Giving Safe Injections

Presented by :Dr Esteghamat

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.

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

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

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

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

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.

Clean Skin

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

Unsafe Injections Can Cause Infections

Unsafe Injections Can Kill

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

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)

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

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

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

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

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

Vaccines Safety

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

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.

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.

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.

Freeze Watch

Freeze-tag

Shelf life is 5 years.

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.

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

Storage

ThermostatThermostat

Ice Packs in freezing

compartment

Ice Packs in freezing

compartment

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“Returnedbox

Oral Polio, MeaslesOral Polio, Measles

BCG, DPT, TT, diluentBCG, DPT, TT, diluent

Ice packsIce packs

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

Vaccines Which Require Specific Diluent

• BCG vaccines

• Measles-containing vaccines

• Freeze-dried Haemophilus Influenza type

b (Hib) vaccines

• Yellow fever vaccines

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

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

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

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

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

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

Sharp Containers

Sharp Containers

• 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

Sharp Containers

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