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Letters to Editor

A recent study by Gupta et al.,(7) found a low prevalence of multiple risk factors among young people which increased considerably between the age of 30-39 years. In this sub-group of persons admitted to the ICU, the high rates of risk factors were mainly seen between the ages of 40-49 years. As this age group was not studied by Gupta et al.,(7) it can only be assumed that a similar rising trend of risk factors is present in this area as well. In conclusion, different parts of India seem to demonstrate the same risk factors, but in varied proportions. This sample is not a true representation of the community burden as only cases admitted to the hospital were included. Therefore, large-scale studies covering more geographical areas will be necessary to investigate the risk factors of a particular area and the required preventive measures needed to reduce the prevalence of ACS. Patient education and awareness programs are of great importance in the rural areas to help reduce the burden of ACS.

on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52. 3. Mandal S, Saha JB, Mandal SC, Bhattacharya RN, Chakraborty M, Pal PP. Prevalence of ischemic heart disease among urban population of Siliguri, West Bengal. Indian J Community Med 2009;34:19-23. Tiwari R, Deb P, Debbarma A, Chaudhuri R, Chakraborty A, Lepcha M, et al. Tobacco use and cardiovascular disease: A knowledge, attitude and practice study in rural Kerala. Indian J Med Sci 2006;60:271-6. Reddy NK, Kumar DN, Rayudu NV, Sastry BK, Raju BS. Prevalence of risk factors for coronary atherosclerosis in a cross sectional population of Andhra Pradesh. Indian Heart J 2002;54:697-701. Prabakaran D, Shah P, Chaturvedi V, Ramakrishnan L, Manhapra A, Reddy KS. Cardiovascular risk factor prevalence among men in a large industry of northern India. Natl Med J India 2005;18:59-65. Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, et al. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord 2009;9:28.

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Abraham Samuel Babu, Mohammed Haneef1, Anupama Naomi Joseph, Manjula Sukumari Noone
Departments of Rehabilitation, 1Internal Medicine, CSI Mission Hospital, Codacal P.O., Tirur 676 108, Kerala, India. E-mail: dr.mhaneef@gmail.com
Received: 25-07-09, Accepted: 27-03-10, DOI: 10.4103/0970-0218.66863

References
1. Deb S, Dasgupta A. A study on risk factors of cardiovascular diseases in an urban health center of Kolkata. Indian J Community Med 2008;33:271-5. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee

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Sharp Disposal Practices in Urban Dispensaries


Sir, Bio-medical waste means waste generated during the process of diagnosis, treatment and/or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological. Injections are among the most frequently used medical procedure with an estimated 12 to 16 billion injections administered each year worldwide.(1) According to IPEN study, 03-06 billion injections are administered annually in India.(2) A large majority of them are administered for curative purpose and rest for immunization. An injection is considered to be safe when it does no harm to the recipient, does not expose the health care worker to any risk and does not result in waste that is dangerous to the community.(3) Although sharps waste constitutes a small proportion of all health care waste, its inadequate management can cause direct negative impact on health personnel and community and in addition, pollute the environment.
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A study was conducted to assess injection [immunization] waste disposal practices in urban dispensaries of Delhi, India. Primary data were collected by a single investigator using observation checklist based on Government of India guidelines(4) during the period October 2005 to March 2006. All [32] government dispensaries operational in a randomly selected municipal zone of Delhi, India were covered after obtaining permission from competent authorities. Owing to limited resources, only one visit was made to each health facility and best of five injections were observed to comment on disposal practices and method of terminal waste disposal from the dispensary was also observed and/or recorded. Results are thus presented according to health facility. All the health facilities were using AD [auto-disable] syringes for primary immunization of children. Correct needle disposal practices [needle shredding/chemical disinfection] and incorrect practices [needle bent/ recapped with both hands] were observed in equal
Indian Journal of Community Medicine/Vol 35/Issue 2/April 2010

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Letters to Editor

Table 1: Sharp disposal practices according to health facilities


Used injection needle practices Correct Incorrect Total Dedicated BMW transport service at health facility Available Not-available N % N % 3 09.37 13 40.62 15 46.87 01 03.12 18 56.25 14 43.75 Total N 16 16 32 % 50.00 50.00 [100]

number (16 [50.00%]) of health facilities respectively. It was noticed that dedicated bio-medical waste transport service was available in 18 [56.25%] health facilities only as per regulatory stipulation for transfer of biomedical including immunization waste to common biomedical treatment facility. Rest of the health facilities i.e. 14 (43.75%) were either disposing off their entire immunization waste into nearby general municipal waste containers [dhalao] or were burning in uncontrolled manner [Figure 1]. An interesting observation was made that incorrect needle practices were more prevalent in those health facilities that had provision of dedicated BMW transport service suggestive of carelessness/need for attitudinal change [Table 1]. BMW labeled colored coded bags were used in 29 [90.62%] health facilities for disposing immunization waste; however, varying color bags were in use. All the injection-related waste was also thrown in respective available bags. Red-colored bags were used in 16 [50.0%], blue bags in 11 [34.37%], and yellow bags in 2 [6.25%] health facilities, respectively. The reason cited was logistic issues. The cut-needle that was collected using hub cutter was emptied back directly into plastic/ cardboard container at the end of immunization day or was being preserved in the hub cutter itself till it got completely filled. It was heartening to note that there was no littering of injection waste in or around any of the health facilities. IPEN study on Assessment of Injection Practices in India reported satisfactory immunization waste disposal in 50.0% of health facilities only. There are multiple government health agencies in Delhi that are providing health services including immunization to community. Some of these agencies had outsource to vendors the practice of transporting biomedical including immunization waste to common biomedical treatment facility in accordance with Bio Medical Waste Management and Handling Rules, 1998 while in rest this was not made available. To conclude, corrective interventions are required at two levels i.e. one at individual/health facility and another at health agency level. It is the organizational responsibility to coordinate and make available dedicated bio-medical waste transport services including other logistics, which is also binding on
Figure 1: Uncontrolled burning of AD syringes in a dispensary

them as per statutory requirement. Re-orientation training/sensitization of health personnel at periodic interval may instill in safe BMW management practices. Similarly, close monitoring and supervision is required by medical officers at individual level to ensure correct waste disposal practices by health workers.

References
1. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of blood borne pathogens: A review. Bull World Health Organ 1999;77:789-800. Assessment of Injection Practices in India. India Programme Evaluation [IPEN] Study Report. New Delhi: AIIMS; 2004. Kane A, Lloyd J, Zaffran M, Simonsen L, Kane M. Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates. Bull World Health Organ 1999;77:801-7. Guidelines for disposal of Bio-Medical Waste [BMW] generated during Universal Immunization Programme. New Delhi: Ministry of Health and Family Welfare, Govt. of India; 2005. Ministry of Health and Family Welfare, Nirman Bhawan, Department of Education and Training, National Institute of Health and Family Welfare, Munirka, New Delhi-110 067, India. E-mail: drsandeepsachdeva@gmail.com

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Sandeep Sachdeva, Utsuk Datta1

Received: 13-05-09, Accepted: 25-03-10, DOI: 10.4103/0970-0218.66866

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