The Law of Unintended Consequences is deeply etched in the history of nursing and other health professions. And teaching first-year nursing students how to critique modern technology can employ nursing history and its artifacts, as Assistant Clinical Professor Lisa-Marie W. Griffiths, MA, MSN, APRN, recently demonstrated to her students in Introduction to Health and the Discipline of Nursing.
Reading an article last winter in the Hartford Courant, “Global Call for the Use of ‘Smart’ Syringes,” Griffiths reflected on the changes in this basic instrument, from the glass syringes she used early in her career in the U.S. Navy in the 1980s, to the disposable plastic syringes commonly in use now, to the new “smart” syringes that self-destruct after one use.
Older glass syringes could be readily sanitized in an autoclave or even boiling water in order to be reused. Glass syringes can admittedly be fragile but may be reused many times when handled carefully, requiring only the initial investment in the instrument. Disposable plastic syringes may seem like a perfect solution, but they should be replaced after each use, which adds an additional cost to healthcare settings that are often resource constrained in many locations around the world. As a result in developing countries, “disposable” syringes are often reused, but because they cannot be boiled, and bleach is often not available, they are not adequately sanitized.
The Courant article brought to Griffiths’s attention that “25 percent of the 18 billion medical injections performed worldwide each year are done with dirty needles. Unsafe injections cause as many as 1.7 million new hepatitis B infections annually, 315,000 hepatitis C infections and 33,800 HIV infections” according to the World Health Organization.
Aware of the complexities of global health, Griffiths decided to explore these issues with her first-year students using glass syringes from the Dolan Collection and a plastic syringe of her own.
As she explained to her students, “What will happen to third world needs when syringes are destroyed after one use? There are communities that wash latex gloves and hang them to dry to have ‘clean’ gloves to use. Not enough donated medical supplies arrive for the needs of communities in Haiti and Africa, so people have to make do.” Single-use syringes may be in short supply, preventing administration of life-saving medications. Plastic syringes also create more hazardous waste, which entails both environmental impact and economic costs.
Griffiths showed her students how glass syringes were handled and sterilized. Then she invited them to brainstorm strategies for remedying the unintended consequences of innovative syringes: Advocating for the remanufacturing of glass syringes? Strategic donations of bleach and isopropyl alcohol? Developing a new cleaning product or mechanism?
Single-use self-destructing syringes are currently pre-loaded for vaccines, but there has been difficulty for optional dose sizes (e.g., 0.5cc to 1.0 cc).
Concluding this class, Griffiths reminded her students, “Nurses need to be involved in all health care innovations and think globally, not just nationally, because what we do in America does affect the world and those in most need.”