Injection Safety

1
Injection Safety

• Definition of unsafe injections
• Problems of unsafe injections
• Practices that harm
• Recipient of injections
• Health workers
• General public
• Promoting safe injections

2
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

3
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

4
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

5
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

6
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

7
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

8
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

9
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

10
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

11
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

WHO/VB/AVI
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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 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

14
Injection Safety

• Reconstituted vaccines should be kept cool,
  between 2º and 8º 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

15
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

16
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

17
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
21
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

24
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

29
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 used injection
  equipment
• Identify practical solutions
• Assess options
• Destruction points
• Monitor disposal
• Monitoring and evaluation
• Regular supervisory visits
• Final evaluation

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Injection Safety
Thank You