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Needle removers are devices that physically remove aneedle from a syringe. In de veloping countries, there is still a needfor improvements in needle safety in hospital settings. Thesecountries cannot afford needles with individual safet y devicesattached, so needle-removers must be used to remove the needlefrom the syringe. This lowers possible pathogen spread bypreventing the reuse of the syringes , reducing incidents ofaccidental needle-sticks, and facilitating syringe disposal. Background In developing countries, most hospitals are lacking in needle [Link] regions surveyed by the Wor ld Health Organization (WHO), thereported number of needle-stick injuries in developing worldcountries ranged from .93 to 4.68 injuries per person and per year,which is five times higher than in industrialized nations (Departmentof Esse ntial Health Technology, 2004). Needle-stick injuries arefurther complicated by disea se transmission, such as Hepatitis B and HIV. In Ghana, a study of 803 schoolchildren revealed that61.2% had at least one marker of hepatitis B virus (Sagoe-Moses etal., 2001). As a result, health care w orkers (HCWs), patients, andthe community in developing nations are at an increase d risk ofcontracting blood-borne pathogens via the reuse and improperdisposal of needles, and accidental needlesticks (Harner, 2004). Before needle safety regulations, HCWs were on their own to avoidaccidental needlesticks and safely disposal of needles. However, inthe U.S., after the Needlestick Safet y Act signed in 2000 and the2001 Bloodborne Pathogens Standard, the burden was n o longer onHCWs. Both of these regulations mandated the use of safetydevices and n eedle-removers with any sharps or needles (Jagger,2003, 27-28). As a result, there was a large increase in research,development, and marketing of needle safety device s and needle-remover. In most hospital and medical settings in the U.S., needlesafet y regulations are maintained through individual needle safetydevices and needle disp osal boxes. Existing solutions One of the most common causes of needle-stick injuries, which theNeedlestick Act an d Bloodborne Pathogens Standard wereattempting to decrease, was two-handed reca pping (Wilburn,2004). As a result, a one-handed capping mechanism was added t oinsulin and tuberculin syringes. The cap is attached to the syringevia a hinge, which allows the cap to be snapped onto the needleusing one hand. The disadvantage to th e hinge system is that thecap can get caught by jewelry and clothing, can get bumpe d whenused, and the fixed position can be a hindrance during low angleinjection. So Becton Dickinson (BD) has recently come out with avariation on this safety: instead of a hin ge, the device slides overthe needle and fully covers the tip of the needle, so acciden talneedle-sticks do not occur (Becton, Dickinson, and Company, 2004,BD SafetyGlide ). However, the rest of the world does not have similar needle andsyringe regulations. For instance, the WHO is only able to regulatevaccinations in developing countries by ensuring that all vaccinationsyringes sent to these countries have autodisable feature s, sincethe major concern is the reuse of contaminated needles andsyringes. These a utodisable features allow the syringes to only beused once, so they cannot be reused

. These mechanisms could beteeth that interlock to prevent the plunger from being p ulled backfor another use or a bag prefilled with the vaccine to stop [Link] examp le, the SoloShot has a metal clip that locks the plungerdown after one use (Internatio nal Council of Nurses, 2005). The BDUniject is a prefilled vaccine syringe that uses a plastic bulb insteadof a plunger and has a disc valve to prevent reuse (Becton,Dickins on, and Company, 2005). Still, over 90% of syringes worldwide do not have autodisablefeatures (Harner, 2004 ). Individual protection devices areexpensive, and regular needles are much more pr [Link], many developing world countries use needle-removers to redu ce the risk of disease transmission via theseexposed. Benefits of needle-removers Needle-removers minimize the occurrence of accidental needle-sticks because they al low immediate removal and containment ofthe needles, especially if the device is nea r the area of use. Reuseof syringes is prevented because the needle-remover physica llyseparates the needle from the syringe, making the syringe [Link] also impro ve waste disposal by decreasing both the amount ofinfectious waste and the amount of safety boxes needed for thewaste, since safety boxes can pack syringes 20-60% morecompactly without the needles (Harner, 2004). Additionally, thesedevices are co st-efficient since one device can handle severalhundred needles. Many developing wo rld countries do not have theresources to afford auto-disable syringes, so with needle -removers,the hospitals can continue to use cheap syringes, while only payinga onetime fee to buy a needle-remover that has a life-span ofabout 200-500 needles (Har ner, 2004). Social and ethical implications A significant ethical issue for the project is whether or not theneedle-remover will ca use more harm than its