An 82-year-old celibate Buddhist abbot from Cambodia has been diagnosed with HIV. His doctor was the cause: He was reusing syringes and infected a reported 272 individuals, including babies and children.
This horror story resonates around the world. More than 2 million people were infected in 2010 alone, according to the most recent World Health Organization research, with hepatitis B, hepatitis C and HIV because of injections with previously used syringes or needles. While data are not available for transmission of all diseases, unsafe needle practices could also put people at risk for bloodborne illnesses, such as Ebola and malaria, according to WHO.
And it happens in rich and poor countries alike.
This week, WHO launched a global campaign to tackle the problem of disease spread because of the reuse of contaminated needles.
The organization is recommending that countries adopt the use of safety-engineered syringes, or "smart" syringes, designed to prevent reuse. "With one injection, the new-style syringes disable themselves," says Dr. Selma Khamassi, the head of the WHO team for injection safety. "Some have a metal clip that blocks the plunger and you cannot pull it back to give another injection. Some have a weak point, so if you try to pull it back, it breaks." And some have a device, like a spring, that automatically retracts the needle after the plunger hits the bottom of the barrel.
About 70 manufacturers are beginning to make versions of the smart syringes. In low-income countries, where the problem of reuse is greatest, affordability is crucial. The cost of traditional syringes without safety features is about 3 to 4 cents each; syringes that automatically disable themselves when used range from 4 to 8 cents each. "They are moving toward affordability. Once the demand increases, the price will decrease," says Khamassi.
Indeed, cost is one reason that health workers in poor countries reuse needles or syringes. "When workers lack equipment, they feel obliged to reuse the same syringe," she says. Or some health care workers have the misconception that changing the needle tip while keeping the same syringe (which holds the medicine) is safe. "It is not," says Khamassi.
A third reason in developing countries is that low-paid health workers can reuse syringes to pick up extra income by giving injections outside their clinics or hospitals in what might be called a private practice of sorts, Khamassi said.
Reuse also happens in wealthy countries, including the United States, because of ignorance of safety procedures, laziness, lack of equipment or simple greed. "Please don't think injection safety is an issue only in poor countries," says Khamassi.
The Centers for Disease Control and Prevention reported more than 50 outbreaks in the U.S. since 2001 of hepatitis B and C as well as bloodborne diseases because health workers reused needles, syringes or vials designed for single use. In other instances of reuse, there was no transmission of disease but patients had to be notified for possible testing. Examples include a urology clinic in Nevada using the same needle for prostate biopsies on more than one patient; a pediatric clinic in Denver reusing syringes to administer flu vaccines; a pain clinic in Los Angeles reusing syringes that exposed patients to hepatitis C; and a health fair in New Mexico that reused finger stick devices to test for blood glucose levels.
Adding to the problem in some countries is a demand by patients for injections when oral medications work as well. "Some patients believe injections are more effective or work faster," says Khamassi. "Some people demand an injection for a fever or vitamin or antibiotic injections." Part of the WHO campaign is to educate communities and patients in order to reduce the number of unnecessary injections.