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View Full Version : Does your country require safety syringes be used?



beskeptical
2005-Nov-26, 07:49 PM
This reply on the China bird flu thread made me curious about other countries' needle stick safety laws.
Oh, it may interest you to know that recently there's been some pressure up here for the provincial government to make safety needles mandatory in all cases. I'm all for it.The USA requires they be used when reasonable designs are available. The law is written under the worker safety section of the code. That means my practice where I have no employees is not affected. Neither is home use of needles such as would be used by diabetics.

TSC told us what Canada is doing.

So does anyone else want to weigh in on their country?
I'm just curious.

The Supreme Canuck
2005-Nov-26, 08:45 PM
Right now they're mandatory in Manitoba and Saskatchewan. Other provinces are fighting nurses unions, who want them implemented. Like I said, I'm all for them.

Halcyon Dayz
2005-Nov-26, 09:29 PM
What makes safety syringes different from standard ones,
I mean, how do they work?

The Supreme Canuck
2005-Nov-26, 09:37 PM
I think that a safety syringe allows the needle to be retracted when you don't need it to stick the patient.

LurchGS
2005-Nov-26, 11:53 PM
The big drawback to saftey syringes is expense - they cost like 3-4 times what yer average syringe costs, so it becomes *very* unlikely that hospitals and private ambulance services will use them on a regular basis.

Personally, I'd LOVE to see them in use - not a day goes by where I don't worry about my wife getting jabbed by a 'sharp' that got left lying around in the back of the ambulance.
I worried about it in New Orleans this past September, too - only with respect to ME - and I'm not in EMS. There were just all kinds of unhappy possibilities down there.

The Supreme Canuck
2005-Nov-27, 06:30 AM
Well, laws can be passed making them mandatory even if they cost more.

LurchGS
2005-Nov-27, 06:34 AM
Well, laws can be passed making them mandatory even if they cost more.

sure - and the company will likely go out of business. The margins - particularly in the private ambulance industry are *very* narrow. There's a reason the average pay for a paramedic is $10/hour.

The Supreme Canuck
2005-Nov-27, 07:30 AM
So one company will go out of business (one company has to be the first). Supply will drop and demand will remain constant. Prices can then be reasonably raised, negating the issue.

Or, if all companies are forced to pay more for syringes, all will raise prices. It's not like there's any other game in town. The hospital has to go to someone to provide ambulance services, and if all raise their prices to accomodate the new law, the hospital just has to shell out a bit more.

In either case, the economics of the situation even out any difficulties.

beskeptical
2005-Nov-27, 08:54 PM
First, how do they work? They use engineering controls to protect you from human error.

The NAPPSI, (National Alliance for the Primary Prevention of Sharps Injuries), Primary and Secondary Prevention Needlestick Safety Device List
&
Notification to Clinicians on Sharps Injury Protection (http://www.nappsi.org/safety.shtml)

You could be more careful on a girder 10 stories up on a construction project, or you could also use a safety harness. You could be more careful and keep your fingers out of a power saw blade, or they could put a guard on the blade to keep your fingers out for you.

In other industries, no one balks at basic worker safety costs such as these.

As to cost, that's ridiculous. First, you're talking about a 10 cent syringe costing 50 cents to deliver a $50.00 medication dose. And as soon as large quantities of those safety syringes are being used the cost comes way down to maybe 20 cents.

And just how much do you think the health care industry pays for the 1,000 cases of hepatitis B a year that are still occurring in the USA alone despite a massive vaccine campaign, the 200 deaths a year from hepatitis B that are the delayed result of the years with no vaccine, the couple hundred cases of hepatitis C and HIV that have occurred over the last twenty or so years and more directly, the thousands and thousands of dollars for medical care spent every year in the USA for every one of those needle sticks that don't lead to an infection.

Sorry, it's a no brainer.

