![Wall-mounted sharps container](https://upload.wikimedia.org/wikipedia/commons/a/a6/Wall-mounted_sharps_container.JPG)
A needle remover is a device used to physically remove a
needle from a
syringe
A syringe is a simple reciprocating pump consisting of a plunger (though in modern syringes, it is actually a piston) that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside ...
. In
developing countries
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
, there is still a need for improvements in needle safety in
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
settings as most of the needle removal processes are done manually and under severe risk of hazard from needles puncturing skin risking infection. These countries cannot afford needles with individual safety devices attached, so needle-removers must be used to remove the needle from the syringe. This lowers possible
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
spread by preventing the reuse of the syringes, reducing incidents of accidental
needle-stick
A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick i ...
s, and facilitating syringe disposal.
Background
In regions surveyed by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) in the early 2000's, the reported number of
needle-stick injuries in developing world countries ranged from .93 to 4.68 injuries per person and per year, which is five times higher than in industrialized nations.
[Department of Essential Health Technology. (2004).]
Proposed Agenda to Evaluate the Risks and Benefits Associated with Using Needle-Removing Devices
Retrieved October 22, 2005. Needle-stick injuries are further complicated by disease transmission, such as
Hepatitis B
Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. Fo ...
,
Hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...
and
HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
. In
Ghana
Ghana (; tw, Gaana, ee, Gana), officially the Republic of Ghana, is a country in West Africa. It abuts the Gulf of Guinea and the Atlantic Ocean to the south, sharing borders with Ivory Coast in the west, Burkina Faso in the north, and To ...
, a study of 803 schoolchildren revealed that 61.2% had at least one marker of hepatitis B virus.
[Sagoe-Moses, C., et al. (2001, August 16).]
Sounding Board: Risks to Health Care Workers in Developing Countries
N Eng J Med 345 (7): 538–541. As a result, health care workers, patients, and the community in developing nations are at an increased risk of contracting
blood-borne pathogens
A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious ...
via the reuse and improper disposal of needles, and accidental needle-sticks.
[Harner, C. (2004, October).]
Needle Remover Device Design Transfer Package
Retrieved September 7, 2005.
In the U.S., the Needlestick Safety Act signed in 2000 and the 2001 Bloodborne Pathogens Standard both mandated the use of safety devices and needle-removers with any sharps or needles. As a result, there was a large increase in research, development, and marketing of needle safety devices and needle-remover. In most hospital and medical settings in the U.S., needle safety regulations are maintained through individual needle safety devices and needle disposal boxes.
Existing solutions
One of the most common causes of needle-stick injuries, which the Needlestick Act and Bloodborne Pathogens Standard were attempting to decrease, was two-handed recapping. As a result, a one-handed capping mechanism was added to
insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...
and
tuberculin
Tuberculin, also known as purified protein derivative, is a combination of proteins that are used in the diagnosis of tuberculosis. This use is referred to as the tuberculin skin test and is recommended only for those at high risk. Reliable admin ...
syringes. The cap is attached to the syringe via a hinge, which allows the cap to be snapped onto the needle using one hand. The disadvantage to the hinge system is that the cap can get caught by jewelry and clothing, can get bumped when used, and the fixed position can be a hindrance during low angle injection. So
Becton Dickinson
Becton, Dickinson and Company, also known as BD, is an American multinational medical technology company that manufactures and sells medical devices, instrument systems, and reagents. BD also provides consulting and analytics services in certai ...
(BD) has recently come out with a variation on this safety: instead of a hinge, the device slides over the needle and fully covers the tip of the needle, so accidental needle-sticks do not occur.
However, the rest of the world does not have similar needle and syringe regulations. For instance, the WHO is only able to regulate vaccinations in developing countries by ensuring that all vaccination syringes sent to these countries have autodisable features, since the major concern is the reuse of contaminated needles and syringes. These autodisable features allow the syringes to only be used once, so they cannot be reused. These mechanisms could be teeth that interlock to prevent the plunger from being pulled back for another use or a bag prefilled with the vaccine to stop reuse. For example, the SoloShot has a metal clip that locks the plunger down after one use. The BD
Uniject Uniject is a disposable, pre-filled, single-use syringe which was developed to promote vaccination in developing countries. It was developed by PATH
A path is a route for physical travel – see Trail.
Path or PATH may also refer to:
Physic ...
is a prefilled vaccine syringe that uses a plastic bulb instead of a plunger and has a disc valve to prevent reuse.
Still, over 90% of syringes worldwide do not have autodisable features.
[ Individual protection devices are expensive, and regular needles are much more prevalent. Consequently, many developing world countries use needle-removers to reduce the risk of disease transmission via these exposed.
