Manually removed needles from syringes: What the health board found at a Pakistani hospital at the center of the HIV epidemic

Concerns have been raised about healthcare standards in Pakistan after allegations of medical negligence and hazardous waste management practices emerged at a Sindh state hospital.

Dawn reported on Saturday (local time) that the Sindh Healthcare Commission found that needles were manually removed from syringes after use and were not placed in sharps containers at the facility. The incident was reported at Valika Hospital.

Read also | Lord’s Mark secures global milestone in HIV diagnosis

Here’s what we know

After the errors were reported, the health commission said in a statement issued on Friday: “This raised serious concerns about the hospital’s medical waste management practices as it was not clear where the removed needles went or how they were disposed of.”

According to the report, a team from the Sindh Health Commission (SHCC) visited the hospital to assess compliance with its earlier recommendations. During the inspection, the technical staff was not able to explain how the used needles are disposed of or whether there is any alternative method of disposal.

The health commission also noted that although the hospital management had previously set up an Infection Prevention and Control Committee (IPC), “many important issues were still found during the visit”.

Despite the presence of the IPC committee, the SHCC team found that the procurement of color-coded cartridges and auto-discard syringes, along with most of the recommendations, had not been fully implemented.

Citing a SHCC statement, Dawn said: “The inspection team noted that no formal IPC training was provided to the hospital staff. The hospital also did not submit any written IPC guidelines or policies to the SHCC team.”

She further stated that the commission was unable to verify the operational status of the autoclave during the visit. In addition, nurses and operating theater (OT) staff were unavailable during working hours, making it difficult for the inspection team to assess routine infection control at their workplaces.

Read also | India has ordered an audit of a blood bank after cases of HIV in children emerged after transfusion

It was also found that medical waste was not sorted and disposed of in accordance with IPC guidelines and staff showed poor knowledge of the safe management of medical waste. In addition, the private contractor responsible for the collection and disposal of medical waste has not received proper training.

Valika Hospital under scanner after HIV outbreak

Valika Hospital, run by the Sindh Employees Social Security Institution (SESSI), was reportedly in the news after an HIV outbreak, with around 78 children found to be infected with the virus. A separate screening in the immediate vicinity confirmed another 120 cases.

Sindh Chief Minister Syed Murad Ali Shah was informed earlier this week that several lapses were reported at Valika Hospital, including failure to follow infection prevention protocols and mishandling of single-use syringes, after two investigations into the HIV outbreak were conducted.

Shah was informed that at least 37 officers and officials, including past and present administrators, doctors, nurses, laboratory staff and support staff, were suspended and were issued show-cause notices on July 3 asking them to submit their replies within 14 days.

HIV cases in Pakistan

The World Health Organization (WHO) and UNAIDS last December identified the HIV crisis in Islamabad as one of the fastest-growing epidemics in the WHO’s Eastern Mediterranean region, which consists of 21 countries, with the annual number of infections increasing by 200 percent over 15 years, from 16,000 in 2010 to 48,000 in 2024, according to Al Jazeera4.

In a joint statement issued on World AIDS Day on December 1, the agencies estimated that there are about 350,000 people living with HIV in Pakistan, with nearly four out of five unaware of their infection.

The statement further said that the number of HIV-infected children under the age of 14 increased from approximately 530 in 2010 to 1,800 in 2023.

He also highlighted large gaps in treatment, noting that only 38 percent of children living with HIV receive treatment, while only 14 percent of pregnant women who need drugs to prevent mother-to-child transmission have access to it.