LurchGS
2005-Nov-28, 06:17 AM
So one company will go out of business (one company has to be the first). Supply will drop and demand will remain constant. Prices can then be reasonably raised, negating the issue.

Or, if all companies are forced to pay more for syringes, all will raise prices. It's not like there's any other game in town. The hospital has to go to someone to provide ambulance services, and if all raise their prices to accomodate the new law, the hospital just has to shell out a bit more.

In either case, the economics of the situation even out any difficulties.

The Hospital doesn't pay for the ambulance - the patient does, via insurance or medicare/medicaid. None of them like to pay squat - it's what happens when accountants are allowed to make medical judgement calls (My wife transported a 'core zero' (essentially dead) a couple years ago. The patient eventually recovered. Medicaid (or medicare, I forget which) denied the claim from the ambulance company, stating that emergency transportation was not required.

That's just one example.

Ambulance services are starting up and going out of business all the time - if safety syringes are mandated by law, with no corresponding compensation to the ambulance companies, the cycle will increase in speed.

There are municpal ambulance services - paid for by tax dollars. Their budgets are just about as thin as those of the private agencies, so this would affect them as well.

beskeptical
2005-Nov-28, 09:40 AM
.....

Ambulance services are starting up and going out of business all the time - if safety syringes are mandated by law, with no corresponding compensation to the ambulance companies, the cycle will increase in speed.

There are municpal ambulance services - paid for by tax dollars. Their budgets are just about as thin as those of the private agencies, so this would affect them as well.Did you not read my post? No one is going to go out of business buying safety syringes. That's just silly.

Argos
2005-Nov-28, 02:45 PM
Brazilians have developed (http://www.hospitalar.com/noticias/not2406.html) a cheaper safety syringe (US$ 0,25), more suitable for emerging markets. The unions are pressing for its adoption by law. I think they will be made mandatory in 2006.

ASEI
2005-Nov-28, 03:17 PM
Why spend all that money on something that's going to be thrown away when used? Why not just keep a plastic lid over it before and after use?

The Supreme Canuck
2005-Nov-28, 06:33 PM
The Hospital doesn't pay for the ambulance - the patient does, via insurance or medicare/medicaid.

Huh. Sorry, not all that well versed in how these things work. Either way, beskeptical makes a good point that the things are bloody cheap. really no need to worry.

ASEI: When you put the cap back on, your're holding it between your fingers. What happens if you slip? And what happens if the patient flinches when you stick 'em, and you get a hand full of needle?

LurchGS
2005-Nov-28, 07:02 PM
I just looked up - in the first catalog I came to - and found them at about 20 cents US - that's four times as expensive as a standard hypo needle (also found at that same site)

The price has come down (last I looked, about a year ago) they were well over a dollar a pop. Now, it probably wouldn't put the company out of business, but the company WOULD feel the difference.

You don't go into EMS to get rich, even if you own the company

The Supreme Canuck
2005-Nov-28, 08:42 PM
But again: if the things are mandatory, all EMS companies take a hit. So raising prices wouldn't have negative consequences for these companies. If I want an ambulance, and all ambulance companies raise prices, I'm stuck paying the higher price, no matter what. So the consumer takes a hit, but it's such a small hit that it doesn't matter at all.

beskeptical
2005-Nov-28, 08:57 PM
Why spend all that money on something that's going to be thrown away when used? Why not just keep a plastic lid over it before and after use?Huh? I have no clue what you mean here. Needles all come with plastic covers (rubber in some cases). Even when recapping is banned needle sticks still occur.

When one provides needle safety training, you assess the success of the training by how many needle accidents you prevented. If you give the health care workers a test afterwards, you assess if you imparted any knowledge to them. When they consistently pass the tests but you see no decrease in injuries, you have a performance problem not a knowledge deficit.

Further analysis shows that despite knowing how to safely handle needles, circumstances occur frequently that prevent that knowledge from being practiced. Mostly, the worker is moving fast, has multiple things to think about, and can't control certain circumstances such as a patient unexpectedly moving. You get needle stick injuries that knowledge about needles and being more careful didn't prevent.

