Needle remover
Encyclopedia
Needle removers are devices that physically remove a needle
from a syringe
. In developing countries, there is still a need for improvements in needle safety in hospital
settings as most of the needle removal processes are done manually and under severe risk of hazard from needles puncturing skin and allowing 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
spread by preventing the reuse of the syringes, reducing incidents of accidental needle-sticks, and facilitating syringe disposal.
(WHO), 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). Needle-stick injuries are further complicated by disease transmission, such as Hepatitis B, Hepatitis C
and HIV
. In Ghana
, a study of 803 schoolchildren revealed that 61.2% had at least one marker of hepatitis B virus (Sagoe-Moses et al., 2001). As a result, health care workers (HCWs), patients, and the community in developing nations are at an increased risk of contracting blood-borne pathogens
via the reuse and improper disposal of needles, and accidental needle-sticks (Harner, 2004).
Before needle safety regulations, HCWs were on their own to avoid accidental needle-sticks and safely disposal of needles. However, in the U.S., after the Needlestick Safety Act signed in 2000 and the 2001 Bloodborne Pathogens Standard, the burden was no longer on HCWs. Both of these regulations mandated the use of safety devices and needle-removers with any sharps or needles (Jagger, 2003, 27-28). 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.
and tuberculin
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
(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 (Becton, Dickinson, and Company, 2004, BD SafetyGlide).
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 (International Council of Nurses, 2005). The BD Uniject
is a prefilled vaccine syringe that uses a plastic bulb instead of a plunger and has a disc valve to prevent reuse (Becton, Dickinson, and Company, 2005).
Still, over 90% of syringes worldwide do not have autodisable features (Harner, 2004). 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.
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 (Department of Essential Health Technology, 2004). Increased pathogen transmission also occurs from the reuse of contaminated needles when supplies are low (Sagoe-Moses et al., 2001). 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 HCWs via contaminated needles. Occupational needle-sticks account for 40%-65% of Hepatitis B and C
infections in HCWs (Prüss-Üstün, Rapiti, and Hutin, 2003). As a result, more HCWs have to undergo postexposure testing and treatment, both of which cost money for the hospitals and the countries. There is also the manpower cost associated with losing trained HCWs 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 HCWs, which is lost when occupational needle-sticks cause HCWs to leave the medical field (Sagoe-Moses et al., 2001).
The economic considerations are not just limited to costs associated with HCWs. 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 HCWs and individuals in the community, as well as needle reuse by members of the community, which can increase the potential spread of diseases.
However, electricity
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 (Choksi et al., 1981; Harner, 2004). There are other designs in which a twisting motion brings a shearing blade in contact with the needle and thus cuts it (W. Thead, D. Thead, and Evans, 2000). 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 (Johan and Morner, 1972). 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 (Samuel, 2004). 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 (Atsumi, 1996). Another one-handed device uses a downward motion to cause rotating gears to unscrew the needle and collar from the syringe (Thead and Evans, 1991). 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 (Han, 1994).
In 2006 a cheap and simple solution utilizing old cola or beer cans to dispose needles and specially developed lid to safely seal them has been developed. One click and the can is permanently sealed by the safely seal. The snap-lock seals the two parts together without using 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 (Business Ideas Forum, 2007).
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 (Harner, 2004). 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 (Advanced Care Products, 2005). 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 (Becton, Dickinson, and Company, 2004). The cost of the Hub Cutter is about four dollars (Department of Essential Health Technology, 2004).
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
with a rotating lid costs about $8 without including shipping costs (GRP & Associates, 2005). 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-removers.
Hypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
from a syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
. In developing countries, there is still a need for improvements in needle safety in hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
settings as most of the needle removal processes are done manually and under severe risk of hazard from needles puncturing skin and allowing 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
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
spread by preventing the reuse of the syringes, reducing incidents of accidental needle-sticks, and facilitating syringe disposal.
Background
In developing countries, most hospitals are lacking in needle safety. In regions surveyed by the World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO), the reported number of needle-stick injuries
Needlestick injury
A needlestick injury is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects. Commonly encountered by people handling needles in the medical setting, such injuries are an occupational hazard in the medical community...
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). Needle-stick injuries are further complicated by disease transmission, such as Hepatitis B, Hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
and HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. In Ghana
Ghana
Ghana , officially the Republic of Ghana, is a country located in West Africa. It is bordered by Côte d'Ivoire to the west, Burkina Faso to the north, Togo to the east, and the Gulf of Guinea to the south...
, a study of 803 schoolchildren revealed that 61.2% had at least one marker of hepatitis B virus (Sagoe-Moses et al., 2001). As a result, health care workers (HCWs), patients, and the community in developing nations are at an increased risk of contracting blood-borne pathogens
Blood-borne disease
A blood-borne disease is one that can be spread through contamination by blood.The most common examples are HIV, hepatitis B, hepatitis C and viral hemorrhagic fevers....
via the reuse and improper disposal of needles, and accidental needle-sticks (Harner, 2004).
Before needle safety regulations, HCWs were on their own to avoid accidental needle-sticks and safely disposal of needles. However, in the U.S., after the Needlestick Safety Act signed in 2000 and the 2001 Bloodborne Pathogens Standard, the burden was no longer on HCWs. Both of these regulations mandated the use of safety devices and needle-removers with any sharps or needles (Jagger, 2003, 27-28). 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 (Wilburn, 2004). As a result, a one-handed capping mechanism was added to insulinInsulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
and tuberculin
Tuberculin
Tuberculin is the name given to extracts of Mycobacterium tuberculosis, M. bovis, or M. avium that is used in skin testing in animals and humans to identify a tuberculosis infection. Several types of tuberculin have been used for this, of which purified protein derivative is the most important....
