PROBABILITY OF THREE TIME EXPENSIVE AUTO DISABLE (AD) SYRINGES IN SPREADING BLOOD BORNE INFECTION AND HIV IN PAKISTAN 

The purpose of writing this article is only to discuss the possible factors responsible for reuse of auto disable syringes. This article is not the intention of any confrontation with government policy. The assessment of risk factors associated with AD syringes reuse should be carried out for betterment of people and society. Otherwise, expensive AD (auto disable) syringes might be failed in reducing the risk of transmission of blood borne infections. Let’s discuss,

CONVENTIONAL SYRINGES
Conventional syringes or hypodermic syringes can be defined as medical devices design to inject fluid or medicine into the body or to withdraw fluid from the body. It consists of barrel with bold scale, plunger with fixed needle or detachable needle. Conventional syringes can be made up of glass, metal or plastic. Syringes which are made up of plastic are commonly called as disposable syringes because they are intended for single use and should be discarded after single use or one time use.

HOW CONVENTIONAL SYRINGES ARE  INVOLE IN SPREADING BLOOD BORNE INFECTION?
Reuse and resell of unsterile syringes after one time use has become the primary cause of spreading blood borne infections such as HIV (human immunodeficiency virus), AIDS (Acquired immunodeficiency syndrome) and HEPATITIS B and C in Pakistan and others developing countries especially in private health care facilities. Although disposable syringes are cost effective and convenient in use but the contributing factors for reuse of conventional syringes are as follows,
1.  To save money
2. Due to unauthorized practitioners
3. due to poor waste disposal
4. due to poor market check
5. Implementation of law is an issue

WHY GOVERNMENT OF PAKISTAN HAS IMPOSED BAN TO CONVENTIONAL SYRINGES?
Due to HIV (human immunodeficiency virus) outbreak in LARKANA primarily due to unsafe and unsterile syringes reuse which make every adult and child of LARKANA city HIV positive. To overcome the spread of blood borne infections via unsafe syringes, Pakistan has been going to set the example by using AD (auto disable) syringes both for immunization and therapeutic purposes. Let’s explore some information about AD syringes.

WHAT IS AUTO DISABLE SYRINGE?
Due to internal safety mechanism, AD syringes locked after single use automatically and ensure not be used for second time. Basically it is designed to defeat the use of syringe for second time.

WHY AD SYRINGES ARE USED IN  IMMUNIZATION PROGRAMMES?
Conventional syringes can be resold and reuse, this unsafe injection practices (unsterile and contaminated needles) increases the risk of transmission of blood borne infections like Hepatitis B and
C. Due to which AD syringes are recommended for immunization programs in which people receive their vaccine shots safely without being exposure to infection.

HOW TRACKING OF USED AD SYRINGES DURING IMMUNIZATION IS EASIER?

AD syringes increase the volume of medical waste during immunization. Despite of it, tracking of used AD syringes during the immunization process is easier because of record which clearly indicates HOW MANY PEOPLE GET IMMUNIZED? HOW MANY SYRINGES ARE CONSUMED? and after the administration of injection, medical stuff immediately cut the needle and locked the plastic body. Due to which, it became practically useless and there will be least chances of reuse. Proper disposal of the medical waste will finally assist us in achieving our objective which is the least chances of spreading of blood borne infections due to contaminated syringes.

WILL ABOVE MENTION DECISION OF GOVERNMENT OF PAKISTAN EVENTUALLY MAKE US THE LEAST
BLOOD BORNE INFECTION EXPOSED STATE?
Yes, decision will be helpful in minimizing the risk of spreading blood borne infection. However, the risk of transmission of blood borne infections will always be exist because Pakistan is a developing country in which implementation of law is a serious issue. Secondly Health Care Waste Management of Pakistan (HCWM) is not well established. There is a lack of HCWM practices in public and private hospitals of Pakistan. Segregation, handling, storage and disposal of waste were below WHO and Pakistan bio-safety rule 2005 standards. It is real situation of the big hospitals of Pakistan then WHAT CAN WE SAY ABOUT PRIVATE CLINICS? Every corner of street has at least 2 or 3 clinics. There is no government agency that can effectively monitor private clinics and can track them either they are following HCWM or not? How they are disposing their medical waste? Suppose if they are not cutting needle after administration of injection then this contaminated needle could be a source of blood borne infections as the profit mafia can resell it.

NOW THE MILLION DOLLARS QUESTION IS THAT CAN SOMEONE DEFEAT DISABLE MECHANISM Of AD SYRINGES?
Yes, there is possibility that someone can defeat disable mechanism of AD syringes intentionally. With little efforts, it is quite easy to defeat disable mechanism of AD syringes (forcibly) if low quality material is being used or if someone has not depressed plunger intentionally via under- dosing (disable mechanism will not be activated because of under-dosing) then the possibility of reuse and resell of AD syringes cannot be rule out. My concern is that poorly handle medical waste may be handle by profit mafia by unlocking and reselling it.

CONCLUSION
Government of Pakistan should keep strict eye to all the issues and must have focused approach towards medical waste management. Otherwise, the least exposure to blood borne infection is only a dream. All the hospitals and private clinics should be monitored by government agencies properly. With poor waste management monitoring or with unstrict market check, it is almost impossible to achieve the reduction of blood borne infection target with 3-time expensive AD syringes as compare to conventional syringes.