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This is common practice in much of developed world. Long ago, they used to have re-usable glass syringes that could be sterilized. Unfortunately, people switche
by satya71 5mo ago
This is common practice in much of developed world. Long ago, they used to have re-usable glass syringes that could be sterilized. Unfortunately, people switched to disposable syringes. The unit costs are...high in the US, unreasonable in developing countries.
It's not just this hospital, it's widespread ([1] report 38%)
[1] https://www.emro.who.int/emhj-volume-26-2020/volume-26-issue-3/reuse-of-syringes-for-therapeutic-injections-in-pakistan-rethinking-determinants.html https://www.emro.who.int/emhj-volume-26-2020/volume-26-issue...
- _bypa 5mo agoDo you know why they couldn't switch back to glass syringes?
- faangguyindia 5mo agoIf you forget to autoclave them or not done properly you end up with infected patients, risk is just too much
- NDlurker 5mo agoPrions aren't destroyed by autoclave
- Loughla 5mo agoNo but viruses and bacteria are. What's your point and how common is transmitting prions?
- NDlurker 5mo agoMy point is disposable is superior
- Marsymars 5mo agoThey can "survive" autoclave cycles that render other pathogens dead/inactive, but there do exist autoclave cycles that seem to pretty reliably inactivate prions.
- seb1204 5mo agoSounds like the same risk as this situation of reusing them.
- kube-system 5mo agoWell if you’re going to infect people, might as well save money while doing so :)
- jjk166 5mo agoWe sterilize plenty of other common tools like scalpels so that doesn't seem like a valid reason. Obviously the disposable design is not even an adequate solution to the risk of cross contamination. I would imagine if it were a real concern you could easily add something like a color changing strip that would indicate whether the needle has been autoclaved since its last use without rendering it useless.
- ButlerianJihad 5mo agoEquipment that can be sterilized has been forced out of the market by these disposable things. It is far easier to push disposable product on medical providers and encourage rent-seeking and subscriptions to such things. It’s exactly the same way with contact lenses. When I was in college in the ’90s, I could get a pair of permanent contact lenses. They would cost a few hundred bucks, but they would last me several years if the prescription didn’t change. They were the same as glasses. You would clean them everyday and disinfect them, and they would serve quite well permanently. But the contact lens industry decided that wasn’t good enough, and decided that they could sell subscription services for contact lenses that you would need to discard every night. And those daily wear contact lenses, the disposable kind, basically forced out of the market the permanent ones and now the optometrist regards me as a Martian when I request permanent lenses instead.
- cromka 5mo agoYou completely ignored human error aspect. Before the blood donation centers used one time use equipment, donors were getting infected with something nasty every now and then. You can sure as hell expect people to commonly forget to properly sanitize those syringes.
- M95D 5mo agoSterilization is* the most strictly controlled process in any hospital. Nobody can just "forget" to sterilize or pick up a used syringe thinking it's sterile. * Or at least it should be. It seems that Pakistan is different.
- cromka 5mo ago> Sterilization is* the most strictly controlled process in any hospital. As aviation has shown—where human error has been studied for decades—reducing mistakes is difficult and expensive because it requires multiple layers of quality assurance. In countries where labor is costly, especially in healthcare, it has got to actually be cheaper to use single-use equipment, with the added benefit of reducing the risk of infection through that route to zero.
- kqgnkqgn 5mo agoIf you can't trust them to follow the very easy directions of "throw away the single use syringe", how likely is it that they are going to follow the much more complicated process of properly sanitizing the glass syringe?
- nameconflicts 5mo ago1. They're talking about the current situation, but you're bringing up history. 2. Given the lessons from the past, why would you still want to do something this dangerous?
- SanjayMehta 5mo agoFrom the WHO article linked to by GP, the issue is that patients also insist on injections over oral meds. That's driving the insistence on injections, and rural doctors/clinics cutting corners.
- seb1204 5mo agoCost, or availability due to cost. Still a driver in developing countries.
- SanjayMehta 5mo agoA quick search found a pack of 100 disposable syringes in Pakistan for PKR 1100/- which is less than USD 4. That's 4 cents per syringe. Seems quite reasonable to me. Seems they don't have economics as an excuse. https://ailaaj.pk/products/apple-disposable-syringe-5ml-100s https://ailaaj.pk/products/apple-disposable-syringe-5ml-100s
- CGMthrowaway 5mo agoA month's wage in Pakistan is about $125. So each syringe would feel like a cup of Dunkin does to many in the USA
- bastawhiz 5mo agoI have orders of magnitude more cups of Dunkin each year than I get injections at a doctor
- garbawarb 5mo agoBut Pakistanis don't.
