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Planning for a safe syringe
disposal system for
Immunization Service
Delivery
Part I Options for syringe waste disposal
Part II Weighing the options
Transmission risks & disposal
patient to patient
transmission of infection due
to the re-use of syringes,
patient to health-worker
transmission due to needlestick and
patient to community
transmission due to
unsatisfactory final disposal.
Safe
Sharps
Waste
Disposal
Systems
Options for syringe waste
disposal
collecting used syringes
method of final destruction
location of final destruction
monitoring safe disposal of syringes
Options for collecting used
syringes
1. Place needles and
syringes in a safety box
immediately after use
A d va n ta g e s :

O n ce th e s a fe ty b o xe s a re pu rc ha s ed , n o ad d itio n a l e q u ip m en t is
n e ce ss a ry.

T h e s a fe ty b o x is d e s ig n e d s o tha t, in m o s t c irc u m s ta nc es , th e
n e ed le w ill n o t p e n e tra te th e bo x w a ll.

T h e s a fe ty b o x a rriv e s p ac ke d fla t, s o it is e a s y to tra n s p o rt em p ty.
It is th e n a s sem b le d o n s ite fo r u s e .

T h e o u ts id e w a ll o f th e b o x p re s e n ts a n o pp o rtun ity fo r th e M in is try
o f H e a lth to p rin t m e ss ag e s a b ou t in je c tio n s a fe ty.
D is a d va n ta g es :






N e ed le re m a in s a h a za rd d u rin g w a s te h a nd lin g .
S yrin g e s w ith n e e d le s a re b u lk y to s to re a n d tra n sp o rt (a p p ro x.
1 0 0 s yrin g e s fit in e a c h 5 -litre b o x) b e c a u se th e n e ed le s p rev e n t
c lo s e p ac k in g .
In s itu a tio n s w h e re m a n y in je c tio n s a re g iv en , s a fe ty b o xe s w ill
a c cum u la te v e ry q u ic k ly.
T h e re is a n e e d le -s tic k ris k if to o m a n y s yrin g e s a re p ac ke d in th e
b o x (i.e . if it is m o re th a n ¾ fu ll).
M o s t b o xe s m a nu fac tu re d fo r th e in te rn a tio n a l m a rk e t a re n o t
p ro te c ted a ga in s t w a te r, s o th e y d is in te g ra te if th e y b e c om e w e t.
T h e n e ed le s em it a to x ic g a s e le m e n t (C h rom e -6 ) if th e y a re
b u rn ed in h ig h te m p e ra tu re in c in e ra to rs .
Options for collecting used
syringes
1. Place needles and
syringes in a safety box
immediately after use
2. Separate needles from
syringes before placing
the syringe in a safety box
A d va n ta g e s :




A s yrin g e w ith o u t th e n e ed le is n o lo n g e r a h a za rd so th e re is
le s s ris k o f n e ed le -s tic k d u rin g h a nd lin g a n d tra n sp o rt.
V o lu m e o f s h a rp s w a s te is re d u ce d b y 2 0 -60 % p e rc e n t w h e n
n e ed le s a re rem ov e d .
M a n y ye a rs w o rth o f n e e d le s w ill fit in a s in g le , p ro te c te d n e ed le
p it.
W ith ou t n e ed le s , m o re s yrin g e s c an b e p u t in e a ch s a fe ty b o x.
D is a d va n ta g es :




T h e n e ed le -re m ov e r c os ts be tw e e n U S $ 2 0 to U S $ 50 p e r dev ic e .
A s p ec ia lly c o n s tru c ted , p ro te c ted p it (s e e a n n e x 3 ) m u s t be b u ilt
in e a c h in je c tio n s ite .
A n e ed le -re m ov e r is n e e de d fo r e ac h pe rs on g iv in g in je c tio n s ,
w h e rev e r th e in jec tio n is g iv e n .
T h e n e ed le -re m ov e r c ou ld fa il, th e n e e d le c o n ta in e r c o u ld g e t
lo s t, o r th e e q u ipm e n t co u ld b e s to le n .
Options for final destruction
1. Incinerating filled
safety boxes (best
method)
A d va n ta g e s :
 M a y b e b u ilt o n s ite (D e M o n fo rt) o r p u rc h a se d .
 P rov id e s com p le te a nd e ffic ie n t d e s tru c tio n o f s yrin g e s .
 C o ns is te n t w ith s ta n d a rd h os p ita l p o lic y a n d p ra c tic e .
 C a n be u se d to d es tro y o th e r in fe c tio u s w a s te .
 L o w e r e nv iro nm en ta l e m is s io n h a za rd .
 L e ss sm o ke d u rin g o p e ra tio n .
D is a d va n ta g es :



C o s t is b e tw e e n U S $1 ,0 00 a nd U S $6 ,0 00 in s ta lle d .
If in s ta lle d a t a re m o te s ite , tra n s p o rt w ill b e n e ce ss a ry.
S u pe rv is io n is re q u ire d fo r p ro p e r u s e a n d m a in te n an ce .


