1. Evaluation of Needle Remover Devices Program for Appropriate Technology in Health Balcan, UK

2. Needle Removers Concept Advantages Disadvantages Contamination Study Design Tradeoffs SIGNOctober 2002 Balcan, UK

3. Needle remover collects needles in a secure container Syringe bodies are put in a safety box Needles are dumped from the container into a protected pit Concept Safely remove used needles from syringes SIGNOctober 2002

4. Advantages Decrease waste volume Decrease/contain sharps waste Lower cost of handling/transport Fewer safety boxes Help prevent reuse SIGNOctober 2002

5. Disadvantages offset by... Additional cost Supply needs Possible splatter contamination –Reusable containers –Bundling? –90% less sharps waste –Fewer safety boxes –Lower transport cost –Long life of device –Conduct study SIGNOctober 2002 Increased handling –Fewer sharps downstream

6. Study Background Literature shows risk of infection –Pathogens spread by hands –Splash to the eye Lauer JL, VanDrunen NA, Washburn JW, Balfour HH Jr. Transmission of hepatitis B virus in clinical laboratory areas. J Infect Dis 1979;140:513-6. Follett EA, Sleigh JD. Hepatitis B as a hazard to laboratory staff: a re-appraisal. J Clin Pathol 1980;33:1017-20. Levy BS, Harris JC, Smith JL, Washburn JW, Mature J, Davis A, Crosson JT, Polesky H, Hanson M. Hepatitis B in ward and clinical laboratory employees of a general hospital. Am J Epidemiol 1977;106:330-5. Sartori M, Terra GL, Aglietta M, Manzin A, Navino C, Verzetti G. Transmission of hepatitis C via blood splash into conjunctiva. Custom 1: 19930713 DCOM- 19930713 LR - 20001218 1993;25:270-1. Ippolito G, Puro V, Petrosillo N, De Carli G, Micheloni G, Magliano E. Simultaneous infection with HIV and hepatitis C virus following occupational conjunctival blood exposure. JAMA 1998;280:28.

7. Design Qualitative Visual Marker Sensitivity < 1mm diameter SIGNOctober 2002

8. Method 0.25 ml dye solution, lumen filled Control drips prior to use Compliant use, manufacturers IFUs 20 uses per device SIGNOctober 2002

9. Materials 5 devices from 4 manufacturers 2 cutters, 3 pullers WHO Safety Box Pliers SIGNOctober 2002

10. Results No splatter from any device EXCEPT... Pliers SIGNOctober 2002

12. Limits Does not measure aerosolization Does not measure non-compliant use One syringe size (23 gauge 1 inch) SIGNOctober 2002

13. Needle Removers Concept Advantages Disadvantages Contamination Study Design Tradeoffs SIGNOctober 2002 Nomoresharps, Australia

14. Design Tradeoffs Cost vs. durability Portability vs. static use Needle container reusable vs. disposable Syringe destruction SIGNOctober 2002

15. Appropriate Device Inexpensive Non-electric Reliable and durable Safe Simple to use SIGNOctober 2002