potential [Link] are obliged to use their skills an d knowledge to improvethe safety, health, and welfare of the public (Biomedical Engi neeringSociety, 2004). The main concern is for the operator of the device;no enginee r should create a device that could injure the [Link] concern is that childre n may gain access to the device andaccidentally hurt themselves. If a device design could potentiallycause either of these problems, the team would be ethicallyobligated to reexamine that design, and it would either have to beimproved or abandoned. When the device functions effectively andsafely, it will serve to protect the welfare of the community. Indeveloping countries, the risk of disease transmission is elevatedd ue to the high percentage of needle-stick injuries, which is a resultof inadequate nee dle collection devices (Department of EssentialHealth Technology, 2004). Increased p athogen transmission alsooccurs from the reuse of contaminated needles when suppl ies arelow (Sagoe-Moses et al., 2001). The device will prevent reuse ofneedles and f acilitate needle collection and disposal, and thus willimprove the health and safety of hospital workers and thecommunity. The social and economic effects of the device also need to berecognized. In developi ng countries, the lack of proper needlecollection devices leads to an increase in the n umber ofoccupational needle-sticks by HCWs via contaminated [Link] needle-sticks account for 40%-65% of Hepatitis B andC infections in HCWs (Prssstn, Rapiti, and Hutin, 2003). As aresult, more HCWs have to undergo postexposu re testing andtreatment, both of which cost money for the hospitals and thecountries . There is also the manpower cost associated with losingtrained HCWs to infections a cquired on the job. With fewer than 10doctors for every 100,000 individuals in sub-

Saharan nations, anyloss of hospital staff puts a strain of hospital resources. In additi on,developing countries have made significant investments in trainingtheir HCWs, wh ich is lost when occupational needle-sticks causeHCWs to leave the medical field (Sa goe-Moses et al., 2001). The economic considerations are not just limited to costsassociated with HCWs. Due to the high cost of needle-disposalcontainers and the fact that the containers usually have to beshipped overseas, unsafe and dangerous substitutes are usedinstead. This practice can potentially lead to needle-sticks by HCWsand individuals in the communi ty, as well as needle reuse bymembers of the community, which can increase the pot ential spreadof diseases. Possible designs The easiest needle-removers to operate are electrically powered,and either melt the needle or cut the needles at multiple [Link] patented design involves a syringe falling down into a chamberwhere powered moveable blades advance the syringe ont o fixedblades on the opposite side, at which point the syringe is cut with ashearing m otion at multiple points (Garvis and Beer, 1974). Thereare other patents that use ele ctricity between electrodes orbetween rotating gears to short-circuit the needle and melt it offthe syringe (Ching-Lung, 1986; Hashimoto, 1990). A more complexdesign involves a hammer mill and grinder to break up and grind upthe plastic and metal parts of the syringes, after which, the piecesare heated and cooled. The end result is metal particlesencaps ulated in a piece of plastic (Wallace et al., 1991). However, electricity in developing countries is not a dependablesource, so handpowered needle-cutters would be preferred. Somedesigns use the squeezing force fro m a hand to force one or twoblades to shear across each other and hence cut the ne edlebetween the blades (Choksi et al., 1981; Harner, 2004). There areother designs i n which a twisting motion brings a shearing blade incontact with the needle and thus cuts it (W. Thead, D. Thead, andEvans, 2000). Another design has a stationary outer surface thatthe syringe body rests against and a cylindrical inner cutting bodywith a bore for the needle to pass through. A lever rotates theinner body, which shears the needle from the syringe and dumpsthe needle into a container (Johan and Morner, 1 972). Acrank system can be used to power a similar design, which alsouses a cylindri cal inner body. However instead of cutting theneedle, the device pulls the needle co mpletely out of the syringe,which deforms the needle, and dumps it into a container (Samuel,2004). A more complicated design actually pulls the needle andcollar from t he barrel of the syringe without a rotational motion: thedownward motion of putting the syringe into the device powers twoarms to pull the needle off the syringe. The int eresting aspect ofthis device is that it appears to be one-handed (Atsumi, 1996).Anot her one-handed device uses a downward motion to causerotating gears to unscrew t he needle and collar from the syringe(Thead and Evans, 1991). This design is very co mplex to implement,so an improvement of this design involves pegs that grip and rot atethe needle collar instead of gears. The downward force istransferred into moving t he pegs in helical slots, which causes thecollar to rotate and the needle to be remove d from the syringe(Han, 1994).

