Injection needles are inevitable tools used for medical interventions. Francis Rynd, an Irish physician invented the hollow needle for subcutaneous injections in 1844. During the later years, Charles Pravaz and Alexander Wood developed hypodermic syringe for drug delivery in combination with the needle.
Hypodermic needles are made of stainless steel tubes of desired diameter ending with a sharp tip for piercing the skin. The hypodermal needle is an old medical tool, with its origin dating back to 19th century and has undergone little change.
Small upgradations have been incorporated for ensuring safety and efficacy. Accordingly, specifically tailored needles are being used for different applications and are in practice since the 1920s.
Fully developed hypodermal needles in combination with a disposable syringe came to be used during the 1950s. Scalpels and lancets are other tools routinely used in medical interventions, and commonly termed as “sharps”.
When and why needle reuse happens?
The reuse of needles and syringes is a global problem, though it is more prevalent among the developing countries, as most of these countries are facing acute shortage of medical devices and other resources.
This provokes the patients as well as the medical professionals to reuse disposable medical devices including needles. Treatment of chronic patients like diabetics or cancer patients, administration of multi-dose drugs and mass immunization projects are the common medical interventions where needle reuse is more common.
According to a WHO report, more than 40% of the total 16 billion annual injections in the developing world are administered through reused needles. The reused needles account for one-third of all Hepatitis B, 40% of Hepatitis C infections and 5% of all new HIV infections worldwide.
The most affected parts of the world include Africa, Eastern Mediterranean Europe, and Southeast Asia. However, the problem is quite widespread in the U.S. and other developed countries as well.
But most of the incidents remain unreported and the trend is progressive. Reuse and sharing of needles are very common among abusers of intravenous drugs, which contribute towards a major share of the total transmission of deadly blood-borne epidemics like AIDS, Hepatitis B, Hepatitis C, Tetanus, Cellutitis, Thrombophlebitis, Necrotising Fasciitis, etc. throughout the world.
What are the risks of needle reuse?
Blood-borne viral pathogens are a major concern for risk in cases of needle reuse, as they get transmitted to new individuals through contaminated needles and sharps. Such pathogens also thrive in other body fluids like vaginal secretions, semen, saliva, and discharge from the wounds.
Sometimes the viruses may also live in sterile body fluids such as pleural, pericardial, amniotic, peritoneal, synovial and cerebrospinal fluids. The individuals who carry these viruses may act as silent transmitters of the pathogens, but without showing disease symptoms by themselves.
Therefore, blood and body fluids being treated could be potentially infectious. The history of the origin and spread of HIV probably can be considered as the strongest evidence of disease transmission through used needles.
Hepatitis is another disease which more often gets transmitted among intravenous drug users by sharing needles and unsafe injection. More than 80% of the Hepatitis C infections are getting mediated by the use of shared needles among drug abusers.
It is presumed that more than 4.5 million people in the US are infected with hepatitis C at present and there are more than 200 million infected individuals around the world. This has raised Hepatitis C to the level of one of the most challenging public health epidemics of the present times.
Few consequences/case studies
According to WHO statistics, around 1.3 million people die every year because of the reuse of needles/syringes. Several cases of fatal infections like hepatitis, MRSA from the US have been reported as consequences of needle reuse since 2001.
In Mongolia maximum cases of Hepatitis transmission was reported during the 1970s and 1980s, prior to the introduction of disposable injection apparatus in the country.
Unsafe injection practices and reuse of needles and syringes have been attributed as the major cause for the spread of the diseases. But the situation is not very safe even now in Mongolia, as hundreds of new cases of Hepatitis B and C are getting registered every year. The patients undergoing surgeries and those receive blood products through transfusion are at high risk of infection.
Some success stories
A British entrepreneur, Marc Koska’s campaign against used needles, led to the revolution in Tanzania by the Govt. opting for the exclusive use of auto-disable (self- destructive) syringes/needles for all injections in the country as a major step towards the prevention of the transmission and spread of HIV infection.
How to ensure safe-injection?
Injections are part and parcel of the modern healthcare services and act as a life-saving medical intervention at a global level.
They saved millions of lives in the past and continue to do the same in the future as well. However, the risk of exposure to blood-borne pathogens continues to haunt this process, particularly because of the reuse of needles and syringes.
Despite the relentless efforts of WHO and Public Health Departments of many countries for ending the needle reuse, this continues to be a major cause of infection in the U.S. and other parts of the world.
Uncompromising policies prohibiting the reuse of needles and syringes, as well as the implementation of auto-disabling syringes at an affordable rate, surplus quantities, and with easy access to all regions of the world would probably facilitate avoidance of needle reuse.
Educating the public, and the medical and paramedical professionals regarding safe use and disposal of the disposable injection devices would help in achieving the goal.
An agile and efficient system of waste management accompanied by zero tolerance regulatory policies towards reuse of injecting devices indeed would play a critical role in implementing ‘safe-injection’ practices.
