1. A National Program for Promotion of Infection Control and Safe Injections In Egypt Annual Meeting of the Safe Injection Global Network SIGN, 2002

2. Ministry of Health and Population Partners USAID WHO Ford Foundation Namru-3

3. A National Program for Promotion of Infection Control and Safe Injections In Egypt Background Goals and objectives of the program Findings of baseline assessment Strategic approach of the program Communication Strategy to prevent BBPs transmission –Objectives –Target audiences –Messages –Means –Material

4. Blood-borne pathogens transmission in Egypt Major public health problems 10-15% of the population have HCV infection Prevalence of HBV is 4% Three epidemics of Aids were reported in Egypt since 1993 Treatment of infected persons is a burden on the economy of Egypt

5. Nosocomial Infections Emerging as important public health problem throughout the world - increase in antimicrobial resistance - high cost of health care - increased morbidity and mortality Particular problem in countries with rapid development of health care services and introduction of new technology - infection control is not a well recognized discipline

6. Risk Factors Associated with HCV Transmission in Egypt ReferenceStudyRisk Factors El-Zayadi ’ 99 Cross- section Unsafe injections, dental procedures, invasive medical Kumar ’ 98 Cross- section Household transmission El-Sayed ’ 97 Cross- section Schistosomiasis, surgery Tibbs ’ 97 Cross- section Poor sterilization of medical equipment Angelico ’ 97 Cross- section Schistosomiasis treatment

7. Risk Factors Associated with HCV Transmission in Egypt ReferenceStudyRisk Factors Quinta ’ 95Cross sectionSchistosomiasis treatment Bassily ’ 95Cross sectionHistory of selling blood, IDU Nanaway ’ 95Cross-sectionTransfusions, El-Sakka ’ 94Case ControlUnsafe injections, Darwish ’ 93Cross sectionSchistosomiasis, injections Hyams ’ 90Case Control (non-A non-B) Transfusion, medical injections

8. Framework of the national program to promote infection control and safe injection practices in Egypt Promotion of safe injection practices in the community Promotion of infection control practices in health care facilities Safe blood transfusions Pilot project in 2 governorates - transition to a national program

9. l Reduce HCV transmission and hepatitis related chronic liver disease l Reduce transmission of hospital-acquired infections in the health care setting l Improve quality of health care services through promotion of infection control Program Goals Program to promote infection control

10. l Promotion of infection control in Health Care Facilities - Implement standard precautions for infection control - Promote safety of injections - Reduce occupational risk of BBP infection l Prevention of transmission of BBP’s in the Community - Promote safe injection practices - Educate the general public on BBP transmission Program Objectives Program to Promote Infection Control

11. Methods Community-based survey Standard questionnaires 6 rural villages 2 urban cities 720 households 4197 persons interviewed

12. Baseline Assessment Injection practices at community level Community-based surveys Quantitative assessmentMeasure injection frequency Describe types of injections Identify injection providers Estimate unsafe injections Qualitative surveysExplore beliefs and attitudes towards injections Aim of the Survey

13. Baseline Assessment Infection Control Practices in HCF Governorate-wide random sample of public and private health care facilities (98 health facilities) 53 public health care facilities 16 private hospitals 29 private dental clinics

14. Baseline Assessment Infection Control Practices in HC Health Facility Surveys Infection control practices (Observation and interview) Assess infection control practices Prescription survey Health Care worker survey Qualitative Survey Measure prescription frequency Assess Occupational risk Explore motivational factors of HCW Aim of the Survey

15. Proportion of Households Reporting at Least One Person Who Received an Injection in the Previous Three Months; Survey in Sharkia and Qena, 2001

16. No. persons No. (%) reporting Site surveyed injection in past 3 mos Sharkia2599 720 (27.7%) Qena 1598 381 (23.8%) Total 4197 1101 (26.2%) Frequency of Injections among Residents of Qena and Sharkia, 2001

17. Site Mean No.ofNo. of injections injections/person per person per year in the past 3 mos Sharkia 1.2 4.8 Qena 0.9 3.6 Total 1.05 4.2 Estimated Number of Injections/ Person/ Year Survey in Sharkia and Qena, 2001

