1. Giving Safe Injections Presented by :Dr Esteghamat

2. Unsafe Injections Injections that harm the recipient, the provider, or that result in waste that is dangerous for other people. Unsafe injections can cause disease, injury and death.

3. Causes of Unsafe Injections World Health Organization estimates: –12 billion injections administered each year –50 % (6 Billion) are unsafe –95% of injections are therapeutic –25% to 95% of outpatient visits resulted in an injection Many injections may be unnecessary, ineffective or inappropriate

4. Causes of Unsafe Injections 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 –Others: Parasitic (Malaria), bacterial (abscess), fungal and other infections Some infections may not be obvious for years

5. Causes of Unsafe Injections Poorly administered injections can cause injuries or drug toxicities when: –Wrong injection site used –Incorrect drug used –Wrong diluents used –Incorrect dose used

6. Rules of Safety Assume all body fluids contain pathogens Assume the skin and the environment contain microorganisms Unsafe injections can spread pathogens more easily than inhalation, swallowing or sex Do No Harm: Health Worker responsibility

7. Body Fluids Any body fluid may contain pathogens and spread disease Treat all human and animal body fluids as contaminated by pathogens Wash hands thoroughly with soap and water until visible dirt is gone.

8. Clean Skin

9. Unsafe Injections Can Cause Infections Unsafe injections can transport microorganisms into the body, that are: –transferred from fingers or objects to the needle –present on the skin and picked up by the needle –in the medication to be injected –inside the syringe or needle that has been previously used

10. Unsafe Injections Can Cause Infections Unsafe Injections Can Kill

11. Health Worker: Do No Harm Give only necessary injections Use sterile syringe and sterile needle for every immunization or DO NOT immunize Arrange the workspace and institute disposal practices to prevent needlesticks to self and others

12. Why Re-Use Occurs Re-use of contaminated syringes/needles: –Inadequate supply –Lack of understanding of danger –Unmonitored/inadequate sterilization –Inadequate disposal and distribution (public access to contaminated equipment)

13. Unsafe Injections Can Cause Infections Today: Millions of people have weakened immune system Billions of injections are given by untrained and unaware people. New pathogens have been recognized

14. Practices That Can Harm Recipients Giving unnecessary injections Loading syringes with multiple doses and injecting multiple people Leaving the needle in the vial Touching the needle

15. Practices That Can Harm Recipients Mixing two partially opened vials of vaccine Keeping freeze-dried vaccine more than 6 hours. Storing medication and vaccine in same refrigerator Applying pressure to bleeding sites with used material or finger Vaccinating infants in the buttocks

16. Practices That Can Harm Health Care Workers Re-using needles and syringes. Carrying needles or placing them on a surface prior to disposal Recapping needles

17. Practices That Can Harm the Community Leaving needles and syringes in areas where children can take them Leaving needles and syringes in areas accessible to the public

18. Vaccines Safety

19. Checking Vials and Labels 1. Label 2. Age of the vaccine (expiration) 3. Signs of contamination 4. Exposure to freezing 5. Exposure to excessive heat

20. Assessing Contamination discard it if: Leaks or cracks are present, Change in appearance or floating particles are seen Submerged in water Pierced with used needle. Vaccine was reconstituted more than 6 hours before. Vial opened for more than 4 weeks.

21. Assessing Exposure to Freezing DPT, DT, Td, TT, hepatitis B, diluents and Hib should be discarded if you highly suspect or are certain that they are/were frozen “Shake taste” DPT, DT, Td and TT (contain aluminum hydroxide adjuvant) when refrigerator log shows subfreezing temperatures. If failed, discard.

22. Assessing Exposure to Freezing Hepatitis B and Hib vials should be discarded if frozen or suspected of freezing. The “shake test” doesn’t work for them.

24. Freeze Watch

25. Freeze-tag Shelf life is 5 years.

26. Assessing Exposure to Heat Vaccine Vial Monitor (VVM) Present: –If VVM inner square is the same color or darker than the outside circle, discard the vial Vaccine Vial Monitor (VVM) Not Present: –Check temperature log and cold-chain monitoring cards. If exposed to temperatures above 8º C, discard it.

27. Checking Vaccine Vial Monitors VVM is a label made of heat-sensitive material, placed on the vial to show cumulative heat exposure over time VVM reduces waste of vaccine, ensuring that only good vaccine is used

30. Storage Thermostat Ice Packs in freezing compartment “Returned box Oral Polio, Measles BCG, DPT, TT, diluent Ice packs

31. Checking the Vaccine and Diluent Vials Before use, check the following: –Is the label still attached to the vial? –Is the right vaccine and right diluent? –Expiration date? –Contamination (discard reconstituted vaccine 6 hours after reconstituted) –Cold sensitive vaccines show no signs of freezing –No signs of heat exposure

33. Vaccines Which Require Specific Diluent BCG vaccines Measles-containing vaccines Freeze-dried Haemophilus Influenza type b (Hib) vaccines Yellow fever vaccines

34. Reconstituting Vaccines Safely Reconstituted vaccines should be kept cool, between 2º and 8º C to maintain their potency Place reconstituted vaccines in slits made in a foam piece that sits in the top a vaccine carrier

35. Reconstituting Vaccines Safely Discard reconstituted vaccine after 6 hours. BCG, measles-containing vaccines, yellow fever vaccines and freeze-dried Hib vaccines do not have preservatives. Death may occur

36. Reconstituting Vaccines Safely Store only vaccines in the refrigerator. Medications can accidentally be administered instead of vaccines Do not reconstitute vaccine until the person needing the vaccine injection is present

37. Reconstituting Vaccines Safely Use a new syringe and needle to reconstitute each vial of vaccine Check that the diluent is the one provided by the manufacturer

38. Reconstituting Vaccines Safely Discard the used mixing syringe and needle in a sharps container Do not leave the mixing needle in the vial (contamination) Mix the contents of vial by rolling the vial between your fingers. Note date and time of reconstitution

39. Safe Disposal of Injection Equipment and Other Sharps To further prevent needlesticks use leak- proof, puncture-proof containers for needles, syringes and other medical waste that might cut or puncture the skin (broken vials, etc) Sharp containers Safety boxes Needle-disposal boxes

40. Sharp Containers

41. Leak-proof Puncture-proof Clearly labeled with warning (easy for the community to understand) Do not overfill (only 3/4 is safe) Do not transfer contents to other container

42. Sharp Containers Unsafe Safe

43. Unsafe Photo: Keith Sabin

44. Unsafe