F u e l o r w o o d re q u ire d .
S m o ke a nd n o xio u s em is s io n s m a y n o t b e to le ra te d in u rb a n
a re a s , so in c in e ra to rs a re o n ly fe a s ib le w e ll a w a y fro m b u ild in g s .
Options for final destruction
1. Incinerating filled
safety boxes (best
method)
2. Burning safety boxes
in a drum, protected
hearth or pit (next best
method)
A d va n ta g e s :

M a te ria ls av a ila b le lo c a lly.

L o w c o s t.
D is a d va n ta g es :






R e qu ire s s u p e rv is io n fo r p ro p e r u sa ge .
D o es n o t b u rn a s c le a n ly a s a s p ec ia l in c in e ra to r th e re m a y b e
sm ok e an d env iro n m e n ta l em is s io n h a za rd .
F u e l is re q u ire d .
N e ed le s w ill n o t b e d e s tro yed – re s id u a l m e ta l a n d as h rem a in s
a h a za rd (th o ug h no t in fe c tio u s a fte r b u rn in g ).
H o t, m o lte n p la s tic is a s e rio u s h a za rd .
B u rn in g p its m a y n o t w o rk w e ll in th e w e t s e a s on .
Options for final destruction
1. Incinerating filled
safety boxes (best
method)
2. Burning safety boxes
in a drum, protected
hearth or pit (next best
method)
3. Burying safety boxes
in the ground (least safe
method)
This option should only be
used:
If no incinerator is
available and
If burning is not
A d va n ta g e s : acceptable or possible and

N o a d d itio n aIf
l eq
u ip m e n t land
re q u ire
suitable
isd

N o sm o k e available:

N o fu e l re q u ire d
The land should be

N o m a in te n a n c e n e e d e d
inaccessible to the

Low cost
community.
D is a d va n ta g e s :
The water table

D ig g in g d e e p p its a n d co v e rin g th e m o v e r p la c e s e n o rm o u s
should be at least
b u rd e n o n s ta ff.
1.50m below the base

S yrin g e s ca n b e u n e a rth e d a cc id e n ta lly o r o n p u rp o s e .
of the pit, even during

C a n n o t b e u s e d w h e n w a te r ta b le is n e a r s u rfa ce b e c a u s e
the
season.
liq u id s le a k in to g ro
u n dwet
w a te
r a n d s yrin g e s m a y s u rfa ce o v e r
The ground should
tim e .

H a rd g ro u n d m a y m
a kbe
e d too
ig g inhard.
g d iffic u lt.
not


S a fe ty b o xe s a re b u lk y (5 m e te rs cu b e d p e r 1 0 0 ,0 0 0
s yrin g e s ) a n d s yrin g e s n e v e r d e g ra d e – m u c h la n d is n e e d e d .
T h e e n v iro n m e n ta l c o s t is h ig h .
Options for the location of final
destruction
1. At the site of outreach
immunization
Options for the location of final
destruction
1. At the site of outreach
immunization
2. At the health center
Options for the location of final
destruction
1. At the site of outreach
immunization
2. At the health center
3. At a location remote from
the health center
Options for monitoring safe
disposal of syringes
Count and record:
1. the total number of syringes supplied to the
facility and the number of safety boxes filled with
syringes or
2. Count and record the total number of
injections given and the number of safety boxes
filled with syringes or
3. Count and record the total number of
injections given and the number of syringes
destroyed
PART II Designing your
disposal system
Designing your disposal
system
Step 1: Collect data and map the district
Step 2: Identify facilities with access to
incineration now
Step3: Identify strategic locations for new
incineration facilities
Step 4: Identify the remaining health
centers and decide their policy for
destruction
Example map of facilities
13 00 syr ing es
pe r mo nth
13 00 syr ing es
pe r mo nth
•H o sp it al w it h e xist in g
incine ra to r
•H ea lt h ce nt e rs ( H Cs )
tr an spo rt in g syr ing es
to ho spita l in ciner at or
•H C s tr a nspo rt in g
syr in ge s to sm all- sca le
incine ra to r
•D ist ric t H eal th
ce n te r w ith sma llscale incine ra tor
•H C s u sin g p r ote cted bu r ning
13 00 syr ing es
pe r mo nth
•O u t rea ch s it es
w he re syr in ge s ar e
bu r ned on - sit e
D ist rict H C
In cine ra to r fo r
8 00 0 syring e s
80 0 syrin ge s p er m on th
pe r mo nth
80 0 syrin ge s
pe r mo nth
26 00 syr ing es
pe r mo nth
D ist rict H C
In cine ra to r fo r
8 00 0 syring e s
p er m on th
80 0 syrin ge s
pe r mo nth
10 00 syr ing es
pe r mo nth
H osp ita l
80 0 syrin ge s
pe r mo nth
S p are ca p acity fo r
5 0, 00 0 syring e s p er
80 0 syrin ge s
pe r mo nth
m o nt h
28 00 syr ing es
pe r mo nth
35 00 syr ing es
pe r mo nth
13 00 syr ing es
pe r mo nth
13 00 syr ing es
pe r mo nth
35 00 syr ing es
pe r mo nth
24 0 syrin ge s
pe r mo nth
M ountains
Example planning grid
Merci !
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