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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.
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
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 [email protected] 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.