1. Injection Safety in EPI: More than just AD Syringes and Safety Boxes World Health Organization HTP/V&B/EPI

2. Use of the Estimated 12 Billions Injections Administered Annually Worldwide Immunizations Therapeutic injections Measles campaigns?

3. Injection Safety l In a year, unsafe injections may be responsible for: $8 to 16 Million cases of Hepatitis B $2 to 5 Million cases of Hepatitis C $80,000 to 160,000 cases of HIV

4. Injection Safety: Definition l No harm to the recipient l No harm to the health-care worker l No harm to the community Reuse of equipment Unsafe collection Unsafe disposal

5. INJECTION SAFETY Key steps to improve safety Use of injection safety equipmentAdequate injection technique Disposal of used sharps in safety boxes Appropriate waste management

6. Injection Safety l Preventing needlestick injury $Do NOT recap needles $Do NOT bend needles $Do NOT manually remove needles from syringes $Do NOT transport without sharp container or safety boxes

7. Injection Safety l Sharp Containers

8. Injection Safety l Sharps container UNSAFE SAFE

9. Challenge How to safely dispose of used injection equipment within the EPI and during mass vaccination campaigns?

10. Assuring safe disposal of used injection material within the EPI Waste mgmt is a chronic and frequently overlooked component of EPI EPI waste only a small proportion of healthcare waste ns greatly increases this chronic problemWeak health and community waste mgmt systems. Mass vaccination campaigns greatly increases this chronic problem Waste mgmt is an essential component of mass vaccination campaigns Early planning necessary to identify options and develop achievable plans

11. Challenges for Waste Management during mass vaccination campaigns No “one-size-fits-all” solution Need local assessment, simple solutions Environmental concerns, pressure groups, Kyoto agreement, bans on burning in some countries Implementation of the “Polluter Pays” principle Waste mgmt must be budgeted/funded/planned Measles and other vaccination campaigns should assist in the development of long-term EPI waste mgmt solutions

12. Options for disposing of used injection material within the EPI l Open burning and burying l High temperature incineration l Burial l Dumping in pit latrine or other secure pit l Transport for off-site treatment l New technologies/recycling

13. Injection Safety l Open burning - cheap and practical option  Combustion is at lower temperature  May not completely destroy injection equipment  More toxic emission, chances of more waste scatter  Usually done in open pit or metal drums  Fence off and clear area and warn people to stay away from site  Ashes should then be buried

14. Injection Safety l High temperature incineration  The high temperature kills microorganisms  Destroys syringes and needles by burning at high temperature (800 0 C)  Minimal toxic fumes from incinerator, less air pollution  Reduce volume of waste to minimum  Requires special facilities  Costly & complex to operate depending on model

15. Advantages of high temperature incineration  Assures complete combustion of used injection equipment  Markedly decreased risk of toxic emissions if properly used  Increased melting of needles  Less risk of blood-borne infections to the community

16. EPI Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – High temperature De Montford Locally built brick Incinerator US $1000 Installed

17. EPI Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – High temperature Factory built Prefabricated Incinerator US $5000 Installed

18. Injection Safety l Burial  Burial can be for unburnt injection waste or waste generated by burning  The pit should be at least 1 meter in depth  It should be cordoned off to prevent access to site by people/children

19. EPI Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Waste Burial Pit

20. Assurance of injection safety with the EPI Conclusions Proper equipment is necessary, but not sufficient. Careful planning/budgeting/training needed Injection safety requires a long-term vision Short-term solutions available Creativity/teamwork needed to find long-term sustainable solutions Solving the overall health care waste mgmt challenge is beyond the scope of the EPI Mass vaccination campaigns should contribute towards finding sustainable solutions to the challenge of EPI waste mgmt. “Bundling” should include waste mgmt plans and financing