Recycling of injection equipments in Pakistan

1. Recycling of injection equipments in Pakistan Dr. Syed Abdul Mujeeb Dr. Arshad Altaf Assistant Professor Senior Instructor Blood Transfusion Services Community Health Sciences Jinnah Postgraduate Medical Centre The Aga Khan University Karachi, Pakistan. Karachi, Pakistan.

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3. Unsafe injection practices • Average injection/person/year - 8.5 • Reuse of needles and syringes - 85% • HCV infection among recipients of unsafe injections - 44% • Anecdotal reports of recycling of medical waste. Khan et al. WHO Bull. 2000.78:949-1066 SIGN Pakistan

4. Objective of the study • To evaluate risk of infection with bloodborne pathogens associated with breaks in universal precaution and how how healthcare waste produced by clinical laboratories is managed in Pakistan SIGN Pakistan

5. Methods. • Clinical laboratories (CL) selected=50 • CL investigated =44 • Hospital based CL private =26 • Hospital based CL public =18 SIGN Pakistan

6. Methods. • Observational check list • Interviews • Pathologists, technologist • Sweepers of healthcare waste • Dealers of healthcare waste • Dealers of used syringes SIGN Pakistan

7. Safe practices. • Use of gloves =4.5%(4) • Use of gowns =27%(12) • Use of disinfectant =16%(17) • Needle cutter = 68%(28) • Use of needle cutters =29%(8) SIGN Pakistan

8. Disposal of medical waste(Pathologists/technologists(44). • Community waste site=70%(26) • Use of incinerator =16%(7) • Selling to dealers of medical waste =9%(4) • Crushing and destruction=7%(3) • Zonal Municipal Corporation ZMC =7%(3) • Declined to respond =2%(1) SIGN Pakistan

9. Sweepers(17) • Selling used syringes = 88%(15) • Selling price/kg = $0.06-0.2 • Readiness to sell to the investigator at higher price =100%(17) • Average needle injuries = 0-5/week SIGN Pakistan

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11. Scavengers boys(26) • 15-18 years age group = 96%(25) • Visits timing = morning,afternoon • Average collection =20-25 syringes/day • Selling price = $0.06-0.2 • Average needle injuries/week = 0-3 SIGN Pakistan

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13. Health care waste dealers (8) • Acknowledge dealing in healthcare waste business =100% (8) • Selling to dealers of used syringes =100% (8) • Readiness to sell to the investigator at higher price =100%(8) • Average needle injuries/week = 0-2 SIGN Pakistan

14. Dealers of used syringes(8) • Selling of used syringes to plastic ware industry =100%(8) • Crusher to crush syringes were available at sites =100(8) • Readiness to sell investigator at higher price =75%(6) • Readiness to sell investigator after washing =25%(2) • Readiness to sell investigator after washing and repackaging =12%(1) SIGN Pakistan

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18. Conclusions • Healthcare waste management is not safe in the country • People other than healthcare workers who are in recycling business are at risk of acquiring diseases. • Possibility of availability of unsafe syringes in the market. SIGN Pakistan

19. Recommendations • Education and training health care workers for universal safety precautions • More organized efforts of ZMC to collect healthcare waste • Development of monitoring system to see adherence to infection control practices, and proper disposal of medical waste SIGN Pakistan

20. Recommendations contd. • Educate and promote disinfection of used syringes and destruction of needles before the final disposal SIGN Pakistan