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Safe and unsafe injections

Community Medicine

Fourth year

Dr Kamel A Elazzabi
Introduction

• Injections are the most common health care procedure worldwide.

• In developing and transitional countries alone, some 16 thousand million


injections are administered each year. Most injections, more than 90%, are
given for therapeutic purposes while 5 to 10% are given for preventive
services, including immunization and family planning.

 The majority of therapeutic injections in developing and transitional


countries are unnecessary

What is Injection Safety?

• Injection safety includes practices intended to prevent transmission of


infectious diseases between

1- one patient and another.

2- between a patient and healthcare provider.

3- to prevent harms such as needle stick injuries.

• 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 Definitions”

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Fact sheet

• Contaminated needles can transmit more than 20 dangerous blood-borne


pathogens including HIV, Hepatitis B and Hepatitis C

• Other pathogens like tuberculosis, diphtheria, herpes, malaria, Ebola virus


infection and Epstein-Barr virus infection have been documented.

• The global burden of disease from unsafe medical injections has been
estimated for the year

2008 by the World Health Organization injections led to:

- 340,000 HIV infections.

-15 million HBV infections.

- 1 million HCV infections .

- 3million bacterial infections

- and 850,000 injection site abscesses in 2008.

- These infections accounted for :

- 14% of HIV infections.

- 25% of HBV infections .

- 8% of HCV infections

-7% of infections with bacteraemia worldwide

- accounted for 28 million disability adjusted life years, from AIDS, acute
hepatitis, liver cancer, end-stage liver disease and fatal sepsis.

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• Estimated proportion of viral hepatitis due to unsafe injection practices in
selected countries where information is available:

• Hepatitis B

- Moldova: 50% (1994-1995)

- Romania: 30% (1997)

- India: 60%

- Taiwan: 60% (1977)

• Hepatitis C

- Egypt: >40% (1996)

- In Libya injecting drug users (IDUs) as the dominant mode of


transmission, and reaching as high as 90% of HIV Cases .(2000).

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Needle stick Injuries Among Health Care Workers

nurses are the most frequently injured in hospitals.

Nurses reported almost 50% of needle sticks. The reasons for this high percentage
include the larger number of nurses employed in the hospital setting as compared
to other groups, the higher rate of reporting compliance, and the high proportion of
nursing tasks which involve needles.

Physicians rank second in number of exposures at 12.6%.

Nursing assistants and housekeepers/laundry workers report 5.3% and 5.1% of the
exposures respectively.

The large “other” category in this pie chart includes students, respiratory
therapists, dental workers, emergency personnel, IV teams, dialysis workers, and
other “others”.

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When Do Needle sticks Happen?
About 20% of injuries occur before or during use.

These injuries usually involve clean needles and present a lower risk to
employees.

Up to 70% of needle sticks occur after the needle has been used (is
contaminated) and before disposal.

The remaining ten percent of injuries occur during or after disposal.

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What are some of the incorrect practices that have resulted in
transmission of pathogens?
• Using the same syringe to administer medication to more than one patient,
even if the needle was changed.

• Using a common bag of saline or other IV fluid for more than one patient,
and

• Leaving an IV set in place for dispensing fluid

• Accessing the bag with a syringe that has already been used to flush a
patient’s IV or catheter

• Accessing a shared medication vial with a syringe that has already been used
to administer medication to a patient.

• Recapping needle .

 Failing to use aseptic technique when preparing and administering


injections.

What is aseptic technique?


Aseptic technique refers to the manner of handling, preparing, and storing of
medications and injection equipment/supplies (e.g., syringes, needles and IV
tubing) to prevent microbial contamination

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Unsafe injection…… example

- This is a picture show Uncapped syringes for flushing IVs, blood drawing
equipment in the area of medication preparation, medication prepared in
advance, and medication prepared in the hood in the patient treatment area.

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Unsafe injection example

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Main factors contributing to transmission of blood borne pathogens
through injections
1- Overuse of therapeutic injections.

2- Lack of awareness of risk.

3- Lack of syringe and needle supplies leading to syringe and needle reuse.

4- Lack of safe disposal infrastructures.

Costs to achieve a safe and appropriate use of injections


 Cost of information, education, and communication / behavior change
campaigns.

 Cost of providing sufficient injection equipment.

 Cost of waste disposal infrastructure

Types of injection equipment

1- Auto-disable syringes

 equipment of choice

Advantages of AD syringes:

1) They can only be used once.

2) They eliminate the patient-to-patient


disease transmission caused by the use
of contaminated needles and syringes.

3) They save time for health workers


from the heavy work of sterilization

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Part of syringe :

2- Prefilled AD injection devices

 available for some antigens “ vaccine” only.

• Advantages of prefilled AD injection devices:

• Prefilled AD injection devices have the same


advantages as AD syringes. In addition:

• 1) They prevent vaccine contamination.

• 2) They ensure an accurate dose.

• 3) They deliver vaccine and syringe together


in the same set.

• 4) Syringe and vaccine can be ordered with a


single request.

• 5) They contain less plastic than a

syringe, so waste is reduced.

• 6) The unit-dose device reduces the vaccine


waste that occurs when using multi-dose vials.

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3-Reusable syringes and needles (boiling) .

 not recommended.

Needle Size

Orange 25 gauge 16 mm long

25 mm long

Blue 23 gauge 25 mm long

Green 21 gauge 38 mm long

• For IM injection, needle needs to be long enough to ensure vaccine is


injected into muscle

- A 25mm needle length is preferable and suitable for all ages


- 16mm needle length is only recommended for pre- term or very small
infants
- In larger adults, a longer length (38mm) may be required – individually
assess patients.

Route of Injection
Vaccines should not be given intravenously
Most vaccines* should be given intramuscularly:
This reduces the chance of local reactions and leads to a better
immune response to the vaccine.
It is important the vaccine is injected into muscle and not into fat.
This is why the deep subcutaneous route is no longer
recommended for most vaccines.

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Simple ways to improve injection safety

- Prepare injections in a clean designated area where blood and body fluid is
unlikely.

- Prepare each dose immediately before administering, do not prepare several


syringes in advance.

- Never leave the needle in the top of the vial.

- Follow product-specific recommendations for use, storage and handling of vial.

- Make sure you have the CORRECT diluent for each product check that both
diluents and powder are produced by the same manufacturer.

- Use a sterile syringe and needle to reconstitute each vial. Use all the diluent
provided for the vial. After use, place the syringe into a safety box .Inspect the
packaging very carefully. Discard a needle or syringe if the package has been
punctured, torn or damaged in any way.

- Do not touch any part of the needle. Discard a needle that has touched any non-
sterile surface.

- Hold the child firmly. Anticipate sudden movement during and after injection.

- Do not recapping needle.

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1. The shaft of the needle

2. The bevel of the needle

3. The adaptor of the needle

4. The adaptor of the syringe

5. The plunger seal of the


syringe

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Waste management
- Incineration
- Burning in a metal drum
- Open burning in a pit
- Encapsulation
- Buried in a disposal pit

Do not for get


- Never administer medications from the same syringe to more than one
patient, even if the needle is changed or you are injecting through an
intervening length of IV tubing.
- Do not enter a medication vial, bag, or bottle with a used syringe or needle.
- Never use medications packaged as single-dose or single-use for more than
one patient. This includes ampoules, bags, and bottles of intravenous
solutions.
- Always use aseptic technique when preparing and administering injections

Good Luck
Dr Kamel A Elazzabi
2014

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