Sterilizable syringes: excessive risk or cost-effective option?

In recent years, many poorer countries have chosen to use disposable instead of sterilizable syringes. Unfortunately, the infrastructure and management systems that are vital if disposables are to be used safely do not exist. WHO estimates that up to 30% of injections administered are unsafe. The traditional sterilizable syringe had many disadvantages, some of which have been minimized through better design and the use of modern materials; others have been overcome because staff are able to demonstrate that they have performed safely. For example, the time-steam saturation-temperature (TST) indicator has enabled staff to demonstrate that a sterilizing cycle has been successfully completed. Health facility staff must be able to sterilize equipment, and the sterilizable syringe remains the least costly means of administering an injection. Data from countries that have acceptable systems for processing clinical waste indicate that safe and environmentally acceptable disposal, destruction and final containment cost nearly as much as the original cost of a disposable syringe. By careful supervision of staff behaviour and good management, some countries have demonstrated that they are able to administer safe injections with sterilizable syringes at a price they can afford.

PIP: This paper examines the risks and cost-effectiveness of sterilizable syringes as compared to disposable injection equipment. According to the WHO, up to 30% of injections administered are unsafe. No single technology will render injection safe; only diligent health care providers who understand and follow the right procedures carefully will achieve safety, and only as long as the whole system is funded and managed adequately and used correctly. Traditional sterilizable syringes had many weaknesses, some of which have been reduced through better design and use of modern materials; still others have been overcome by safe and correct performance of the staff. Whereas health workers because of their convenience prefer disposable syringes, they do have their own limitations and disadvantages. Health facility staff must be able to sterilize injecting equipment, and the sterilizable syringe remains the least expensive means of giving an injection. Data from countries that have acceptable clinical waste disposal system indicate that safe and environmentally acceptable disposal, destruction and final containment cost closely as much as the original amount of a disposable syringe. Through careful supervision of staff practices and good management, some countries have demonstrated the ability to administer safe injections with sterilizable needles at an affordable cost.

Strategies for safe injections.

In 1998, faced with growing international concern, WHO set out an approach for achieving injection safety that encompassed all elements from patients' expectations and doctors' prescribing habits to waste disposal. This article follows that lead and describes the implications of the approach for two injection technologies: sterilizable and disposable. It argues that focusing on any single technology diverts attention from the more fundamental need for health services to develop their own comprehensive strategies for safe injections. National health authorities will only be able to ensure that injections are administered safely if they take an approach that encompasses the whole system, and choose injection technologies that fit their circumstances.

PIP: This article reviews a WHO approach aimed to achieve injection safety that encompasses all elements from patients' expectations and doctors' prescribing habits to waste disposal. Additionally, the paper describes its implications for two injection technologies: sterilizable and disposable. It argues that focusing on any single technology diverts attention from the more fundamental need for health services to develop their own comprehensive strategies for safe injections. National health authorities will only be able to ensure that injections are administered safely if they take an approach that encompasses the whole system and choose injection that fit their circumstances. When national authorities seek to identify the strategy most suited to their needs, they must take account of all three elements: behavior, management, and finance.