1. 1 Dr.I.A.Joshua 2 Dr JG Makama 3 Dr A Oyemecho 1 Department of Community/ 2 Department of Surgery Kaduna State University, Kaduna, Nigeria 3 Department of Epidemiology and Community Health, Benue State University, Makurdi, Nigeria

2. OBJECTIVES OF THE SEMINAR To improve the knowledge of the University community including students, hospital staff and general public on injection safety and management of hospital waste. To prevent/ decrease the occurrence of needle stick injuries among staff and others. To sensitize the management on the need for periodic injection safety assessment. To improve knowledge on proper process of hospital waste management.

3. INJECTION SAFETY OUTLINE OF PRESENTATION 1. INTRODUCTION 2. CONCEPT OF SAFE INJECTION 3. ISSUES IN MISUSE AND OVERUSE OF IINJECTION 4. MAGNITUDE OF THE PROBLEM OF UNSAFE INJ 5. PUBLIC HEALTH IMPORTANCE 6. WAY FORWARD 7. MANAGEMENT OF NEEDLE STICK INJURY 8. CONCLUSION

4. INTRODUCTION Injected medicines are commonly used in healthcare settings for the prevention, diagnosis, and treatment of various illnesses Unsafe injection practices put patients, healthcare providers and the community at risk of infectious and non-infectious adverse events and have been associated with a wide variety of procedures and settings. This harm is preventable. Safe injection practices are part of general precautions and standard practices in health care delivery aimed at maintaining basic levels of patient safety and provider protection

5. As defined by the World Health Organization (WHO), 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, 2005). Syringes with a reuse prevention features offer the highest level of injection safety to recipients WHO (2005) urges that by 2005 all injectable medications are supplied with matching quantities of single use injection devices, appropriate diluents and safety boxes through essential medicine programmes and other health programme supply mechanism

6. CONCEPT OF SAFE INJECTION A safe injection does not harm the recipient, does not expose the health workers to any avoidable risk and does not result in waste that is dangerous for the community The safe collection and disposal of used sharps (needles, syringes with fixed needles) is an integral part of the life cycle of injection device The collection of sharps waste in safety containers (safety boxes) at the point of use and their safe and environmentally responsible disposal protect health care workers and the general public from needle stick injuries

7. A first step toward evaluating the frequency of unsafe injection practices in countries is an injection safety assessment Three major considerations are especially relevant in the assessment of potential unsafe injections- The safety of the recipient The safety of the health workers The safety of the community

8. ISSUES IN MISUSE & OVERUSE OF INJECTION Injection is one of the most common health care procedures Each year at least 16 billion injections are administered in developing & transitional countries (WHO,2005). The vast majority, about 95% are given in curative care, immunization accounts for about 3% of all injections, the remainder for other indications including use of injections for transfusion of blood/blood products & contraceptives

9. Majority of therapeutic injections in developing and transitional countries are unnecessary. In some situation, as many as 9 out of 10 patients presenting to PHC providers receive an injection, over 70% of which are unnecessary or could be given in an oral formulation.

10. REASONS FOR INJECTION MISUSE & OVERUSE 1.Patients tend to prefer injections because they believe these to be stronger and faster. 2.They also believe that doctors regards injections to be best treatment. 3. In turn, Drs over prescribed injections because they believe that this best satisfies patients. 4.In addition, prescription of injection sometimes allows the charging of higher fee for service. Better communication between patients & providers can clarify these types of misunderstandings & help to reduce injection overuse!

11. MAGNITUDE OF THE PROBLEM In general, the assessments undertaken have shown that reuse of reconstituted syringe is common. So there is need for advocacy for policy change which will lead to the implementation of safe injection practices Epidemiological studies indicate that a person who experiences one needle-stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively to become infected with HBV, HCV and HIV

12. Dumping Hospital waste in open areas is a practice that can have major adverse effects on the population. The «recycling» practices that have been reported, particularly, the reuse of syringes is certainly the most serious problem in a number of countries. The WHO estimates that over 23 million infections of hepatitis B, C and HIV occur yearly due to unsafe injection practices (reuse of syringes and needles in the absence of sterilization)(WHO, 2005).

13. PUBLIC HEALTH IMPORTANCE  Unsafe injections or unsafe practices in relation to immunization are not only- Responsible for cases of Hepatitis B,C,HIV/AIDS, etc And other serious potentially lethal side effects suffered by vaccine recipients May pose an occupational hazard to health providers Environmental hazards to the community (soil, air & water) Unsafe injection practices can seriously impede the progress made by immunization programmes leading to substantial negative effects on global immunization coverage

17. WAY FORWARD  Safe & appropriate injections can be achieved by adopting a 3 part strategy- 1. Changing behaviour of health workers and patients 2. Ensuring availability of equipment and supplies 3. Managing waste safely and appropriately

19. MANAAGEMENT OF NEEDLE STICK INJURY In the event of a sharp or needle stick injury Encourage bleeding from the wound- do not suck or rub Wash area thoroughly with soup and water Cover with a water –proof dressing If known, note the name of the patient Report to occupational health unit Notify line manager and document the accident If patient is thought to be HIV +, post-exposure prophylaxis (PEP) may be required. This should be given as soon as possible after injury. STAFF SHOULD BE FAMILIAR WITH LOCAL PEP GUIDELINES!

20. CONCLUSION The safe use of injections, collection, transportation and disposal of used sharps (needles, syringes with fixed needles) is an integral part of the life cycle of injection device. All have a responsible so ensure that is done properly!

21. THANK YOU!

22. REFERENCES SIGN (Safe Injection Global Network) www.safeinjection.or (accessed April 2013) www.safeinjection.or WHO (2005). Managing an injection safety policy, WHO/V& B/0.1.30 CDC 24/7 : Saving lifes and protecting people. WHO fact sheet No 231: Injection safety (revised October 2006). A paper presented by Dr.I.A.Joshua at a conference @ Byumba Health Institute, Rwanda, 2005. Bailliere’s Nurses Dictionary, edited by Barbara F.Weller, 23 edition, p 556, appendix 15