To Understand injection safety. Describe hazards of Unsafe injections and its prevention. To understand the role of health education in prevention of blood born disease. OUTLINE OF PRESENTATION 1. INTRODUCTION 2. CONCEPT OF SAFE INJECTION 3. ISSUES IN MISUSE AND OVERUSE OF IINJECTION 4. MAGNITUDE OF THE PROBLEM OF UNSAFE INJ 5. PUBLIC HEALTH IMPORTANCE 6. WAY FORWARD 7. MANAGEMENT OF NEEDLE STICK INJURY 8. CONCLUSION

1. UNSAFE INJECTIONS; HAZARDS AND ITS
PREVENTION
DR SINDHU ALMAS
MBBS, MPH (PHD)
DEPARTMENT OF COMMUNITY MEDICINE & PUBLIC HEALTH SCIENCES
LUMHS

2. CLASSROOM RULES
• NO CROSS TALK
• RAISE HAND IF YOU HAVE QUESTION
• CELLPHONE: SWITCH OFF OR PUT ON SILENT MODE

3. LEARNING OBJECTIVES
• TO UNDERSTAND INJECTION SAFETY.
• DESCRIBE HAZARDS OF UNSAFE INJECTIONS AND ITS PREVENTION.
• TO UNDERSTAND THE ROLE OF HEALTH EDUCATION IN PREVENTION OF BLOOD
BORN DISEASE.

4. INJECTION SAFETY
OUTLINE OF PRESENTATION
1. INTRODUCTION
2. CONCEPT OF SAFE INJECTION
3. ISSUES IN MISUSE AND OVERUSE OF IINJECTION
4. MAGNITUDE OF THE PROBLEM OF UNSAFE INJ
5. PUBLIC HEALTH IMPORTANCE
6. WAY FORWARD
7. MANAGEMENT OF NEEDLE STICK INJURY
8. CONCLUSION

5. INTRODUCTION
 INJECTED MEDICINES ARE COMMONLY USED IN HEALTHCARE
SETTINGS FOR THE PREVENTION, DIAGNOSIS, AND TREATMENT OF
VARIOUS ILLNESSES
 UNSAFE INJECTION PRACTICES PUT PATIENTS, HEALTHCARE
PROVIDERS AND THE COMMUNITY AT RISK OF INFECTIOUS AND NON-
INFECTIOUS ADVERSE EVENTS AND HAVE BEEN ASSOCIATED WITH A
WIDE VARIETY OF PROCEDURES AND SETTINGS. THIS HARM IS
PREVENTABLE.
 SAFE INJECTION PRACTICES ARE PART OF GENERAL PRECAUTIONS
AND STANDARD PRACTICES IN HEALTH CARE DELIVERY AIMED AT
MAINTAINING BASIC LEVELS OF PATIENT SAFETY AND PROVIDER
PROTECTION

6. CONCEPT OF SAFE INJECTION
 AS DEFINED BY THE WORLD HEALTH ORGANIZATION (WHO), A SAFE INJECTION
DOES NOT HARM THE RECIPIENT, DOES NOT EXPOSE THE PROVIDER TO ANY
AVOIDABLE RISKS AND DOES NOT RESULT IN WASTE THAT IS DANGEROUS FOR
THE COMMUNITY(WHO, 2005).
 SYRINGES WITH A REUSE PREVENTION FEATURES OFFER THE HIGHEST LEVEL OF
INJECTION SAFETY TO RECIPIENTS

7. • A SAFE INJECTION DOES NOT HARM THE RECIPIENT, DOES NOT
EXPOSE THE HEALTH WORKERS TO ANY AVOIDABLE RISK AND DOES
NOT RESULT IN WASTE THAT IS DANGEROUS FOR THE COMMUNITY
• THE SAFE COLLECTION AND DISPOSAL OF USED SHARPS (NEEDLES,
SYRINGES WITH FIXED NEEDLES) IS AN INTEGRAL PART OF THE LIFE
CYCLE OF INJECTION DEVICE
• THE COLLECTION OF SHARPS WASTE IN SAFETY CONTAINERS
(SAFETY BOXES) AT THE POINT OF USE AND THEIR SAFE AND
ENVIRONMENTALLY RESPONSIBLE DISPOSAL PROTECT HEALTH CARE
WORKERS AND THE GENERAL PUBLIC FROM NEEDLE STICK INJURIES