The Indian healthcare sector has undergone a paradigm shift from a status of basic service to an industry over the last couple of decades. The healthcare industry is witnessing a tremendous growth and is projected to touch $280 billion worth by 2020, with a compound annual growth rate of 17%.
Medical consumables represent a major segment of the healthcare industry and present a steady growth. According to 2015 reports the market segment for medical consumables in India have been valued at of $3.5 billion and a projected growth up to 4.8 billion by 2019.
The innovation ecosystem of Indian medical technology is evolving and turned vibrant since few years. Academic research, venture funding, policy support and entrepreneurship promotion schemes from the Government have created a conducive environment for the development and promotion of innovative products and services.
The private sector has emerged as a dominant player in the healthcare sector in India accounting for 72% of the healthcare expenditure countrywide. Setting up of super specialty hospitals, the introduction of telemedicine service, the establishment of state-of-the-art hospitals and diagnostic facilities in Tier 2 and Tier 3 cities, mostly by the private players are some of the visible progressive trends observed during the recent years in Indian healthcare scenario.
The inception of production facilities by MNCs and entrepreneurial initiatives by domestic technocrats for the development and production of medical devices and consumables have brought down the cost of many consumable items for healthcare, facilitating the affordability of the massive consumer segment, the Indian middle class.
What are Medical consumables?
Medical consumables comprise heterogeneous objects and materials. Needles, syringes, sutures, staples, tubing, packaging, catheters, gowns, surgical gloves, masks, adhesives and sealants for wound dressing and a variety of other devices and tools used in a hospital or surgical environment and sanitary and hygiene products used for patient care all make the list of medical consumables.
When compared to earlier days, the categories and types of consumables in use at home and hospital healthcare are much higher. Many of the conventional consumables have transformed to upgraded versions with value addition in terms of quality, durability, user-friendly status, safety or other attributes.
Disposable syringes, absorbable sutures, disposable gloves, many surgical items, etc. are some of the examples of such consumable items.
Changing Mind-Set of the Indian Society Towards Healthcare
Limited public awareness on diseases, disorders and healthcare options, affordability and accessibility of health care services were the limiting factors in seeking better options for healthcare by the Indian population until the 1980s. The scenario witnessed a rapid transformation and evolved to a more demanding mentality among the people.
The increased literacy rate, higher levels of income and enhancement of awareness of the public through penetration of mass media into every corner, and availability of affordable consumables have brought a paradigm shift in the mind-set of the patient in seeking healthcare services. Still, other factors influencing the choice of better options for health care by the people include the policy level incentives and encouragement from the Government to upgrade and expand healthcare innovation and service industries.
The competition among the health care providers, addition of innovative products, and provision for subsidized/ free healthcare options extended by the Government during the recent years further complement to the demand for better healthcare services by the common man in India.
The disintegration of joint family culture and transformation to nuclear family is another critical factor boosting the medical consumables, as caring for the elderly population is either outsourced or made more sophisticated with modern devices or materials for self-care. Regular health check-ups for the adults, preventive medicines for the children and use of fitness products also add to the healthcare budget of every family.
Currently, the expectation of the Indian society towards healthcare service standards has shifted from basic to more fine-tuned and patient-friendly options. This boosts the impact of service standards of hospitals and other healthcare establishments and creates more demands for medical consumables. The rising population and the demographic shift towards the elderly population play a key role in enhancing the demand for healthcare services and consumables.
Rising incidents of diseases, increase of causalities, growing numbers of chronic patients like diabetics, cancer patients, etc. result in increased impact on the demand for medical consumables. The changing lifestyle of the people also influences the demand for healthcare and medical consumables by increasing trends of lifestyle-related diseases.
Healthcare insurance plays a critical role in addressing the healthcare affordability factor across the society. The recent introduction of health cards for senior citizens, disabled and weaker sections of the society have created considerable opportunities for the medical consumables. The telemedicine, quality enhancement of healthcare infrastructure and increasing number of new drugs and nutraceuticals further enhance the demand for medical consumables.
The Indian medical device industry is on an upward trend and is strongly backed by the robust legal framework available here. The recognition of medical device industry as a focus industry under “Make in India” initiative, of the Govt. of India and the introduction of the Medical device Rules 2017 have boosted the industrial environment for this sector.
The National Health Policy, approved by the Indian Govt. during this year assures healthcare as an essential service and makes provision for inclusive healthcare of all the sectors of the society. This initiative would definitely increase the demand for healthcare services and consumables to a great extent.
The support from the Govt., availability and accessibility to high-end healthcare services and consumables, increased standards of living, medical insurance facility, shifting family structure, the need for caring for the growing elderly population, rising number of diseases and population growth together play a synergistic role in enhancing the demand for medical consumables in India. Ultimately, the changing mind-set of Indian middle class acts as a driving force for flourishing the health care service and allied industries.