]
Benefits of needle-removers
Needle-removers minimize the occurrence of accidental needle-sticks because they allow immediate removal and containment of the needles, especially if the device is near the area of use. Reuse of syringes is prevented because the needle-remover physically separates the needle from the syringe, making the syringe useless. They also improve waste disposal by decreasing both the amount of infectious waste and the amount of safety boxes needed for the waste, since safety boxes can pack syringes 20-60% more compactly without the needles.[ Additionally, these devices are cost-efficient since one device can handle several hundred needles. Many developing world countries do not have the resources to afford auto-disable syringes, so with needle-removers, the hospitals can continue to use cheap syringes, while only paying a one-time fee to buy a needle-remover that has a life-span of about 200-500 needles.][
]
Social and ethical implications
A significant ethical issue for the project is whether or not the needle-remover will cause more harm than its potential benefits. Engineers are obliged to use their skills and knowledge to improve the safety, health, and welfare of the public. The main concern is for the operator of the device; no engineer should create a device that could injure the operator. Another concern is that children may gain access to the device and accidentally hurt themselves. If a device design could potentially cause either of these problems, the team would be ethically obligated to reexamine that design, and it would either have to be improved or abandoned. When the device functions effectively and safely, it will serve to protect the welfare of the community. In developing countries, the risk of disease transmission is elevated due to the high percentage of needle-stick injuries, which is a result of inadequate needle collection devices.[ Increased pathogen transmission also occurs from the reuse of contaminated needles when supplies are low.][ The device will prevent reuse of needles and facilitate needle collection and disposal, and thus will improve the health and safety of hospital workers and the community.
The social and economic effects of the device also need to be recognized. In developing countries, the lack of proper needle collection devices leads to an increase in the number of occupational needle-sticks by health care workers via contaminated needles. Occupational needle-sticks account for 40%-65% of ]Hepatitis B
Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. Fo ...
and C infections in health care workers. As a result, more health care workers have to undergo post-exposure testing and treatment, both of which cost money for the hospitals and the countries. There is also the manpower cost associated with losing trained health care workers to infections acquired on the job. With fewer than 10 doctors for every 100,000 individuals in sub-Saharan nations, any loss of hospital staff puts a strain of hospital resources. In addition, developing countries have made significant investments in training their health care workers, which is lost when occupational needle-sticks cause health care workers to leave the medical field.[
The economic considerations are not just limited to costs associated with health care workers. Due to the high cost of needle-disposal containers and the fact that the containers usually have to be shipped overseas, unsafe and dangerous substitutes are used instead. This practice can potentially lead to needle-sticks by health care workers and individuals in the community, as well as needle reuse by members of the community, which can increase the potential spread of diseases.
]
Possible designs
The easiest needle-removers to operate are electrically powered, and either melt the needle or cut the needles at multiple sections. One patented design involves a syringe falling down into a chamber where powered movable blades advance the syringe onto fixed blades on the opposite side, at which point the syringe is cut with a shearing motion at multiple points. There are other patents that use electricity between electrodes or between rotating gears to short-circuit the needle and melt it off the syringe. A more complex design involves a hammer mill
A hammer mill, hammer forge or hammer works was a workshop in the pre-industrial era that was typically used to manufacture semi-finished, wrought iron products or, sometimes, finished agricultural or mining tools, or military weapons. The featur ...
and grinder to break up and grind up the plastic and metal parts of the syringes, after which, the pieces are heated and cooled. The end result is metal particles encapsulated in a piece of plastic.
However, electricity
Electricity is the set of physical phenomena associated with the presence and motion of matter that has a property of electric charge. Electricity is related to magnetism, both being part of the phenomenon of electromagnetism, as described ...
in developing countries is not a dependable source, so hand-powered needle-cutters would be preferred. Some designs use the squeezing force from a hand to force one or two blades to shear across each other and hence cut the needle between the blades.[ There are other designs in which a twisting motion brings a shearing blade in contact with the needle and thus cuts it. Another design has a stationary outer surface that the syringe body rests against and a cylindrical inner cutting body with a bore for the needle to pass through. A lever rotates the inner body, which shears the needle from the syringe and dumps the needle into a container. A crank system can be used to power a similar design, which also uses a cylindrical inner body. However instead of cutting the needle, the device pulls the needle completely out of the syringe, which deforms the needle, and dumps it into a container. A more complicated design actually pulls the needle and collar from the barrel of the syringe without a rotational motion: the downward motion of putting the syringe into the device powers two arms to pull the needle off the syringe. The interesting aspect of this device is that it appears to be one-handed. Another one-handed device uses a downward motion to cause rotating gears to unscrew the needle and collar from the syringe. This design is very complex to implement, so an improvement of this design involves pegs that grip and rotate the needle collar instead of gears. The downward force is transferred into moving the pegs in helical slots, which causes the collar to rotate and the needle to be removed from the syringe.