8. • A FIRST STEP TOWARD EVALUATING THE
FREQUENCY OF UNSAFE INJECTION PRACTICES
IN COUNTRIES IS AN INJECTION SAFETY
ASSESSMENT
• THREE MAJOR CONSIDERATIONS ARE
ESPECIALLY RELEVANT IN THE ASSESSMENT OF
POTENTIAL UNSAFE INJECTIONS-
• THE SAFETY OF THE RECIPIENT
• THE SAFETY OF THE HEALTH WORKERS

9. ISSUES IN MISUSE & OVERUSE OF
INJECTION
 INJECTION IS ONE OF THE MOST COMMON
HEALTH CARE PROCEDURES
 EACH YEAR AT LEAST 16 BILLION INJECTIONS ARE
ADMINISTERED IN DEVELOPING & TRANSITIONAL
COUNTRIES (WHO,2005).
 THE VAST MAJORITY, ABOUT 95% ARE GIVEN IN
CURATIVE CARE, IMMUNIZATION ACCOUNTS FOR
ABOUT 3% OF ALL INJECTIONS, THE REMAINDER
FOR OTHER INDICATIONS INCLUDING USE OF
INJECTIONS FOR TRANSFUSION OF BLOOD/BLOOD
PRODUCTS & CONTRACEPTIVES

10. • MAJORITY OF THERAPEUTIC INJECTIONS IN DEVELOPING AND
TRANSITIONAL COUNTRIES ARE UNNECESSARY.
• IN SOME SITUATION, AS MANY AS 9 OUT OF 10 PATIENTS
PRESENTING TO PHC PROVIDERS RECEIVE AN INJECTION, OVER
70% OF WHICH ARE UNNECESSARY OR COULD BE GIVEN IN AN
ORAL FORMULATION.

11. REASONS FOR INJECTION MISUSE &
OVERUSE
1.PATIENTS TEND TO PREFER INJECTIONS BECAUSE THEY BELIEVE
THESE TO BE STRONGER AND FASTER.
2.THEY ALSO BELIEVE THAT DOCTORS REGARDS INJECTIONS TO
BE BEST TREATMENT.
3. IN TURN, DRS OVER PRESCRIBED INJECTIONS BECAUSE THEY
BELIEVE THAT THIS BEST SATISFIES PATIENTS.
4.IN ADDITION, PRESCRIPTION OF INJECTION SOMETIMES
ALLOWS THE CHARGING OF HIGHER FEE FOR SERVICE.
BETTER COMMUNICATION BETWEEN PATIENTS & PROVIDERS CAN
CLARIFY THESE TYPES OF MISUNDERSTANDINGS & HELP TO
REDUCE INJECTION OVERUSE!

12. MAGNITUDE OF THE PROBLEM
• IN GENERAL, THE ASSESSMENTS UNDERTAKEN HAVE SHOWN
THAT REUSE OF RECONSTITUTED SYRINGE IS COMMON. SO
THERE IS NEED FOR ADVOCACY FOR POLICY CHANGE WHICH
WILL LEAD TO THE IMPLEMENTATION OF SAFE INJECTION
PRACTICES
• EPIDEMIOLOGICAL STUDIES INDICATE THAT A PERSON WHO
EXPERIENCES ONE NEEDLE-STICK INJURY FROM A NEEDLE USED
ON AN INFECTED SOURCE PATIENT HAS RISKS OF 30%, 1.8%,
AND 0.3% RESPECTIVELY TO BECOME INFECTED WITH HBV, HCV
AND HIV

13.  DUMPING HOSPITAL WASTE IN OPEN AREAS IS A
PRACTICE THAT CAN HAVE MAJOR ADVERSE
EFFECTS ON THE POPULATION. THE
«RECYCLING» PRACTICES THAT HAVE BEEN
REPORTED, PARTICULARLY, THE REUSE OF
SYRINGES IS CERTAINLY THE MOST SERIOUS
PROBLEM IN SEVERAL COUNTRIES.
 THE WHO ESTIMATES THAT OVER 23 MILLION
INFECTIONS OF HEPATITIS B, C AND HIV OCCUR
YEARLY DUE TO UNSAFE INJECTION PRACTICES
(REUSE OF SYRINGES AND NEEDLES IN THE
ABSENCE OF STERILIZATION)(WHO, 2005).

