The WHO injection safety assessment tool: first results

SIGN Meeting 2001New Delhi, India

Rationale for Assessments

Assessments identify local problems to design effective, efficient interventions

Data provide baseline information, & suggest indicators for monitoring

Data open the door to dialogue

Overall, it shall help countries designing and implementing a safe injection policy

Standard assessment of injection practices

ObjectivesTo determine if the country meets necessary

requirements for staff competence, equipment, supplies, and waste disposal

To assess if the injections are administered according to recommended best practices

To estimate the proportion of healthcare facilities where injection practices are safe

MethodsStandardized and representative

method to allow for: Measuring and documenting progress Comparison across countries

Simple/structured and flexible 2-3 weeks

Can be adjusted to country needs (for instance focus on immunization and/or therapeutic injections)

Standard assessment of injection practices

Methods (contd.)Cross sectional observational study

Observation of supplies Observation of injections Interview of healthcare workers

Two stage cluster sampling 8 districts selected 10 health care centres in each district

Representative of the country

Standard assessment of injection practices

The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organization concerning the legal status of any country,territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

Safe injection assessments June 2000-August 2001

Assessments done (14 countries)

Assessments planned (14 countries)

Nepal, Kyrgyzstan,

Egypt, Morocco, Oman, Syria,

Paraguay, Honduras,

Burkina Faso, Niger, Ethiopia,

Chad, Zimbabwe and Gambia

First results: use of injection material (based 9 available reports)

3 countries are not using sterilizable injection material any more

In 6 countries, between 6 and 84% of observed injections are done with sterilizable material (countries in transition)

1 country is using AD-syringes for all observed immunizations

Only 2 countries practice the bundling of vaccines, injection equipment and safety boxes for the immunization activities

Risk for the recipient(Use of sterile equipment for injections)

100% use of sterile equipment for all observed injections in only one country (using disposable equipment)

In 6 countries using sterilizable equipment:Non documented sterilisation regularly with TST spotUse of sterile equipment between 55 and 88% Spare parts and a 2 day supply were not available in a

majority of the health facilities

Countries using AD or disposable syringes have between 85 to 100% of health facilities using sterile equipment

Risk for the health care worker

Use of safety-boxes observed in 60% of health facilities (0-89%)

Sharps found in open containers in 80% of health facilities (34-95%)

Used syringes recapped in 54% of health facilities (16-71%)

At least 1 needle-stick injury in the last 12 months for 61% of health care workers (22-76%)

Risk for the community

No sharps found in the surroundings of health facility in 50% of cases (27-77%)

Waste disposal, open burning or dumping unsupervised in 39% of health facilities (18-64%)

Health care waste policy in only 5% of the health facilities (0-9%)

Conclusions

The risks for the recipient are high in countries using sterilizable equipment

The safety of the health care worker and the community is a problem in all observed countries

Limitations in comparing across countries - the tool is designed to help individual countries to develop and implement a safe injection policy

Next step: very important to follow-up these assessments, country by country...