Sharps Waste - in The Developing World

In The Developing World

Sharps waste is of great concern in developing and transitional regions of the world. The advances in sharps waste management made in developed countries have not been seen in these regions. Striking social and economical differences make implementing the same protocols and technologies unrealistic. In addition factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste. These factors make sharps disposal a pressing issue when addressing public health in these regions. As with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes. Symptoms of fever, upper respiratory infections, colds, ear infections, skin infections, diarrhea, and fatigue are all commonly treated with injections. The average person has been estimated to receive up to 8.5 injections per year. Newly developed injection technologies, such as AD syringes and one handed capping mechanisms, are rarely used to provide these injections. These technologies add unaffordable costs. Therefore the majority of injections are given with standard disposable syringes in developing regions

The infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste (particularly injection devices) in the environment. This can lead to accidental needle sticks, reuse, or misuse. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).

Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually. For each year, these infections are modeled to cost society over 270,000 lives between 2000 and 2030. Additionally, it has been shown that most exposures to disease among health care workers in developing regions are attributable to sharps waste injuries. 40-65% of new HBV and HCV are due to percutaneous occupational exposure. The ratio of educated health care professionals to population disease prevalence is already a reason for concern in the developing world. The loss of these individuals is very damaging to public health interest in these regions.The majority of death, disability, and disease in these regions can not be attributed to deficient sharps waste management. However, their effective and practical management promotes public health and reduces disease spread. Remedying the current situation has been modeled to show an opportunity provide substantial social benefit at a relatively low cost. In addition this situation poses the opportunity to provide this considerable social benefit within a short time frame. For the most rapid improvements protocols and technologies must be developed specific for these regions. These must be designed in line current available resources and infrastructure. If tailored for these regions the sharps waste management methods rapid acceptance is more likely.