If we were talking about a saw blade guard or a pole climber's safety belt, would we even be having this thread? Are you all suggesting we take away the safety belt to save money on utilities? Excuse me?

beskeptical
2005-Nov-28, 09:16 PM
I just looked up - in the first catalog I came to - and found them at about 20 cents US - that's four times as expensive as a standard hypo needle (also found at that same site)

The price has come down (last I looked, about a year ago) they were well over a dollar a pop. Now, it probably wouldn't put the company out of business, but the company WOULD feel the difference.

You don't go into EMS to get rich, even if you own the companyFor heavens sakes, here it is again. You are looking at one needle and one cost. The bigger picture is lacking. Let me spell it out more clearly.

One, the overall percent of cost impact on the delivery of the medication to the patient in minuscule. Four times the cost of .001% of the total product cost is not significant.

Example: You make product A with parts B and C. B represents 99.999% of the cost of A. C represents .001% of the cost of A. The price of C goes up 400%. What does the cost of making A go up?

.001 x 4 = .004%.


Two, there are big costs paid for all needle stick injuries. I am the least expensive and I charge a little over $300 if I see both the exposed worker and the source of the blood who needs to be tested to see what the worker was exposed to. If the employee goes to the ED for the exposure, you are looking at around $2,000. Then there is the cost of the employee's time loss getting the medical care. Even if you don't pay them sick time, you have to pay their replacement when the employee is being treated.

Needle stick injuries are directly related to how many you use.

Subtract the cost of needle stick exposure medical care that you save for every needle stick prevented from the cost of the more expensive needles that were only .001% of your product (delivering a medication to the patient) and it's a wash, or you are even possibly ahead.

Add in the cost of ONE HIV, Hepatitis B, or Hepatitis C case of disease and you would have been waaaay ahead buying the safety devices.

LurchGS
2005-Nov-28, 09:29 PM
Hrm... that does make sense. I apologise for being so dense.

So, that brings us to the question we (I) should have been asking from the outset; why aren't ambulance services USING safety syringes? Are they even available in pre-load configuration? Do they come in IV configuration?

The Supreme Canuck
2005-Nov-28, 10:11 PM
Why don't people use seatbelts? Or practice safe sex? People are stupid. Or set in their ways. Or way, way, way too cheap. Or...

The list goes on.

genebujold
2005-Nov-28, 11:52 PM
Sorry, but I agree with beskeptical on this one. Flaps on an airplane are expensive, but necessary. The cost is more than compensated by the increase in long-term savings.

The only thing that will get us from point A to point B, however, is a paradigm shift in the legal system which imparts liability to those who make the decisions as to which needles to buy. Until then, companies, hospitals, etc. will continue to buy the cheaper product, focusing instead on worker/user eduction.

That's really the the way these things go, though, isn't it?

beskeptical
2005-Nov-30, 10:15 AM
Hrm... that does make sense. I apologise for being so dense.

So, that brings us to the question we (I) should have been asking from the outset; why aren't ambulance services USING safety syringes? Are they even available in pre-load configuration? Do they come in IV configuration?Yes, yes and yes, in that order.

We still need a needle to start an IV and draw blood. For those there are self sheathing needles that have safer recapping mechanisms.

IV lines don't require needles to put meds into them despite that being the most common way meds were delivered IV for years. There are special ports that blunt needles go into and most emergency drugs are available in prefilled syringes with blunt needles.

The paradigm shift genebujold mentions is exactly what finally occurred about 15 years ago. It was not only in the legal requirements, but in the mentality that telling health care workers to "be more careful" was not the same standard as was in almost all other industries. In other industries, you engineer in safer designs. To do so with needle devices was not the least bit difficult technically. The only thing stopping the change was the mentality that it was the health care workers' fault rather than an inherently unsafe design which led to needlestick injuries.