1. Improvement of Injection Safety in Burkina Faso, 1995-2000 JF. Aguilera, J. Fitzner, A. Yaméogo, Y. Hutin

2. Kane et al, Injection Safety: A World-wide Challenge 12 billion injections –95% therapeutics and 5% vaccinations Injection-Associated infections –HBV: 8-16 million –HCV: 2.3 - 4.7 million –HIV: 80,000 to 160,000 Years of Life lost: 26 million Direct medical cost: $ 535 million Kane A. et al, Bulletin of the WHO, 1999

3. AFRO Logistics Project (1995)

4. SIGN Initiative Initial Assessment –Standardised methodology –Structured sampling –Adequate sample size Implementation of a New Approach –Behaviour change –Equipment and supplies –Sharps waste management

5. Survey in Burkina Faso, June 2000 >Objectives –Estimate the frequency of unsafe injection practices in Burkina Faso –Pilot test the WHO/SIGN standardised tool

6. Study Design Cross-sectional study Two stage cluster sampling – 8 districts, probability of selection proportional to population size – 10 health centres, simple random sampling

7. Standardised Data collection –Direct observations forms Supplies of injection equipment Injections observation (max 3 / centre) –Standardised Questionnaire to HCWs Analysis –Design Effects using CSAMPLE –Confidence Interval using EPITABLE

8. Results 80 health centres visited 80/80 centres had a nearby pharmacy were patients could buy new disposable equipment In 52 centres, 116 injections were observed 50/52 centres used new disposable equipment 5/80 centres additionally used sterilisable equipment

9. Hazard to Patients at 52 Centres

10. Hazard to Healthcare Workers

11. Hazard to Community in 80 Centres

12. Limitations Replacement of 13 (16%) of selected centres because of inaccessibility No assessment of quality-assurance of different brands of new disposable equipment used in centres Injections observed in 52/80 centres

13. Conclusions Improvement of injection practices –Increased use of sterile disposable injection equipment between 1995 and 2000 Some areas still require improvement: –Re-use of disposable equipment –Two-handed recapping –Vaccines supplied without boxes/equipment –Use of safety boxes for sharps is uncommon –Sharps disposable unsafe

14. Recommendations Behaviour change –Eradicate re-use of disposable equipment –Prevent two-handed re-capping –Heightening staff awareness on waste disposal Equipment and supplies –Ensure supplies of vaccines through “bundling” –Facilitate community supply of sharp boxes Sharps waste management –Development of a national policy addressing medical waste disposal

15. Recommended changes to the Standardised Tool Optimise the survey time frame –Timing eg. season –Standardisation / Briefing / Debriefing Adapt observation forms / questionnaires Increase the observation of injections –Injection simulation could be organised Improve the logistics –Reaching remote centres

16. Acknowledgements EPI Team Health Staff Centres WHO Representation in Burkina Faso EPIET coordinators FED ARIVAS Project, Burkina Fasoj