Injection Safety

Definition of unsafe injections Problems of unsafe injections Practices that harm

Recipient of injections Health workers General public

Promoting safe injections

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Injection Safety
Safe practices
reconstituting vaccine safely avoiding needle stick injury safe disposal of injection wastes and sharps

Injection Safety education Assuring Injection Safety in a campaign

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Injection Safety
Definition of unsafe injections
Injections that harm the recipient, the provider, or that result in waste that is dangerous for other people.

The Problem
WHO estimates that 12 billion injections administered each year; 50 % (6 Billion) of which are considered

unsafe
25 to 95% of outpatient visits resulted in an injection (95% are therapeutic), which may be unnecessary
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Injection Safety
In a year, unsafe injections may be responsible for:
8 to 16 Million cases of Hepatitis B
2 to 5 Million cases of Hepatitis C 80,000 to 160,000 cases of HIV Others: Parasitic (Malaria), bacterial (abscess), fungal and other infections
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Injection Safety
Why unsafe injections are given?
Lack of knowledge of dangers of injection False belief that injection are more effective than oral medications Some healthcare workers may think patients want an injection, even when they dont Some patients may demand injections, even against the advice of their health care provider Some clinicians make more money if they give an injection
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Injection Safety
Practices that harm the recipient of injections
Keeping freeze-dried vaccine more than 6 hours after reconstitution Mixing two partially opened vials of vaccine Storing medication and vaccine in same refrigerator Applying pressure to bleeding sites with used material or finger Vaccinating infants in the buttocks use of unsterile needles and syringes

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Injection Safety
Practices that harm the health worker
Re-using needles and syringes (sharpening, etc) Carrying needles or placing them on a surface prior to disposal Recapping needles Reaching into a container of used syringes or needles
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Injection safety
For Health Worker, Do No Harm principle
Give only necessary injections Use sterile syringe and sterile needle for every immunization or DO NOT immunize Arrange the workspace and institute disposal practices to prevent needlesticks to self and others Most vaccinators give curative injections as well as immunizations Most curative injections are not necessary
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Injection Safety
Practices that harm the general public
Leaving needles and syringes in areas where children can take them

Giving or selling needles and syringes to vendors who will resell them
Leaving needles and syringes in areas accessible to the public

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Injection Safety
Promoting safe injections:
use of auto-disable syringes for all injections proper storage and handling and reconstitution of vaccines proper disposal of injection wastes and sharps proper training of health care workers public education and information dissemination
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WHO-UNICEF-UNFPA joint statement on the use of auto-disable syringes in immunization services AD syringe and safety boxes should be supplied as a bundle for all campaigns As of January 2001 no procurement service contracts for standard disposable syringes entered into by UNICEF By the end of 2001, all countries should use only AD syringes or sterilizable equipment By the end of 2003 sole use of ADs All partners requested to finance not only vaccines but also the safe administration of vaccines, AD syringes and safe management of waste
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Injection Safety
Promoting safe practices
Proper storage and handling
Do not store vaccine & diluents with other medicine such as insulin and laboratory reagents Make sure that correct diluent is stored with the correct vaccine Make sure that the correct diluent is issued and use for the correct vaccine

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Injection Safety
Promoting safe practices
Reconstituting vaccines safely
Use ONLY diluent reconstitute vaccine recommended by the manufacturer to Do not interchange diluents The wrong diluent makes the vaccine ineffective and less able to provide protection against disease The following vaccines require specific diluents BCG vaccine
Measles-containing vaccines Freeze-dried Haemophilus Influenza type b (Hib) vaccines Yellow fever vaccine
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Injection Safety
Reconstituted vaccines should be kept cool, between 2 and 8 C to maintain their potency Place reconstituted vaccines in slits

made in a foam piece that sits in the

top a vaccine carrier Discard reconstituted vaccine after 6 hours. BCG, measles-containing vaccines, yellow fever vaccines and freeze-dried Hib vaccines do not have preservatives. Death may occur
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Injection Safety
Reconstituting vaccine safely, cont
Check expiry date of the vaccine & diluents Cool diluent prior to mixing Draw entire contents of the diluent into the mixing syringe and empty it into the vaccine vial Mix the contents of the vial either by gently shaking it or rolling it between fingers Keep reconstituted vaccine cool - place it in slits cut in the top of foam pad that fits vaccine carrier
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Injection Safety
Preventing needlestick injury

Do NOT recap needles Do NOT bend needles Do NOT manually remove needles from syringes

Do NOT transport without sharp container or safety boxes

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Injection Safety
Disposal of injection wastes and sharps
No easy solutions Use of leak-proof, puncture-proof containers for syringes & needles
Sharp containers Safety boxes Needle-disposal boxes or needle destroyers

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Injection Safety
Sharp Containers

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Injection Safety
Sharp Containers should be
leak-proof puncture-proof clearly labelled with warning (easy for people to understand) Do not overfill (only 3/4th is safe) Do not transfer contents to other containers
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Injection Safety
Sharps container

SAFE UNSAFE
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Injection Safety
Destroying syringes & needles
Where available high temperature incineration is the best, but too costly to have it at every level Therefore, other methods such as
Burial Burning

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Injection Safety
Incineration
The high temperature kills microorganisms Completely destroys needles and syringes by burning at high temperature (800 0C) Minimal toxic fumes from incinerator, less air pollution Reduce volume of waste to minimum But requires special facilities to be built Costly & complex to operate
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Injection Safety
An example of a low cost incinerator- De
Montford

De M Locally built
Made of locally available bricks
Cost approx. US $ 1500 Temp can exceed 800 deg C
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Injection Safety
Open burning - cheapest option
Combustion is at lower temperature May not destroy injection equipment completely More toxic emission, chances of more waste scatter Usually done in open pit or metal drums Fence off and clear area and warn people to stay away from site Make sure that fire is not left unattended Prevent waste from scattering & littering
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Open pit burning

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Injection Safey
Burial
Burial can be for unburnt injection waste or waste generated by burning The pit should be at least 1 meter in depth It should be cordoned off to prevent access to site by people/children Some even recommend covering pit with concrete when full
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Injection Safety
Waste Burial Pit

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Injection Safety
Injection Safety education
Training & Re-training of of health care workers is important to reduce errors and to ensure safe injections Communications and public education are also equally important to understand the risks and benefits of injections

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Injection Safety
Assuring Injection Safety in a campaign
Develop an injection safety plan Assess the situation and identify needs and challenges Identify stakeholders Develop a specific plan Assuring safe injections at the point of use Proper supplies of ADs and disposal boxes

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Injection Safety
Assuring Injection Safety in a campaign
Assuring safe disposal of equipment Identify practical solutions Assess options Destruction points Monitor disposal Monitoring and evaluation Regular supervisory visits Final evaluation
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used

injection

Injection Safety

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