Injection Safety in EPI:More than just AD

Syringes and Safety Boxes

World Health Organization

HTP/V&B/EPI

Use of the Estimated 12 Billions Injections Administered Annually

Worldwide

Immunizations Therapeutic injections

Measles campaigns?

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

Injection Safety: Definition

No harm to the recipient No harm to the health-care worker No harm to the community

Reuse of equipment

Unsafe collection

Unsafe disposal

INJECTION SAFETYINJECTION SAFETYKey steps Key steps to improve safety to improve safety

Use of injection safety equipment Adequate injection technique

Disposal of used sharps in safety boxes Appropriate waste management

Injection Safety

Sharp Containers

Injection Safety

Sharps container

UNSAFESAFE

ChallengeHow to safely dispose

of used injection equipment within the EPI and during mass

vaccination campaigns?

Assuring safe disposal of used injection material within the EPI

• Waste mgmt is a chronic and frequently overlooked component of EPI

• EPI waste only a small proportion of healthcare waste

• Weak health and community waste mgmt systems. Mass vaccination campaigns greatly increases this ns greatly increases this chronic problemchronic problem

• Waste mgmt is an essential component of mass vaccination campaigns

• Early planning necessary to identify options and develop achievable plans

Challenges for Waste Management during mass vaccination campaigns

• No “one-size-fits-all” solution

• Need local assessment, simple solutions

• Environmental concerns, pressure groups, Kyoto agreement, bans on burning in some countries

• Implementation of the “Polluter Pays” principle

• Waste mgmt must be budgeted/funded/planned

• Measles and other vaccination campaigns should assist in the development of long-term EPI waste mgmt solutions

Options for disposing of used injection material within the EPI

Open burning and burying High temperature incineration Burial Dumping in pit latrine or other secure pit Transport for off-site treatment New technologies/recycling

Injection Safety

Open burning - cheap and practical option Combustion is at lower temperature May not completely destroy injection equipment 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 Ashes should then be buried

Injection Safety

High temperature incineration The high temperature kills microorganisms Destroys syringes and needles by burning at high

temperature (800 0C) Minimal toxic fumes from incinerator, less air

pollution Reduce volume of waste to minimum Requires special facilities Costly & complex to operate depending on model

Advantages of high temperature incineration

Assures complete combustion of used injection equipment

Markedly decreased risk of toxic emissions if properly used

Increased melting of needles Less risk of blood-borne infections to the

community

EPI Waste Management

Protection of the Human Environment (PHE)

Technical Options for Managing Waste

Burning – High temperature

De MontfordLocally built brick IncineratorUS $1000Installed

EPI Waste Management

Protection of the Human Environment (PHE)

Technical Options for Managing Waste

Burning – High temperature

After-burning

Air inlet

Factory builtPrefabricated IncineratorUS $5000Installed

Injection Safety

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

EPI Waste Management

Protection of the Human Environment (PHE)

Technical Options for Managing Waste

Waste Burial Pit

Assurance of injection safety with the EPI

Conclusions• Proper equipment is necessary, but not sufficient.• Careful planning/budgeting/training needed

• Injection safety requires a long-term vision

•Short-term solutions available

•Creativity/teamwork needed to find long-term sustainable solutions

• Solving the overall health care waste mgmt challenge is beyond the scope of the EPI

• Mass vaccination campaigns should contribute towards finding sustainable solutions to the challenge of EPI waste mgmt. “Bundling” should include waste mgmt plans and financing