g Injection Safety

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WHO/V&B/AVI

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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WHO/V&B/AVI

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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WHO/V&B/AVI

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 consideredunsafe

25 to 95% of outpatient visits resulted in an injection

(95% are therapeutic), which may be unnecessary


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WHO/V&B/AVI

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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WHO/V&B/AVI

Injection Safety

Why unsafe injections are given? Lack of knowledge of dangers of injection

False belief that injection are more effective thanoral medications

Some healthcare workers may think patients want

an injection, even when they dont

Some patients may demand injections, evenagainst the advice of their health care provider

Some clinicians make more money if they give an

injection


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WHO/V&B/AVI

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 samerefrigerator

Applying pressure to bleeding sites with usedmaterial 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 everyimmunization 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 jo int s tatemen t on the use of

auto-disable syr inges in immun izat ion services

AD syringe and safety boxes should be suppliedas a bundle for all campaigns

As of January 2001 no procurement servicecontracts for standard disposable syringesentered into by UNICEF

By the end of 2001, all countries should use onlyAD syringes or sterilizable equipment

By the end of 2003 sole use of ADs

All partners requested to finance not onlyvaccines but also the safe administration ofvaccines, AD syringes and safe management ofwaste

WHO/V&B/AVI


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Injection Safety

Promoting safe practices

Proper storage and handling

Do not store vaccine & diluents with othermedicine 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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WHO/V&B/AVI

Injection Safety

Promoting safe practices

Reconstituting vaccines safely Use ONLY diluent recommended by the manufacturer to

reconstitute vaccine

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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WHO/V&B/AVI

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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WHO/V&B/AVI

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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WHO/V&B/AVI

Injection Safety

Preventing needlestick injury

DoNOT recap needles

DoNOT bend needles

Do NOT manually remove needles from

syringes

DoNOT transport without sharp container

or safety boxes


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WHO/V&B/AVI

Injection Safety

Disposal of injection wastes and sharps

No easy solutions

Use of leak-proof, puncture-proofcontainers for syringes & needles

Sharp containers

Safety boxes

Needle-disposal boxes or needle destroyers


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WHO/V&B/AVI

Injection Safety

Sharp Containers


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WHO/V&B/AVI

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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WHO/V&B/AVI

Injection Safety

Sharps container

UNSAFE

SAFE


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WHO/V&B/AVI

Injection Safety

Destroying syringes & needles

Where available high temperature

incineration is the best, but too costly tohave it at every level

Therefore, other methods such as

Burial

Burning


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WHO/V&B/AVI

Injection Safety

Incineration

The high temperature kills microorganisms

Completely destroys needles and syringesby 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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WHO/V&B/AVI

Injection Safety

An example of a low cost incinerator- DeMontford

De M

Locally builtMade of locallyavailable bricks

Cost approx. US $1500

Temp can exceed800 deg C


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WHO/V&B/AVI

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 stayaway from site

Make sure that fire is not left unattended

Prevent waste from scattering & littering


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WHO/V&B/AVI

Open pit burning


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WHO/V&B/AVI

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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WHO/V&B/AVI

Injection Safety

Waste Burial Pit


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WHO/V&B/AVI

Injection Safety

Injection Safety education

Training & Re-training of of health care

workers is important to reduce errors andto ensure safe injections

Communications and public education are

also equally important to understand the

risks and benefits of injections


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WHO/V&B/AVI

Injection Safety

Assuring Injection Safety in a campaign Develop an injection safety plan

Assess the situation and identify needs and

challengesIdentify stakeholders

Develop a specific plan

Assuring safe injections at the point of use

Proper supplies of ADs and disposal boxes


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WHO/V&B/AVI

Injection Safety

Assuring Injection Safety in a campaign Assuring safe disposal of used injection

equipment

Identify practical solutionsAssess options

Destruction points

Monitor disposal

Monitoring and evaluationRegular supervisory visits

Final evaluation


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WHO/V&B/AVI

Injection Safety

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g Injection Safety