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
Becton, Dickinson and Company , is an American medical technology company that manufactures and sells medical devices, instrument systems and reagents. Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD does business in nearly 50 countries and has 28,803 employees worldwide. In...
(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 (Becton, Dickinson, and Company, 2004, BD SafetyGlide).
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 (International Council of Nurses, 2005). The BD Uniject
Uniject
Uniject is a disposable, pre-filled, single-use syringe which was developed to promote vaccination in developing countries. It was developed by PATH as part of the solution to the problem of delivering vaccines to areas which have insufficient medical workers to meet the needs of traditional,...
is a prefilled vaccine syringe that uses a plastic bulb instead of a plunger and has a disc valve to prevent reuse (Becton, Dickinson, and Company, 2005).
Still, over 90% of syringes worldwide do not have autodisable features (Harner, 2004). 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 (Harner, 2004). 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 (Harner, 2004).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 (Biomedical Engineering Society, 2004). 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 (Department of Essential Health Technology, 2004). Increased pathogen transmission also occurs from the reuse of contaminated needles when supplies are low (Sagoe-Moses et al., 2001). 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 HCWs via contaminated needles. Occupational needle-sticks account for 40%-65% of Hepatitis B and C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
infections in HCWs (Prüss-Üstün, Rapiti, and Hutin, 2003). As a result, more HCWs have to undergo postexposure testing and treatment, both of which cost money for the hospitals and the countries. There is also the manpower cost associated with losing trained HCWs 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 HCWs, which is lost when occupational needle-sticks cause HCWs to leave the medical field (Sagoe-Moses et al., 2001).
The economic considerations are not just limited to costs associated with HCWs. 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 HCWs 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 moveable 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 (Garvis and Beer, 1974). There are other patents that use electricity between electrodes or between rotating gears to short-circuit the needle and melt it off the syringe (Ch’ing-Lung, 1986; Hashimoto, 1990). A more complex design involves a hammer mill 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 (Wallace et al., 1991).However, electricity
Electricity
Electricity is a general term encompassing a variety of phenomena resulting from the presence and flow of electric charge. These include many easily recognizable phenomena, such as lightning, static electricity, and the flow of electrical current in an electrical wire...
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 (Choksi et al., 1981; Harner, 2004). There are other designs in which a twisting motion brings a shearing blade in contact with the needle and thus cuts it (W. Thead, D. Thead, and Evans, 2000). 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 (Johan and Morner, 1972). A crank
Crank (mechanism)
A crank is an arm attached at right angles to a rotating shaft by which reciprocating motion is imparted to or received from the shaft. It is used to change circular into reciprocating motion, or reciprocating into circular motion. The arm may be a bent portion of the shaft, or a separate arm...
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 (Samuel, 2004). 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 (Atsumi, 1996). Another one-handed device uses a downward motion to cause rotating gears to unscrew the needle and collar from the syringe (Thead and Evans, 1991). 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 (Han, 1994).
In 2006 a cheap and simple solution utilizing old cola or beer cans to dispose needles and specially developed lid to safely seal them has been developed. One click and the can is permanently sealed by the safely seal. The snap-lock seals the two parts together without using 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 (Business Ideas Forum, 2007).
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 plasmaPlasma (physics)
In physics and chemistry, plasma is a state of matter similar to gas in which a certain portion of the particles are ionized. Heating a gas may ionize its molecules or atoms , thus turning it into a plasma, which contains charged particles: positive ions and negative electrons or ions...
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 (Harner, 2004). 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 (Advanced Care Products, 2005). 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 (Becton, Dickinson, and Company, 2004). The cost of the Hub Cutter is about four dollars (Department of Essential Health Technology, 2004).
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 HCWs 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 container
A sharps container is a container that is filled with used medical needles . They fit into two main types:* single use which are disposed of with the waste inside,...
with a rotating lid costs about $8 without including shipping costs (GRP & Associates, 2005). 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-removers.
See also
- Occupational Safety and Health AdministrationOccupational Safety and Health AdministrationThe United States Occupational Safety and Health Administration is an agency of the United States Department of Labor. It was created by Congress of the United States under the Occupational Safety and Health Act, signed by President Richard M. Nixon, on December 29, 1970...
- Hypodermic needleHypodermic needleA hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
- Injection (medicine)Injection (medicine)An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...
- International Council of NursesInternational Council of NursesThe International Council of Nurses 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...
- Biomedical technologyBiomedical technologyBiomedical technology broadly refers to the application of engineering and technology principles to the domain of living or biological systems. Usually inclusion of the term biomedical denotes a principal emphasis on problems related to human health and diseases, whereas terms like "biotechnology"...
- Biomedical engineeringBiomedical engineeringBiomedical Engineering is the application of engineering principles and design concepts to medicine and biology. This field seeks to close the gap between engineering and medicine: It combines the design and problem solving skills of engineering with medical and biological sciences to improve...
- Needle-exchange programmeNeedle-exchange programmeA Needle & syringe programme or syringe-exchange programme is a social policy based on the philosophy of harm reduction where injecting drug users can obtain hypodermic needles and associated injection equipment at little or no cost. Many programmes are called "exchanges" because some require...