San Francisco Chronicle - Tuesday, October 27, 1998
William Carlsen, Chronicle Staff Writer

Nurses prick themselves recapping needles in Thailand. Immunization workers get stuck while sterilizing syringes in Tanzania. And Pakistani doctors repeatedly jab themselves during mass inoculations.

And because they are often injured with reused, unsterile syringes and needles, they face even greater risks of contracting hepatitis, HIV or other deadly viruses.

Yet little has been done to protect them. In a series of articles earlier this year, The Chronicle reported that safety syringes -- devices that incorporate features like sliding plastic sheaths or retractable needles -- have been available in the United States for nearly a decade.

Few U.S. health care employers, however, have provided their workers with the more expensive syringes. None have found their way into impoverished nations of the developing world.

The Chronicle articles reported that U.S health care workers suffer up to 1 million accidental needle sticks every year and thousands of nurses, doctors and public safety workers have contracted HIV, hepatitis and other blood-borne infections over the past decade.

Prompted by the series, a bill was passed this summer making California the first state in the nation to require the use of safety needles.

Yet needle stick rates in the United States are a fraction of those reported in Africa, Asia and Latin America, where the World Health Organization estimates that an average of five accidental needle injuries occur for every 100 injections.

In Cambodia, one study showed that 40 percent of nurses reported needle injuries at a provincial hospital during a single month.

In Tanzania, a 1997 study showed that health care workers in one region suffered an average of four needle sticks a year. In Pakistan, up to 1 percent of immunization workers are stuck during each clinic session.

"When interviewed, health workers always admit to having pricked their fingers several times in the recent past," said WHO technical officer Michel Zaffran.

"This can be caused by recapping disposable syringes or handling sterilizeable syringes to clean them."

Both procedures, combined with a lack of training about the dangers of needle sticks, explain the higher injury rates in developing countries compared to U.S. rates.

In the United States, for example, recapping is discouraged and there are sufficient supplies of disposable syringes to ensure that they are discarded in special plastic containers after being used.

At a 1991 international conference, U.S. needle stick expert Janine Jagger called upon syringe makers to develop a nonreusable syringe with safety features that would protect foreign medical workers.

"Worldwide demand for needle technology must not be viewed merely as a business opportunity," she told the health experts and syringe manufacturers at the conference. "It is a necessity that can be met with nothing less than a global revolution in needle design."

But the revolution never happened.

Syringe makers say no demand materialized. Health experts say the added costs of making nonreusable syringes are higher than most developing nations are willing to pay; needle safety will have to come later.

"We looked at some (safety feature) concepts," said Michael Free, who helped develop two nonreusable syringes in the 1980s. "But we were not able to devise a concept that did not add significant costs."

WHO officials recently estimated that the extra costs have come down to 2 to 3 cents per syringe and are considering requiring safety features in their specifications for a new generation of nonreusable syringes.

Still, the existing nonreusable syringes offer one safety feature: Since they cannot be reused, they are not re-sterilized, eliminating the extra handling that is a major cause of needle injuries.
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