The WHO injection safety assessment tool: first results

1
The WHO injection safety assessment tool first
results
SIGN Meeting 2001 New Delhi, India
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Rationale for Assessments

• Assessments identify local problems to design
  effective, efficient interventions
• Data provide baseline information, suggest
  indicators for monitoring
• Data open the door to dialogue
• Overall, it shall help countries designing and
  implementing a safe injection policy

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Standard assessment of injection practices

• Objectives
• To determine if the country meets necessary
  requirements for staff competence, equipment,
  supplies, and waste disposal
• To assess if the injections are administered
  according to recommended best practices
• To estimate the proportion of healthcare
  facilities where injection practices are safe

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Standard assessment of injection practices

• Methods
• Standardized and representative method to allow
  for
• Measuring and documenting progress
• Comparison across countries
• Simple/structured and flexible
• 2-3 weeks
• Can be adjusted to country needs (for instance
  focus on immunization and/or therapeutic
  injections)

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Standard assessment of injection practices

• Methods (contd.)
• Cross sectional observational study
• Observation of supplies
• Observation of injections
• Interview of healthcare workers
• Two stage cluster sampling
• 8 districts selected
• 10 health care centres in each district
• Representative of the country

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Safe injection assessments June 2000-August 2001
Nepal, Kyrgyzstan, Egypt, Morocco, Oman, Syria,
Paraguay, Honduras, Burkina Faso, Niger,
Ethiopia, Chad, Zimbabwe and Gambia
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First results use of injection material (based 9
available reports)

• 3 countries are not using sterilizable injection
  material any more
• In 6 countries, between 6 and 84 of observed
  injections are done with sterilizable material
  (countries in transition)
• 1 country is using AD-syringes for all observed
  immunizations
• Only 2 countries practice the bundling of
  vaccines, injection equipment and safety boxes
  for the immunization activities

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Risk for the recipient(Use of sterile equipment
for injections)

• 100 use of sterile equipment for all observed
  injections in only one country (using disposable
  equipment)
• In 6 countries using sterilizable equipment
• Non documented sterilisation regularly with TST
  spot
• Use of sterile equipment between 55 and 88
• Spare parts and a 2 day supply were not available
  in a majority of the health facilities
• Countries using AD or disposable syringes have
  between 85 to 100 of health facilities using
  sterile equipment

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Risk for the health care worker

• Use of safety-boxes observed in 60 of health
  facilities (0-89)
• Sharps found in open containers in 80 of health
  facilities (34-95)
• Used syringes recapped in 54 of health
  facilities (16-71)
• At least 1 needle-stick injury in the last 12
  months for 61 of health care workers (22-76)

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Risk for the community

• No sharps found in the surroundings of health
  facility in 50 of cases (27-77)
• Waste disposal, open burning or dumping
  unsupervised in 39 of health facilities (18-64)
• Health care waste policy in only 5 of the health
  facilities (0-9)

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Conclusions

• The risks for the recipient are high in countries
  using sterilizable equipment
• The safety of the health care worker and the
  community is a problem in all observed countries
• Limitations in comparing across countries - the
  tool is designed to help individual countries to
  develop and implement a safe injection policy
• Next step very important to follow-up these
  assessments, country by country...