UNICEF Safe Injection Equipment Key highlights
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1 Safe Injection Equipment VPPEF 03 October 2017 UNICEF Safe Injection Equipment Key highlights Nagwa Hasanin, HTC
2 Vaccine Pharmaceutical form Route of administration Liquid Freeze- dried oral Inject Site Rotavirus x Oral Polio x Oral BCG x Injectable ID Pneumococcal x Injectable IM Pentavalent or Hibcontaining x x Injectable IM DTP x Injectable IM HepB or HepA x Injectable IM Measles- and rubellacontaining x Injectable SC Yellow fever x Injectable SC Japanese encephalitis x Injectable SC Meningococcal x x Injectable SC Polio, inactivated (IPV) x Injectable IM / ID Influenza x Injectable IM Rabies x Injectable IM/ ID Human papillomavirus (HPV) x Injectable IM
3 Vaccine Pharmaceutical form Route of administration Liquid Freeze- dried oral Inject Site Rotavirus x Oral Polio x Oral BCG x Injectable ID Pneumococcal x Injectable IM Pentavalent or Hibcontaining x x Injectable IM DTP x Injectable IM HepB or HepA x Injectable IM Measles- and rubellacontaining x Injectable SC Yellow fever x Injectable SC Japanese encephalitis x Injectable SC Meningococcal x x Injectable SC Polio, inactivated (IPV) x Injectable IM / ID Influenza x Injectable IM Rabies x Injectable IM/ ID Human papillomavirus (HPV) x Injectable IM
4 Vaccine Pharmaceutical form Route of administration Liquid Freeze- dried oral Inject Site Rotavirus x Oral Polio x Oral BCG x Injectable ID Pneumococcal x Injectable IM Pentavalent or Hibcontaining x x Injectable IM DTP x Injectable IM HepB or HepA x Injectable IM Measles- and rubellacontaining x Injectable SC Yellow fever x Injectable SC Japanese encephalitis x Injectable SC Meningococcal x x Injectable SC Polio, inactivated (IPV) x Injectable IM / ID Influenza x Injectable IM Rabies x Injectable IM/ ID Human papillomavirus (HPV) x Injectable IM
5 Vaccine Pharmaceutical form Route of administration Liquid Freeze- dried oral Inject Site Rotavirus x Oral Polio x Oral BCG x Injectable ID Pneumococcal x Injectable IM Pentavalent or Hibcontaining x x Injectable IM DTP x Injectable IM HepB or HepA x Injectable IM Measles- and rubellacontaining x Injectable SC Yellow fever x Injectable SC Japanese encephalitis x Injectable SC/IM Meningococcal x x Injectable SC Polio, inactivated (IPV) x Injectable IM / ID Influenza x Injectable IM Rabies x Injectable IM Human papillomavirus (HPV) x Injectable IM
6 As of today, injectable vaccines are delivered with needle and syringe
7 Product Diversity within the immunization context Profile Vaccines Injection Devices Product profile Biological Plastics Quality Assurance WHO PQ, GMP, Batch Release WHO PQS, UNICEF Tech. Assessment, Field Test, Inspection Production Lead time 6-24 months 2-4 weeks Storage requirements Temp controlled (Cold Chain) Dry Stores Supply Base Restricted Healthy (Ability to respond dependent on forecast accuracy) Shelf life 2 years 5 Years Shipment Mode Air Sea Waste at end of useful life empty vaccine vials Bulky Sharps infectious medical waste
8 Safe Injection Equipment for immunization Commodity Groupings Commodity Overview Usage/ Application Auto-Disable (AD) Syringes Injection for Immunization Safety Boxes Disposable Syringes Re-Use Prevention (RUP) Syringes Safe Disposal of Syringes Reconstitution of Vaccines
9 AD SB 1999 Joint UNICEF, WHO, UNFPA Policy Issued Auto-Disable (AD) as a step-stage technology (added attribute to already established technology) AD start 2005 Safe Injection Device Development UNICEF Expressed preference for early activation of the disabling mechanism (to reduce risk of reuse) leading to redefining technology and improve product design Adequate Supply Available with preferred AD mechanism for full award - with multiple suppliers start 2009 RUP/SIP RUP 2008 Introducing the RUP & RUP/SIP feature for reconstitution of freeze dried vaccines 2015 Introducing the RUP & RUP/SIP in therapeutic injections- participation in WHO expert group for new guideline recommendation RUP/SIP 2017 Planned new guidance is intended to support the transition from Disposable to RUP syringes, improving Injection Safety RUP RUP Needle-free devices
10 Discussion Feedback on use of products (AD, RUP, SB) field evaluation of new devices Intradermal delivery RUP technology
11 Healthcare Waste Management UNICEF shipped over 30,000m3 (5,500 tons) of SIE in 2016, generating contaminated waste, requiring disposal.
12 Points of action for HCWM Generation Segregation De-central storage Waste minimization HCW generation Segregation and containerization Intermediate storage (in the HCF) Internal transport (in the HCF) Centralized storage (in the HCF) External transport Treatment and final disposal Identification following the classification system (On-site treatment) Reduction of the hazardousness Central storage Packaging and labelling Transport Central storage Interim storage and set ready for external disposal External transport (Off-site treatment) Bringing together of small amounts (Recycling) Transport Final disposal Reduction of the hazardousness Reduction of energy consumption and use of raw materials
13 Composition of healthcare waste MOST HAZARDOUS
14 Sharps waste disposal Disposal methods should: Ensure that needles can not be re-used, Be selected in consideration of economical and environmental aspects. Treatment as infectious waste: Incineration, Autoclaving. Disposal option for rural areas: Sharp pit
15 1 m 2 m 0,3 m Sharps pit Requirements Hatch should be easy to open, should hermitically close the tank and should be lockable. Tank should be water tight and impermeable. 0,9 m 0,3 m Final sealing 2nd sealing Capacity planning (for 5years): 3rd sealing V = 50l * number of beds Groundwater
16 Schematic of Typical Controlled Air Dual Chamber Incinerator
17 What is a waste treatment area?
18 What is a waste treatment area? Highlights: Environmental friendly Capacity Preventative Maintenance Site readiness Training
19 Thank you
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