In 2006 a cheap and simple solution utilizing old cola or beer cans todispose needles and specially developed lid to safely seal them hasbeen developed. One click and the can is permanently sealed by thesafely seal. The snap-lock seals the two parts toget her withoutusing glue or tools. The collar of the cap is protecting the userduring the needle separation process. The insertion hole is designedto separate needle and syri nge at the point of use. No finger canpass through the opening. Each can securely co ntains 150-200used needles (Business Ideas Forum, 2007). Commercial models There are several electrically powered needle-removers on themarket now. One mod el from Techno Fab uses a regular electricalshort-circuit to melt the needle, while ano ther needle-remover,seen at [Link], uses a plasma arc to melt the needl e.A unique needle-remover design is the Needle Remover Device,designed by the Pro gram for Appropriate Technology in Health(PATH). It uses two handles that are sque ezed together to slidetwo circular blades across each other, which cuts the hub from thesyringe. It is also reusable, and its target cost is about $15 (Harner,2004). Anoth er needle-removers currently on the market isAdvanced Care Productss Clip&Stor, w hich uses a hand-poweredclipper action to remove the needle (Advanced Care Produc ts,2005). The cost of the Clip&Stor is about seven dollars. There isalso the BD Hub C utter, which uses a squeezing hand motion to cutthe syringe. The edges of the squee zable parts have blades that dothe actual cutting. However, unlike a regular needleremover, theBD Hub Cutter cuts the syringe at the hub so the needle iscompletely se parated from the syringe. As a result, the risk of acontaminated puncture is complete ly eliminated because no needleshards remain on the syringe. The Hub Cutter is not reusablethough, and disposal of the whole unit must occur (Becton,Dickinson, and Co mpany, 2004). The cost of the Hub Cutter isabout four dollars (Department of Essent ial Health Technology,2004). Limitations Most of these current needle-removers require the use of twohands; one to hold the needle in place and the other to activatethe mechanism. This form of operation can c ause problems becauseif hospital personnel are busy, especially in a developing worl dcountry, they may not have the time or hands needed to operatethe device. As a re sult, the needle will remain exposed on thesyringe, posing a risk to both HCWs and p atients. Furthermore, many of these existing needle-removers do not makeuse of cheap and readily available materials, like used motor oil jugs,for containers, which raises the p rice of the device and requiresthat the hospital continuously buys more containers fr om thecompany. A typical 3-gallon Bemis sharps container with a rotatinglid costs about $8 without including shipping costs (GRP &As sociates, 2005). If these containers must be shipped overseas,the price of the device can far exceed the available resources ofmany hospitals in developing countries, whic h causes them not tobuy needle-removers. References 1. Advanced Care Products, Ltd. (2005). Clip&Stor Pen Needleand Syringe Ne edle Cutter. Retrieved October 5 2005. 2. Atsumi, H. (1996, December 31). Patent #5588966: Device forRemoving a needle from a Syringe. Retrieved October 24 2005.

