Illustration: needle remover

The materials below provide insight on the use of needle removers in low-resource settings.

Safely managing infectious sharps waste is one of the critical challenges facing health systems in low-resource settings. It is an important component of injection safety strategy. Manual needle removers are one technology being used to manage sharps waste in low-resource settings.

PATH has gathered available resources on needle removal to provide easy access to the information. This web page is intended to serve as a resource for countries and programs considering the introduction of needle removers. Included in these resources are some essential pieces of information for planning and decision-making:

Background

Needle Remover Technical Overview
PATH, 2006
This document provides an overview of the issues around introduction and use of needle removers in low-resource settings. Information on advantages, disadvantages, training, and device availability are all included. The document is intended to serve as a resource for countries and programs considering introducing needle removers and includes information to share with policymakers.

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Policy and planning

“First, do no harm”: Introducing Auto-disable Syringes and Ensuring Injection Safety in Immunization Systems of Developing Countries
WHO, 2002
This document was developed to assist policymakers and program managers in planning the introduction of auto-disable (AD) syringes as part of a comprehensive national policy and plan of action to improve injection safety, both for routine immunization and for mass campaigns. Needle removers are listed among the methods for managing sharps waste.

Management of Waste from Injection Activities at District Level
WHO, 2006
This guide is designed as a simple and practical tool to help district health managers develop a realistic district-level plan to reduce improper disposal of waste from injection activities. An accompanying poster is also available.

Management of Solid Health-Care Waste at Primary Health-Care Centres, a Decision-Making Guide
WHO, 2004
This document provides guidance for selecting the most appropriate method for safely managing solid waste generated at primary health care centers in developing countries. It includes six decision trees aimed at assisting the user in identifying appropriate waste management methods. It is intended for staff working in primary health care centers and technical staff working in local, state, or central administration. Needle removers are listed among the options for management of sharps waste.

Planning for Safe Syringe Disposal: Making Medical Injections Safer
PATH, 2004
This guide is designed help health workers plan disposal systems for sharps waste. The document details critical planning steps including mapping the district, reviewing sharps collection options including needle removal, reviewing options for disposal, developing a disposal system, and creating a district planning guide to calculate needs and plan implementation.

Optimal Settings for Needle Removers
PATH, 2006
This document contains descriptions of health facilities and injection settings detailing where use of needle removers is optimal and where it is not recommended.

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Field evaluations

Published reports

Evaluation of a Needle Remover Demonstration Project: A Study from Huong Khe District, Ha Tinh Province, Vietnam
PATH, 2007
This report summarizes an evaluation of the BMDi nomoresharps device in use in commune health centers in Vietnam.

Evaluation of a Disposable Needle-Removal Device in Uganda: A HealthTech Report
PATH, 2005
This report summarizes an evaluation of the BD Hub Cutter in family planning settings in Uganda.

Evaluation of a Needle-Remover Device and Sharps Barrel in Health Posts in Senegal: Final Report
PATH, 2005
This report summarizes an evaluation of the Balcan Mini-Destructor and use of a sharps barrel in health posts in Senegal.

Injection Safety and Healthcare Waste Management. Pilot Project: Needle Removing and Plastic Recycling
Ukraine Ministry of Health and WHO, 2005
This report summarizes a pilot project in Ukraine that evaluated the use of needle removal and plastic recycling as options for management of sharps waste. Balcan Needle Destructor and BMDi Nomoresharps devices were used in the pilot project.
Download/view digital file (754 KB PDF) from WHO website.

Pilot Trial of Needle Remover Devices in Eritrea
WHO, 2004
This report summarizes a pilot trial of needle removers that was conducted in Eritrea. The BD Hub Cutter and Balcan Needle Destructor were evaluated in this trial.
Download/view digital file (768 KB PDF) from WHO website.

Review of Studies Conducted on the Use of Needle Removal Devices
WHO, 2006
This paper was published in January 2006 and was sponsored by WHO in an effort to summarize the body of work related to evaluation of needle removal that has been conducted to date.
Download/view digital file (142 KB MS Word doc) from TechNet21 website.

