Reduce, reuse, recycle. It seems sensible but in many countries the reality is of illicit salvage of items from clinical wastes followed by repackaging (of sorts) and reuse, all without effective sterilisation and in some cases without any cleaning or sterilisation at all. The inevitability of bloodborne virus infection transmission, and of other health risks such as the contamination of medicines, injections and infusions with contaminating drug residues, are massive and the public health impact is immense.

How does it happen? Generally, those who tease out a subsistence income will scavenge from hospital wastes. These are rich pickings. In many countries, these wastes – especially wastes from public hospitals – are removed without any sterilisation. Facilities may be unavailable or the cost of processing simply too high. Not infrequently, the process is organised with an insider making sure waste is removed without processing and shipped to a particular location where scavengers operate in organised gangs. No doubt money changes hand to make sure that this happens.

In many parts of S America and ISC it is possible to find scavengers laying out their wares, often complete with bloodstains [click here for a news report that includes a picture very typical of this illicit recycling]. Swaps and trades bulk up the products with one chap trading syringes with another who might ‘specialise’ in bandages or IV tubing. Yet another will have gathered syringe wrappers while someone else re-assembles syringes and packages these as if new. There can then be sold back to a hospital as ‘new’ goods.

It’s a revolving door of unimaginably high risk. International action is required to ensure that sufficient resource exists to prevent this and remove the various drivers including poverty and ignorance, and greed, that perpetuate such unsafe practices.