18. Type of Injections Received Survey Sharkia and Qena, 2001

19. Who administers injections in Community -based survey

20. Prescribers of injections Community-based Survey

21. Challenges: 70% household prevalence rate of injections (3mos) 26% individual based prevalence rate of injection ( 3 mos) 84% therapeutic injections 4.2 injections/person/year 281 millions of injections yearly in Egypt 8.4% of injections are unsafe (23 millions injections) 20-40% of injections provided by the informal sector 37-49% of injections are prescribed by doctors Findings of Baseline assessment Population-based Survey

22. Qualitative Assessment Population-based Survey Challenges General rural population prefers injections - They cure faster - An Injection is easier to use than tablets - Injections don’t cause stomach problems - They are useful in serious diseases - Injection providers are accessible - Lack of awareness of risks associated with injections

23. Key findings Health care facility Survey Infection Control Challenges –No concept of infection control –No hand washing or wearing gloves –Unsafe injections provided –Unsafe sharp disposal –Lack of training –Lack of supplies and material –Inappropriate sterilization methods –Overprescription of injections (23%) –Lack of waste management –High exposure of HCWs to needlestick injuries

24. Frequency of Needlestick Injuries Health Care Worker Survey No. % with Annual Mean Group Interviewed needlestickNo. of (3 months) needlesticks Allied HCW 6427% 1.8 Dentists 7836% 3.9 Nurses 683 38% 4.5 Housekeepers 22940% 5.0 Doctors 33931% 5.9 Lab techs 92 32% 6.3 TOTAL148536% 4.9

25. Behaviors Associated with Recent Needle Stick Injury, Health Care Worker Survey 2001

26. Hep B Vaccine Coverage among HCWs No. No Percent Interviewed vaccinated vaccinated Group Doctors 339129 38% Dentists 78 30 38% Nurses 683 60 9% Lab techs 92 5 5% Housekeepers 229 8 3% Allied HCW 64 3 5% TOTAL1485235 16%

27. Strategic Approach National Program for Promotion of Infection Control I.Organizational Structure II.Development of national guidelines for infection control III.Training and capacity building IV.Surveillance of nosocomial infections V.Occupational safety health program VI.Provision of critical supplies and equipment VII.Advocacy VIII.IEC Communication Strategy to prevent transmission of BBPs

28. IEC communication strategy to prevent transmission of BBPs Objectives Target audiences Messages Means Material Implementation Evaluation

29. IEC communication strategy to prevent transmission of BBPs Objectives: Raise the awareness of the public and health care providers to promote injection safety

31. IEC communication strategy to prevent transmission of BBPs Target Audiences All sectors of the rural population Health care providers Doctors Nurses Janitors

32. IEC communication strategy to prevent transmission of BBPs Messages Messages to the public - Reduce overuse of injections - Don’t reuse a syringe Message to the doctors –Rational use of injections Message to the nurses –Provide a safe injection

33. IEC communication strategy Means of conveying messages  Radio and TV programs  Airing of TV spots in 2003  Continuous Press Release  Community outreach and mobilization for public –Partnership and networking (NGOs and Government) –Disseminate messages through an existing structure –Leadership (community leaders) –Community participation –Volunteers –Reach different social and cultural complexes

34. Launching of a campaign for prevention of BBPs transmission Launching started in September, 2002 Slogan –Safe injections save lives Local activities are focused in two governorates –Sharkia –Qena

35. IEC communication strategy to prevent transmission of BBPs Motivation of health care workers Regular meetings with key personnel –Primary health unit directors –Head nurses of facilities Competition between facilities “ Safe sharp disposal” Awards Recognition Certificates

36. Community leaders target different groups –Teachers illiterate (illiteracy programs) school children –Women community leaders (house to house visits to illiterate housewives) –Religious leaders (men in rural villages) –Students’ unions in universities –Events and meetings Communication Strategy Community outreach and mobilization

37. Communication Strategy IEC Material Process of development of IEC material –SIGN consultant –Development of image bank –Field Testing of material –Modification of material –Printing and distribution of the material

38. Communication Strategy IEC Material IEC material for the Public –Community leaflet for the educated –Power point presentation for the illiterate –Posters –Give aways (calendars and others) IEC material for health care providers - Good prescribers guide for doctors - Safe injection providers guide for nurses - Video film (Zahra)

43. Good Provider’s Guide

44. PROTECT YOURSELF

50. Community Leaflet

54. Communication Strategy to prevent BBP’s transmission Evaluation Long term process Community-based indicators –Injection use –Safety of injections Health facility indicators –Prescription rate of injections –Qualitative surveys

55. Thank you