In 2006 a cheap and simple solution utilizing old cola or beer cans to dispose needles and specially developed lid to safely seal them was designed by Yellowone and given the name Antivirus. The lid snaps onto the top of the can permanently sealing it without using any glue or tools. The ’collar’ of the cap is protecting the user during the needle separation process. The insertion hole is designed to separate needle and syringe at the point of use. No finger can pass through the opening. Each can securely contains 150-200 used needles (Yellowone).
]
Commercial models
There are several electrically powered needle-removers on the market now. The Disintegrator Needle Destruction Device, offered by American Scientific Resources (ASFX), uses plasma arch technology to destroy the needle, kill pathogens and blunt the syringe. Designed to be used with only one hand, this device completely eliminates the sharp. One model from Techno Fab uses a regular electrical short-circuit to melt the needle, while another needle-remover, seen at CarePathways.com, uses a plasma
Plasma or plasm may refer to:
Science
* Plasma (physics), one of the four fundamental states of matter
* Plasma (mineral), a green translucent silica mineral
* Quark–gluon plasma, a state of matter in quantum chromodynamics
Biology
* Blood pla ...
arc to melt the needle. A unique needle-remover design is the Needle Remover Device, designed by the Program for Appropriate Technology in Health (PATH). It uses two handles that are squeezed together to slide two circular blades across each other, which cuts the hub from the syringe. It is also reusable, and its target cost is about $15.[ Another needle-removers currently on the market is Advanced Care Products's Clip&Stor, which uses a hand-powered clipper action to remove the needle. The cost of the Clip&Stor is about seven dollars. There is also the BD Hub Cutter, which uses a squeezing hand motion to cut the syringe. The edges of the squeezable parts have blades that do the actual cutting. However, unlike a regular needle-remover, the BD Hub Cutter cuts the syringe at the hub so the needle is completely separated from the syringe. As a result, the risk of a contaminated puncture is completely eliminated because no needle shards remain on the syringe. The Hub Cutter is not reusable though, and disposal of the whole unit must occur. The cost of the Hub Cutter is about four dollars.][
]
Limitations
Most of these current needle-removers require the use of two hands; one to hold the needle in place and the other to activate the mechanism. This form of operation can cause problems because if hospital personnel are busy, especially in a developing world country, they may not have the time or hands needed to operate the device. As a result, the needle will remain exposed on the syringe, posing a risk to both health care workers and patients.
Furthermore, many of these existing needle-removers do not make use of cheap and readily available materials, like used motor oil jugs, for containers, which raises the price of the device and requires that the hospital continuously buys more containers from the company. A typical 3-gallon Bemis sharps container Sharps may refer to:
* Plural form of many of the terms as defined on Sharp (disambiguation)
* Sharps waste, a form of biomedical waste composed of used ''sharps''
* Sharps, Virginia, unincorporated community in Richmond County
* Sharps Bedrooms
* ...
with a rotating lid costs about $8 without including shipping costs.[GRP & Associates, Inc. (2005).]
Medical Waste Disposal Supplies
Retrieved 12-7-05. If these containers must be shipped overseas, the price of the device can far exceed the available resources of many hospitals in developing countries, which causes them not to buy needle-remover
See also
* Occupational Safety and Health Administration
The Occupational Safety and Health Administration'' (OSHA ) is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agenc ...
* Hypodermic needle
A hypodermic needle (from Greek ὑπο- (''hypo-'' = under), and δέρμα (''derma'' = skin)), one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used w ...
* Injection (medicine)
An injection (often and usually referred to as a "shot" in US English, a "jab" in UK English, or a "jag" in Scottish English and Scots) is the act of administering a liquid, especially a drug, into a person's body using a needle (usually a hyp ...
* International Council of Nurses
The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations. It was founded in 1899 and was the first international organization for health care professionals. It is headquartered in Geneva, Switzerl ...
* Biomedical technology Biomedical technology is the application of engineering and technology principles to the domain of living or biological systems, with an emphasis on human health and diseases.
Biomedical engineering and Biotechnology alike are often loosely called ...
* Biomedical engineering
Biomedical engineering (BME) or medical engineering is the application of engineering principles and design concepts to medicine and biology for healthcare purposes (e.g., diagnostic or therapeutic). BME is also traditionally logical sciences ...
* Needle-exchange programme
A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
References
{{Reflist
External links
Becton Dickinson Corporate Website
International Health Care Worker Safety Center
Biomedical engineering
Medical hygiene