Ensuring the safe and appropriate use of injections at country level
WHO proposes a framework to assist national policy makers in assessing, planning, implementing and evaluating national policies for the safe and appropriate use of injections.
- Rapid assessment techniques may be used to estimate the proportion of injections that are unsafe, estimate the frequency of injections, identify injection providers and characterize the determinants of injection practices. These assessment techniques are based upon (1) interviews of prescribers, (2) observations and interviews of injection providers and (3) interviews of the general population.
- The full injection safety assesment tool (Tool C) and the Tool C Revised, when performed according to protocol, provide a statistically valid means of assessing injection safety in a Geographic area. A full survey provides also considerable other information of use to a programme e.g. an assessment of waste disposal, needle stick injuries among injection providers and any other information needed. The survey assesses potential modes of transmission of blood borne pathogens other than injections, e.g. intravenous injections, multi dose vial use, phlebotomy and lancet procedures. The assessment indentifies multiple potential areas for improvement
Planning for change
The key elements of a plan for the safe and appropriate use of injections include (1) the programmes on HIV/AIDS and hepatitis prevention and care communicating the risk of unsafe injections to patients and health care workers, (2) essential drugs ensuring availability of safe injection equipment, diluent and safety boxes and promoting rational use of injections within the national drug policy, (3) immunization and family planning services making auto-disable (AD) injection equipment and safety boxes available with vaccine and injectable contraceptives and (4) curative health care services managing sharps waste within the health care waste management plan.
Implementing multidisciplinary interventions
Tools are available to:
Develop safe and appropriate use of injection behaviours among patients and health care workers;
Procure injection equipment;
Manage sharps waste.
Progress towards safer and more appropriate use of injection needs to be demonstrated through inclusion of injection practices criteria into indicators of technical quality of health systems using a combination of input, process and outcome indicators. In addition, a supervision tool is available to strengthen good injection practices and improve weak ones.