Other evaluations

A number of other evaluations have been conducted on introduction and use of needle removers in several countries. WHO has completed evaluations in Myanmar and Madagascar. PATH has also conducted evaluations in India and, most recently, in Vietnam. As reports continue to be published, this list will be updated.

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Needle disposal

Building a Protected Sharps Pit
PATH, 2005
This resource provides brief guidelines and technical drawings to assist with construction of a protected sharps pit. Two designs are included, one modeled after an approach by Médecins Sans Frontière (lined with cement) and another modeled after an approach used in Indonesia (lined with a large pipe).

Building a Protected Sharps Barrel
PATH, 2005
This resource provides brief guidelines and technical drawings to assist with construction of a protected sharps barrel and the associated funnel. A sharps barrel is recommended for facilities located in areas where the water table is high or access to land is limited.

Guidance for Building a Sharps Pit Using a Plastic Barrel as a Pit Liner
PATH, 2006
This document provides guidelines for constructing a sharps pit using a plastic barrel as a pit liner. It includes a drawing to assist with planning. These pits have been installed in some health facilities in Kenya. This method of construction was found to be of lower cost compared to a cement-lined pit and took less time to install.

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Training

Training Health Workers in the Management of Sharps Waste. Version 1.
PATH, 2005
This training manual includes a set of training modules that are designed to be adapted for use in various health care settings. The purpose of these materials is for use in training health workers in the management of sharps waste. These materials are divided into two training guides, one for training injection providers and one for training waste handlers. The training for injection providers includes a module on use and maintenance of needle removers. The training for waste handlers includes modules on disposal of removed needles using sharps pits and barrels.

The training manual also includes a series of job aids related to use of needle removers. These generic tools were designed to assist programs using reusable needle removers with removable containers (as opposed to disposable devices). The job aids are listed separately below:

Using a Needle Remover
PATH, 2005
This job aid summarizes the key steps for proper use of a needle remover.

Maintaining a Needle Remover
PATH, 2006
This job aid emphasizes the importance of routine maintenance to ensure a needle remover works efficiently for a longer period of time. It outlines the key steps for regular maintenance as well as troubleshooting device malfunction.

Using a Protected Sharps Pit
PATH, 2005
This job aid summarizes key steps for disposal of removed needles from a needle remover, using a protected sharps pit.

Using a Protected Sharps Barrel
PATH, 2005
This job aid outlines key steps for disposal of removed needles from a needle remover, using a protected sharps barrel.

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Availability of devices

Below are links to three manufacturers who have manual needle removers that are commercially available and in use in various countries. Included on the company web sites is information about needle removers as well as contact information for purchasing these devices. Inclusion in this list does not constitute an endorsement by PATH. Descriptions and cost information are also included in the Needle Remover Technical Overview.

Balcan Engineering Ltd.
Manufacturer of the Needle Destructor device
Visit the Balcan website.

BD
Manufacturer of the BD Hub Cutter
Visit the BD website.

BMDi Pty Ltd
Manufacturer of the nomoresharps® device
Visit the BMDI website.

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Online resources

Safe Injection Global Network (SIGN) Alliance
This alliance is coordinated through WHO. SIGN is a voluntary coalition of stakeholders aiming to achieve safe and appropriate use of injections throughout the world.
Visit the SIGN website.

Healthcare Waste Management Resource Page
This website is managed by WHO. It is a resource for policy, planning, and management of health care waste and includes a number of databases that can be searched for technical reference material.
Visit the Healthcare Waste Management website.

Technical Network for Strengthening Immunization Services (TechNet21)
TechNet21 is a professional network of experts in logistics who are involved in the management of immunization and other primary health care operations at the country and international levels. It serves as a forum where issues relevant to implementation of immunization services can be discussed, debated, and clarified. The forum is maintained by WHO.
Visit the TechNet21 website.

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Acknowledgments

PATH’s work in the area of health care waste management is supported by the US Agency for International Development through funding under the HealthTech Program, the President's Emergency Plan for AIDS Relief under the Making Medical Injections Safer Project, and others.

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