Worldwide Humanization of Health Organizations A Proposal To The WHO* The First Model for a Needle-free, Infection-free and Pain-free Hospital is the University of Illinois Hospital Elemer K Zsigmond, MD DSc FCP Professor Emeritus of Anesthesiology, Medical Director for the NFIFPF UICH Project, UICMC, Chicago, IL 60612 USA The concept for the humanization of hospitals worldwide has been initiated by the successful campaign of mass-immunization against smallpox, polio, yellow fever, etc. by Robert H Hingson, MD and associates. It was evident that the Med-E-Jet injector (Peace Gun) caused no pain or discomfort, since billions of illiterate, tribal people voluntarily underwent immunization without any evidence of fear or discomfort in thirty years. Therefore, Dr. Hingson and I hoped that children could be anesthetized by the Med-E-Jet injector without fear of needles and any unpleasant recall for surgery. Indeed, Drs. Kovacs, Fekete and I were able to induce anesthesia with midazolam and/or ketamine fast and safely at the Semmelweis Medical University (1,2). Based on these favorable results, I started the campaign to eliminate needles altogether from daily medical practice by the use of jet-injection (ji) for drug delivery, thereby halting the worldwide epidemic of needle-stick injuries resulting in one million death annually. Since the two most common adverse experiences reported by patients are l/ the pain on intravenous injection/catheterization and 2/ the pain experienced during phlebotomy,we first wanted to provide painless local anesthesia for these procedures. ZERO pain scores were recorded with the Med-E-Jet or Biojector jet injections in contrast to the conventional needle/syringe (3). A new Hospital Policy had to be proposed, voted on and approved by the medical staff, which mandated the use of local anesthesia with buffered lidocaine given by a jet-injector in order to reduce pain to ZERO. Slowly but surely, all units in the hospital compiled with the new policy. Starting in the Surgicenter and Emergency Department with outpatients, we were able to collect from the insurers for the added cost of the technique (30-40cents). The positive financial balance created by the ji local anesthesia allowed us to convert to the use of ji technology for all the sc. and im. injections after new policies for drug administration were approved by the medical staff. At present, the UICH serves as a model hospital to other hospitals, which wish to convert into a needle-free, infection-free and pain-free hospital, which is mandated by Federal Law, the OSHA and JCAHO. The prime task for the WHO in the battle to combat the worldwide epidemic of needle-stick injuries can be accomplished only by the use of ji technology with elimination of needles for drug delivery. References: 1. Zsigmond EK, Kovacs V, and Fekete G: A new route, jet-injection for anesthetic induction in children I. Midazolam dose-range finding studies Intl J Clin Pharmacol Ther, 33:580-584,1995. 2. Zsigmond EK, Kovacs V and Fekete G: A new route, jet-injection for anesthetic induction in children. II. Ketamine dose-range finding studies Intl J Clin Pharmacol Ther, 34:84-88,1996. 3. Zsigmond EK, Darby P, Koenig H and Goll E: A new route, jet-injection of lidocaine for skin wheal for painless intravenous catheterization Intl J Clin Pharmacol Ther, 37:90-99,1999. * Proposal made by Elemer K. Zsigmond to the WHO in 1999.