14. PUBLIC HEALTH IMPORTANCE
UNSAFE INJECTIONS OR UNSAFE PRACTICES IN RELATION TO
IMMUNIZATION ARE NOT ONLY-
• RESPONSIBLE FOR CASES OF HEPATITIS B,C,HIV/AIDS, ETC
• AND OTHER SERIOUS POTENTIALLY LETHAL SIDE EFFECTS SUFFERED BY
VACCINE RECIPIENTS
• MAY POSE AN OCCUPATIONAL HAZARD TO HEALTH PROVIDERS
• ENVIRONMENTAL HAZARDS TO THE COMMUNITY (SOIL , AIR & WATER)
• UNSAFE INJECTION PRACTICES CAN SERIOUSLY IMPEDE THE PROGRESS
MADE BY IMMUNIZATION PROGRAMMES LEADING TO SUBSTANTIAL
NEGATIVE EFFECTS ON GLOBAL IMMUNIZATION COVERAGE

17. WAY FORWARD
SAFE & APPROPRIATE INJECTIONS CAN BE ACHIEVED BY ADOPTING A 3 PART
STRATEGY-
1. CHANGING BEHAVIOUR OF HEALTH WORKERS AND PATIENTS
2. ENSURING AVAILABILITY OF EQUIPMENT AND SUPPLIES
3. MANAGING WASTE SAFELY AND APPROPRIATELY

19. MANAGEMENT OF NEEDLE STICK
INJURY
IN THE EVENT OF A SHARP OR NEEDLE STICK INJURY
• ENCOURAGE BLEEDING FROM THE WOUND- DO NOT SUCK OR RUB
• WASH AREA THOROUGHLY WITH SOAP AND WATER
• COVER WITH A WATER –PROOF DRESSING
• IF KNOWN, NOTE THE NAME OF THE PATIENT
• REPORT TO OCCUPATIONAL HEALTH UNIT
• NOTIFY LINE MANAGER AND DOCUMENT THE ACCIDENT
• IF PATIENT IS THOUGHT TO BE HIV +, POST-EXPOSURE PROPHYLAXIS
(PEP) MAY BE REQUIRED. THIS SHOULD BE GIVEN AS SOON AS POSSIBLE
AFTER INJURY.
STAFF SHOULD BE FAMILIAR WITH LOCAL PEP GUIDELINES!

20. RECOMMENDATIONS: ASSURE POLICIES AS
PER THESE POINTS.
• ASEPTIC TECHNIQUES SHOULD BE APPLIED TO AVOID CONTAMINATION OF STERILE
INJECTION EQUIPMENT
• USED-SYRINGES, NEEDLES AND CANNULAS MUST BE DISCARDED AT THE POINT OF
USE, IN AN APPROVED CONTAINER IMMEDIATELY AFTER USE.
• SINGLE USE SYRINGES SHOULD BE USED AND NEVER USE THE MULTI-DOSE VIALS
WHICH INCREASES THE RISK OF CONTAMINATION AND CROSS-INFECTION
• FLUID INFUSION AND ADMINISTRATION SETS ( DRIP SETS, INTRAVENOUS BAGS,
CONNECTORS AND TUBES) SHOULD BE USED ONLY ONE TIME AND NEVER AGAIN.
• ONCE I/V BAGS HAVE BEEN SPIKED, ADMINISTRATION MUST BEGIN WITHIN ONE
HOUR.
• PROPER WASTE MANAGEMENT IS NECESSARY AFTER USE OF SYRINGES/INFUSION
MATERIALS.

21. CONCLUSION
THE SAFE USE OF INJECTIONS,
COLLECTION, TRANSPORTATION AND
DISPOSAL OF USED SHARPS (NEEDLES,
SYRINGES WITH FIXED NEEDLES) IS AN
INTEGRAL PART OF THE LIFE CYCLE
OF INJECTION DEVICE.
ALL HAVE A RESPONSIBILITY, SO
ENSURE THAT IS DONE PROPERLY!