Making allinjectionssafe

All of us, at some point in our lives, have had orwill have an injection to retain or restore goodhealth.But sometimes injections that are intended topromote health do the opposite. This happenswhen they are given in an unsafe way - using thesame needle or syringe to give injections to morethan one person. Practices like this can lead tothe transmission of life-threatening infections. Forthese reasons, the World Health Organization(WHO) is launching a new policy on injectionsafety to help countries tackle the pervasive issueof unsafe injectionsA 2014 study found that in 2010 as many as 33800 people became infected with HIV, up to 1.7million were infected with hepatitis B virus andup to 315 000 with hepatitis C virus through anunsafe injection. Usually infections are transmittedfrom one patient to another, but health workersare also at risk of becoming infected throughneedle injury.Towards Safe Injections For AllWHO and partners – including the Safe InjectionGlobal Network (SIGN) , UNICEF and Gavi, theVaccine Alliance – have been working activelytogether for more than a decade to promote safeinjection practices by educating policy makers onmaking sterile equipment available and educatinghealth workers on the critical importance of usingonly sterile material. The initial push focusedstrongly on spurring countries to use only autodisablesyringes for vaccinating children. Thiskind of syringe has an internal mechanism thatblocks the barrel after a single use so that thesyringe cannot be used again.Now the spotlight is on the risks associated withinjections into muscle (intramuscular) or skin(subcutaneous or intradermal) to treat medicalconditions; and how to make them safer througheducation on safe procedures, elimination ofunnecessary injections and better design ofequipment.The New Smart SyringesThe surest way to protect against unsafeinjections is to use devices for injections thathave been engineered so they cannot be re-usedand don’t lead to accidental needle stick injuriesamong health workers.Re-use prevention features are essentially thesame as the auto-disable features designedfor immunization of a single child. The maindifference is that syringes designed for deliveringmedicines allow the health worker to adjustthe dose as needed and to move the plungertwice when it is necessary to mix two differentmedicines in one syringe or reconstitute vaccinesand medicines if necessary. Some modelsinclude a weak spot in the plunger that causesit to break if the user attempts to pull back onthe plunger after the injection. Others have ametal clip that blocks the plunger so it cannot bemoved back while in others the needle retractsinto the syringe barrel at the end of the injectionSyringes are also being engineered with featuresto protect health workers from “needle stick”injuries and resulting infections. A sheath orhood slides over the needle after the injection iscompleted to protect the user from being injuredaccidentally by the needle. These syringes alsogenerally have a re-use prevention feature.

PROGRESS ON INJECTION SAFETYBetween 2000 and 2010, in developing countriesworldwide, re-use of injection equipment decreasedfrom 39.6% to 5.5%86%Reduction in re-use of injection equipment200039.6%Over the same period,unnecessary injectionsalso fellAverage number of injections perperson in developing countries20003.420105.5%20102.9In 2009 Gavi, whichfollows WHO and UNICEFrecommendations on theuse of auto-disable syringesfor immunization injections,reported that 66 of the 71countries to which it providedsupport for injection safetywere exclusively using autodisablesyringes.Infection safety hasplayed a crucial role inprogress on reducingthe global burden ofHIV and hepatitis83%reduction in hepatitis B infectionsdue to unsafe injections200020101.7 million21 million66/71Countries exclusively usingauto-disable syringes forimmunization87% 91%Reduction in HIV infectionsdue to unsafe injections280 000reduction in hepatitis C infectionsdue to unsafe injections2 million200020002010201033 900315 000

Every year at least16 billion injectionsare administeredworldwideAbout 90% of these injections are given in curative care.A great many of these injections are unnecessary orcould be replaced by an oral formulation. WHO urgesreduction in the number of unnecessary injections asan urgent and critical strategy for reducing transmissionof viral infections.Other injection devices are still needed– and need to be used safelySyringes engineered to prevent re-use arenot suitable for certain medical procedures,including the following:Administering multiple medicines: Healthworkers need to use disposable syringes that donot block or break if the plunger is moved whenthey mix more than two different medicines intothe same syringe for treatment of a single patient.Nasal feeding: A large disposable syringe isneeded to push nutrients through a feeding tube.Standard safety procedures are critical inall these situations. That is why education ofboth health workers and patients on injectionsafety represent a crucial part of WHO’s policyrecommendations.Maintenance of intravenous lines: Healthworkers need standard disposable syringes(equipped with plungers that will not block) toflush out intravenous lines and keep them flowing.Local anaesthesia: This type of anaesthesia,which requires injections to multiple sites,requires a standard disposable syringe.

What needs tohappen, whoneeds to do itGovernmentsBy 2020 transition to the exclusive use, where appropriate, of safety-engineeredinjection devices with re-use prevention and sharps (needle) injury prevention.These devices should meet WHO quality standards.Set health-system-wide policies and standards for procurement, use and safedisposal of disposable syringes in situations where they remain necessary,including in syringe programmes for people who inject drugs.Develop an implementation strategy for procurement of safety-engineeredsyringes, training and education of health workers and sound wastemanagement. Establish a targeted communications programme and a frameworkfor evaluating overall progress.Donors and development partnersOnly fund procurement of safety-engineered injection devices in all projects thatinclude administration of injectable medicines.Provide funding for ancillary needs, including appropriate quantities of singledosediluents and safety boxes, sharps waste management and health workertraining.ManufacturersBegin or expand production as soon as possible of safety-engineered injectiondevices while maintaining sufficient production of single-use disposablesyringes.Seek WHO Performance, Quality and Safety prequalification for their products.

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