Introduction of Auto-Disable (AD) Syringes

Program for Appropriate Technology in Health

Cairo, EgyptOctober 2000

The Common Sense Approach

Troubleshoot early on to correct unintended consequences.

Supervise injection technique. Monitor satisfaction with products.

In Other Words

Monitor the system, the user, and the product.

Know Which Syringes You Are Using

UNICEF should track what they ship.

Programs should track what they receive: – brand and type – fixed or detached needle, length and

gauge of needle, dose lines– save a sample, if necessary

Prepare Users for Multiple Types of AD Syringes

UNICEF provides several brands.Brands and models change from

year to year.If 1 syringe is shipped for every 1

dose of vaccine, syringes will be left over.

Bundling 1:1

:

Bundling 1:1

Vaccine wastage rates may be 10-60%.

AD syringe wastage rates are more typically <10%.

Over time, different types of AD syringes may accumulate.

Training Manual Available

PATH and partners prepared a Training Manual to introduce AD syringes.– English copies are available.– PDF copy available in November.– Contact info@path.org to discuss

translation.

Contents of Manual

1 page instructions for 4 types of AD syringes

Background information for trainers or supervisors

Sample lessonsSafe injection techniques

We Know Current Injections are Unsafe

Use the introduction of AD syringes to review:– Dose accuracy with all syringes– Reuse in curative sectors– Recapping– Keeping syringes from the public

Dose Accuracy

Surprising variability in doses given by nurses with standard syringes

Re-train and supervise

Dose Volumes Using Standard 21G 2 ml Syringe

Nurse 1

Nurse 2

Nurse 3

Nurse 4

Nurse 5

Number of Attempts

Do

se V

olu

me

(ml)

-0.05

0.15

0.35

0.55

0.75

0.95

1.15

1 2 3 4 5 6 7 8 9 10

Dose Volumes Using an AD 23G 1 ml Syringe Without Instructions

Nurse 1

Nurse 2

Nurse 3

Nurse 4

Nurse 5

-0.05

0.15

0.35

0.55

0.75

0.95

1.15

1 2 3 4 5 6 7 8 9 10

Number of Attempts

Do

se V

olu

me

(ml)

Dose Volumes Using an AD 23G 1 ml Syringe After Reading Instructions

Nurse 1

Nurse 2

Nurse 3

Nurse 4

Nurse 5

-0.05

0.15

0.35

0.55

0.75

0.95

1.15

1 2 3 4 5 6 7 8 9 10

Number of Attempts

Do

se V

olu

me

(ml)

Look for Unexpected, Unsafe Consequences

Old BCG syringe has a 0.05 and 0.1 ml dose line.

New AD syringe has only 0.05 ml?What are people doing to

compensate?

Unintended Consequences

Do they give two injections?Do they use one syringe and guess

the volume?Do they change the dose?Do they use the syringe twice?Do they use another sterilizable

syringe with a 0.1 ml dose?

Preventing Reuse withAD Syringes

Depends on How You Manage Stock-Outs:– When mothers come with their

syringe will it be used? – When stock runs out will the family be

sent to purchase any syringe available?

– Do clinics revert to sterilizable syringes?

Policy Changes for Equity and Safety

Argue for facilities to improve management and provide syringes and supplies.

Facilities can purchase at lower costs than consumers.

Post Marketing Surveillance

Settle safety disagreements with data.– Can WHO prepare a statistically

sound framework with the correct unit of analysis that controls for user, facility, and injection order biases?

Remember, If You Change a Familiar Object

AND look for problems (adverse events surveillance), people may assume existing, but previously unnoticed problems, are caused by the change.

Prepare for that Change

Troubleshoot early on and correct for unanticipated, system-related impacts.

Monitor practice: train and supervise.

Monitor products.