AD%20SYRINGES%20IN%20INDIA

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FIRST EXPERIENCE OFAD SYRINGES IN INDIA

• A CASE STUDY Dr. K.Suresh,
  UNICEF, Delhi
• MD, DIH, DF, FIAP, FIPHA, FISCD

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BACKGROUND

• Before 1985
• Syringes needles for vaccination/ other uses
  were state responsibility
• Sterilization process was boiling in saucepan
  Electric sterilizer autoclave
• Syringes needles supply Inadequate

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BACKGROUND

• 1985- Inception of UIP
• GOI supplied Glass syringes and needles
  (UNICEF-Sup)
• Norm - 1 syringes _at_ 40 injection
• 1 needle _at_ 10 injection
• 1 BCG needle _at_ 5 injection
• Autoclave Drum sterilizers for PHCs
  institutions
• 1986-87
• Double rack pressure cooker sterilizer provided
  for SC for outreach sessions

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BACKGROUND

• 1987-88
• Plastic reusable syringes were supplied and tried
• Experience not encouraging, so banned
• Reverted back to glass syringes
• UNICEF continued to supply all Glass Syringes and
  replacement of gas kit other spare parts
• 1995-96 onwards
• GOI supplies glass syringes from GOI/ WB fund
• 1998-99
• AD syringes tried for the first time

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INTRODUCTION OFAD SYRINGES

• The existing mechanisms of sterilizing reusable
  glass /plastic disposable syringes were a matter
  of concern
• For injection safety, UNICEF India procured
  offshore AD syringes and supplied to all the
  districts (NNT)/cities (measles) since 1998.
• 8.5 m women have been immunized with TT
• Around 3.3 million children in age group 9-59
  months urban urban measles campaign

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0.5ml AD Syringes
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METHOD OF TRAINING THE VACCINATORS
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USER FRIENDLINESS

• Observers from UNICEF Delhi and Jaipur and state
  Government officers were involved
• 64 sites were visited during NNT campaigns in
  Rajasthan and MP and over 200 workers were
  interviewed using a structured protocol.
• During urban measles campaigns assessment was
  carried out in 8 and at least 600 workers were
  interviewed and their opinion were recorded.

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REASONS FOR USERS CHOICE

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WITHDRAWL OF VACCINEADS Vs. CONVENTIONAL
Rest were non-responders
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RESIDUAL VACCINE IN SYRINGE
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WASTAGE OF ADS
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One piece
Two piece
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EXPERIENCE WITH ONE PIECE Vs. TWO PIECE

• Observation- Disadvantage of using two piece ADS
• Sterilization of needle is compromised in field
  situation while fixing the needle
• Leakage of vaccine when needle is not fixed well
• Air bubble get in due to loose fitting of needle
• Proportion of vaccine wastage was more
• Overall time per injection is more for two piece
• Based on this, ICO requested Copenhagen not to
  supply two piece ADS to India Programme

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USER FRIENDLINESS STUDY OF MONOJECT BCG ADS AND
NEEDLES

• Around 8500 protocol of around 280 users were
  received and analyzed
• Observations
• Instruction given on the packet of syringe - 4.54
  pt.
• Plunger rod in terms of easy to break - 4.42
• (this lead to higher wastage rate 14)
• Sharpness of needle - 4.58
• Comfortability of intradermal injection - 4.41
• Preference for Monoject - 4.51

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DISPOSAL OF ADS

• Disposal of AD Syringes continued to be the main
  concern
• Several methods were tried during the campaign
• First Method -syringes and needles were burnt in
  the open space on the ground using dry twigs,
  leaves and paper.
• Second Method - needles and syringes were burnt
  in a pit using dry wings, leaves and papers. The
  burnt syringes and needles formed an ugly lump of
  molten plastic in both the methods.

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DISPOSAL OF ADS

• Third method - digging of pits around 9-12 deep.
  Used needles and syringes were kept in cardboard
  or shoeboxes with a hole of about 2 inches radius
  on the top of the box. These boxes were then kept
  inside the pit and cotton swaps soaked with
  spirit/ kerosene were slipped inside the boxes
  through these holes. The boxes then were lit with
  fire. It burnt them completely, even without
  raking. In the end only the burnt needles
  remained. Finally the pits were closed with the
  excavated earth.

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STUDY ON FUME RESIDUAL

• Carried by Shri-ram Institute for Industrial
  Research
• Purpose
• To ascertain the air quality on burning in
  enclosed area
• Outdoor exercise ? dispersal of smoke formed

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STUDY ON FUME RESIDUAL

• Characterisation
• The burnt material of disposable syringes does
  not show any reactive nature.
• ADS is not self combustible.
• The pH of the water leachate of the sample is
  6.9. The sample does not reveal the chance of
  corrosive nature.
• The water leachate of the sample is free from
  acute toxicity.

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STUDY ON FUME RESIDUAL

• Observations Recommendations
• Burning in enclosed area ? high concentration of
  pollutants ? strictly prohibited
• Burning in open area
• Addition of 5-8 pollution
• Dioxins were not detected.
• Needs - Clearance from Environmental Authorities

Burning in open area could be done
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STUDY ON FUME RESIDUAL

• Suggestions for Open Area Burning
• area with sufficient assimilative capacity
• Not more than 100 syringes are burnt at one time
• Kerosene/spirit use very less quantity to start
  ignition
• Ensure sufficient wind speed
• Ash disposal
• ash not hazardous nature and is safe for disposal
  in the pit
• pit should be immediately covered after complete
  burning and further cooling to avoid the scatting
  of waste

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CONCLUSION

• Injection Safety is a major concern
• NO Monitoring of injection Practices
• Replenishment Ensuring use of injection safety
  equipment-NOT EASY
• AD syringe is the best option
• Management of sharps and plastics-a challenge
• Environmental safety
• Reduce injection over use