Unsafe injections cause an estimated 1.3 million premature deaths every year, a loss of 26 million man-years and an annual burden of US $ 535 million in direct medical costs. This was stated by Air Marshal (retd.) L. K. Verma at the third annual conference of Indian Society of Hospital Waste Management held recently in Pune at AFMC. He was speaking on `Injection waste disposal in India'.
Dwelling on the subject he said, “The use of injections became widespread after the second world war. Initially the syringes were used for curative medicines only. In India the used syringes are perceived as a source of income by the waste handlers. There are studies which have revealed that about 30 to 50 per cent of used syringes find their way back to the shops after washing and wrapping.” He further added that suburbs of any city have 'basties' where this activity takes place. The used syringes are culled out from the heap of medical waste by rag pickers and taken to the vendors for repacking. This has become a thriving industry. He revealed that in Delhi, it is said to be an industry worth Rs. 5 crore.
In the future too the immunization programmes are expected to contribute to the increase in the injection waste. Elucidates Verma, “With the universal immunization against Hep B in the offing, a massive increase in the quantum of injection waste is expected. As it is 4.2 billion Injections are given in India out of 12 billion injections per year worldwide. Addition of injection waste from the immunization program is going to make the disposal of the injection waste even more complex.'' As per the estimates, India is adding 16 million to its population every year. Thus 48 million injections per year will be required under the universal immunization program. This will result in fresh addition to the percentage of injection waste, which stands at only 1 per cent of total waste of health care facility.
Moreover major portion of the injection waste is said to be in the rural area, where awareness about infection control will be poor to non-existent, said Verma. “The expenditure for proper treatment of injection waste has not been calculated simply because there is no proper disposal being practiced in India. Bio-medical waste including the injection waste can be seen strewn all over in the dumping areas with municipal waste, pointed out he. And further added that this infects whole waste, thus increasing the infected waste 10 times or to 100 per cent from merely 1-2 per cent. If all PHCs were planned to have a reasonable system of waste disposal it would cost about Rs 40,000 per PHC. India has over 22,000 PHCs, and over 1,000 district level hospitals. The budgetary requirement would thus be over Rs. one billion. The injection waste cannot be burned, nor an effective autoclaving of AD syringes be ensured.
About 30 per cent incidence of Hep B and C can be attributed to reuse of plastic syringes. With the immunization drives against Hep B, 48 million additional injections will be required every year. This will require one time investment of Rs 1.2 billion for disposal equipment. With this kind of money a safe system to ensure injection safety can be developed. At the same time there is a lot of merit in the concept of going back to glass syringes era.