- bastawhiz 5mo agoThe point is that if the analogy of a $0.04 syringe is supposed to be as expensive as a cup of coffee, it's still not expensive even if you do it often. Maybe they have too many injections. Either way we have a bunch of kids with a disease that can kill because someone thought something as expensive as a cup of coffee was too expensive.
- crazygringo 5mo agoWhich would be entirely reasonable cost as part of a healthcare visit. When people complain about healthcare costs, they're not complaining about things that cost the same as a cup of coffee locally.
- wildzzz 5mo ago
- Marsymars 5mo agoThat article also makes it seem like patients in Pakistan are receiving what seems to me like a wildly high number of injections: > An injection was provided during 53% of patient visits in Rawalpindi and 92% in Tando Allah Yar > Patients from Tando Allah Yar reported a mean 3.8 visits to a healthcare provider by a member of their household during the previous month, compared to 2.5 by those from Rawalpindi (Table 2). During all such visits, an injection was given. Overall, 56% patients felt that an injection was necessary. Such perceptions were higher in Tando Allah Yar than in Rawalpindi (79% vs. 39%) (Table 2). Providers reciprocated such perceptions in that 44–56% of providers felt that an injection was required for common ailments such as fever, influenza, body aches or diarrhoea. > Patients expect to receive injections for minor ailments such as fever or influenza-like symptoms and willingly pay for these, on the mistaken belief in the efficacy of injections to overcome common symptoms that eventually abate with time (10). Healthcare providers comply with such wishes and are convinced of the necessity of injections. > We have previously demonstrated that the total national supply of syringes in Pakistan is sufficient to meet the demand for the ~1.1 billion syringes used annually for immunization, diabetes, laboratory testing and drug administration in clinics or hospitals On the last point, I did a bit of a search to look for the total number of syringes used worldwide. I'm actually questioning whether that number is using similar methodology to arrive at the ~1.1 billion number, since I'm seeing numbers around 15 billion for the annual number of injections - meaning that Pakistan would be using over double the average per-capita number of syringes (and re-using many of them) while simultaneously having a population that's much younger (23 vs 31 median age) and poorer ($7k vs $26k median PPP/capita) than average. If those numbers check out, the simple solution would just be to stop giving unnecessary injections, money would be saved, and there'd be no need to reuse syringes.
- ceejayoz 5mo agoA similar thing happens in the US; people demand antibiotics for a cold. It’s easier to say yes than to explain the reason it won’t work.
- deleted 5mo ago[deleted]
- loeg 5mo ago> This is common practice in much of developed world. Do you mean "developing?" This is not common practice in rich Western countries. Additionally, as sibling has already pointed out, sterile disposable syringes are extremely cheap.
- Ferret7446 5mo agoThe reason we switched is because it's cheaper (including the logistics overhead costs). Sterilization and transport isn't free
- SoftTalker 5mo agoIt's also not perfect. Sure you can throw instruments into an autoclave or even boiling water but they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areas.
- M95D 5mo ago> they have to be kept sterile after they come out, which is probably harder to do especially in underdeveloped, resource-poor areas It's actually very easy. Sterilization takes place in a stainless steel container that has "windows" on it's sides. When the sterilization cycle ends, these "windows" are closed just as the container is taken out of the autoclave. The container will remain sterile inside until opened. Also, simply opening the container to take one syringe from it doesn't make it dangerously contaminated. As demonstrated by the article, the biggest danger comes from other people's blood (HIV, HCV, HBV), not ordinary bacteria we have on our skin.
- themafia 5mo ago> The unit costs are...high in the US So many products are bundled into purchase agreements at hospitals that you can't, in general, sensibly talk about per-unit costs.
- heffert 5mo ago[flagged]
- imtringued 5mo agoThe unit costs per syringe are incredibly low even by Pakistani cost of living standards and the cost of reusing a syringe is extremely high. You're coming up with an extremely complicated solution that would be a complete non-issue if the yearly salary of Pakistani citizens rose by even a single dollar.