The International Council of Societies of Industrial Design (Icsid), Montréal, Canada, awarded the 2013-2014 World Design Impact Prize to A Behavior Changing (ABC) Syringe, designed and led by David Swann, PhD, at the University of Huddersfield, UK, at the end of February.

Fig. 1 – The ABC syringe label changes color from clear to bright red to show previous use.

Swann explained that in 2008, the World Health Organization calculated the global incidences of diseases transmitted through unsafe injection practices to a reported 1.3 million deaths, 340,000 HIV infections, 15 million Hepatitis B Virus infections, 1 million Hepatitis C Virus infections, 3 million bacterial infections and 850,000 injection site abscesses. The ABC Syringe is an intelligent label that provides an easy way to recognize which syringes have been used versus those that have not.

Fig. 2 – Children in Mumbai instinctively chose the red syringe as the hazardous one.

“We have developed a super-frugal innovation that improves the safety performance of any injectable device: disposables, AD (auto-disable) syringes and prefilled syringes. To achieve our objective, we have synthesized theories of risk perception and chromism to make invisible risk, visible. Our design hypothesis is to utilize persuasive design to visually communicate with absolute certainty the safety status of the device,” he explained. (See Figure 1)

How It Works

Although the original intent was to develop a totally new syringe, the researchers discovered that introducing any physical design change to an existing syringe would entail a more than a 10-year FDA regulatory process costing about £1 million. So, taking into account economic and regulatory factors, they changed their strategy to a color-changing label that could be applied to any production injectable: auto-disables, pre-filled, and especially disposable ones that continue to dominate the market (71%, or about 25 billion units). For a label application, a streamlined three-month FDA approval process is achievable, they said.

This innovation combines two proven technologies: colorimetric inks and modified atmosphere packaging (MAP). MAP is a popular technology used by food processing industries to minimize product deterioration and to extend the shelf life of food products. Inside a nitrogen-filled blister pack the syringe label remains deactivated. Exposure to air (by opening or pack failure) activates the label, which rapidly absorbs CO2 in the atmosphere. This provides a short time window for the syringe to be used in a procedure before a dramatic color transformation takes place, changing from colorless to red in 60 seconds. The recoloration inhibits the operability of the syringe and serves as a visual warning of prior use to both literate and illiterate patients.

The team conducted a simple knowledge and attitude test on the streets of Mumbai, India, to validate their innovation strategy. Participants were shown a conventional clear syringe and a red-colored syringe and asked which device they perceived to be most dangerous. In reality, both syringes were equally dangerous as they were not sterile. However the red color was shown to trigger an innate sensitivity and aversion to risk. One hundred percent of participants identified the red syringe as a threat to their personal safety with many associating the coloration to drug use or blood. (See Figure 2)

Unsafe injection practices reported from around the world included: reuse of disposable syringes and syringes for curative injections, loading disposable syringes with multiple doses and injecting people consecutively, reusing the same syringe on more than one patient after changing the needle, using multiple-dose vials pierced with a single drawing up needle, soaking syringes and needles in sodium hypochlorite, flushing syringes with disinfectant to clean them prior to reuse, discarding syringes into general waste, and the collection and resale of used syringes from landfills.

While initially considered to be a third world concern only, the team discovered that this challenge is not confined only to low-resource settings. A 2012 US government report recently captured data related to the prevalence of unsafe injection practices and the transmission of blood-borne infections in hospitals. In one instance, the use of a contaminated syringe resulted in 63,000 patients being recalled for testing at a cost of $13.8 million and $30,000 in treatment costs for each infected individual.

The team estimates that by year 5, the ABC Syringe could prevent 700,000 unsafe injections, save 6.5 million life years and $130 million in medical costs in India alone.

Established by Icsid in 2010 and awarded biennially, the World Design Impact Prize recognizes and elevates industrial design driven solutions to societal challenges. By sharing these solutions, and the challenges they address, the prize hopes to raise awareness of perhaps unknown obstacles and encourage a global exchange of ideas.


Medical Design Briefs Magazine

This article first appeared in the May, 2014 issue of Medical Design Briefs Magazine.

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