3. Becton, Dickinson, and Company. (2004). BD Hub [Link] October

23 2005. 4. Becton, Dickinson, and Company. (2004). BD SafetyGlideSyringe for Insulin, TB, and Allergy: Quick Reference [Link] October 23 2005. 5. Becton, Dickinson, and Company. (2005). BD Uniject: PrefillInjection Device. Retrieved October 23 2005. <[Link] 6. Biomedical Engineering Society. (2004). Code of Ethics. 7. Business Ideas Forum. (2006). Antivirus a cap to protectagainst needle infe ctions. 8. [Link]. (2005). Disintegrator plus Insulin NeedleDestruction. Ret rieved October 25 2005. 9. Ching-Lung, H. (1986, December 9). Patent #4628169: MiniElectrical Syringe Needle Destroyer. Retrieved Octobe r 172005. 10. Choksi, P. et al. (1981, March 17). Patent #4255996: NeedleDestroyer with Improved Mechanical Advantage. RetrievedOctober 18 2005. 11. Department of Essential Health Technology. (2004). ProposedAgenda to Evaluate the Risks and Benefits Associated withUsing Needle-Removing Devic es. Retrieved October 22 2005. 12. Garvis, M. and Beer, M. (1974, April 2). Patent #3800644:Destruction and Disposal Device for Hypodermic Syringes andthe Like. Retrieved October 17 2005. 13. GRP & Associates, Inc. (2005). Medical Waste DisposalSupplies. Retrie ved 12-7-05. 14. Han, S. (1994, May 17). Patent #5312346: Needle RemovingDevice. Retrieved October 13 2005. 15. Harner, C. (2004, October). Needle Remover Device DesignTransfer P ackage. Retrieved September 7 2005. 16. Hashimoto, T. (1990, October 9). Patent #4961541:Apparatus for Disposing of a Used Hypodermic [Link] rieved October 17 2005. 17. International Council of Nurses. (2005). Nursing Matters factsheet. Fi rst Do No Harm: Auto-Disable Syringes forImmunization Safety. Retrieved Octo ber 22 2005. <[Link] 18. Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003).Chapter 31: Occupational Exposure to Bloodborne Pathogens:Epidemiology and Preventi on. Prevention and Control ofNosocomial Infections (4th Ed). Lippincott, William s, andWilkins. 19. Johan, B. and Morner, S. (1972, August 15). Patent#3683733: Apparatus for Destroying Hypodermic Needles,Needle-

Equipped Ampules, Hypodermic Syringes, and the [Link] October 13 2005. 20. Prss-stn A., Rapiti E., Hutin Y. (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers Geneva, World Health Organization (WHOEnvironmental Burden of Dise ase Series, No. 3). 21. Samuel, P. R. (2004, September 21). Patent #6792662:Needle Puller for Destroying Hypodermic Needles. Retriev edOctober 25 2005. 22. Techno Fab. (2005). Needle Destroyer. Retrieved October 222005. 23. Thead, W. and Evans, J. (1991, January 22). Patent#4986811: Apparatus and Method for Safely Removing Needlesfrom Syringes. Retrieved October 13 2005. 24. Thead, W., Thead, D., and Evans, J. (2000, December 12).Patent #6158314: Method and Apparatus for Disabling andDisposing of a Si ngle-Use Hypodermic Syringe. RetrievedOctober 23 2005. 25. Sagoe-Moses, C., et al. (2001, August 16). Sounding Board: Risks to Health Care Workers in Developing Countries N Eng JMed 345 (7): 538-541. 26. Wallace, A. et al. (1991, September 10). Patent #5046669:Syringe Disposal Apparatus and Method. 27. Wilburn, S. (2004). Preventing Needlestick Injuries among Health Care Workers: A WHO-ICN Collaboration Int J OccupEnviron Health 10:451-456.