Injection safety policy and global campaign
All of us, at some point in our lives, will have an injection to retain or restore good health. But sometimes injections that are intended to promote health do the opposite. This happens when they are given in an unsafe way - using the same needle or syringe to give injections to more than one person. Practices like this can lead to the transmission of life-threatening infections.
According to a new study, unsafe injections are responsible for as many as 33 800 HIV infections, 1.7 million hepatitis B infections and 315 000 hepatitis C infections annually. Both patients and health workers are at risk through needle injury.
Towards safe injections for all
WHO and close partners – including the Safe Injection Global Network (SIGN), UNICEF and GAVI, the Vaccine Alliance – have been working actively together for more than a decade to promote safe injection practices. Educating policy makers and health workers on the critical importance of sterile equipment is key. The group’s initial push in 1999 focused strongly on spurring countries to use only auto-disable syringes for vaccinating children. Now the spotlight is on the risks associated with injections into muscle (intramuscular) or skin (subcutaneous or intradermal) to treat medical conditions; and how to make them safer through education on safe procedures, elimination of unnecessary injections and better design of equipment.
Breakthrough: The new smart syringes
The surest way to protect against unsafe injections is to use injection devices that have been engineered so they cannot be re-used and don’t lead to accidental needle stick injuries among health workers.
Re-use prevention features are essentially the same as the auto-disable features designed for immunization of a single child. The main difference is that syringes designed for delivering medicines allow the health worker to adjust the dose as needed and to move the plunger twice when it is necessary to mix two different medicines in one syringe or for the reconstitution of vaccines and medicines where appropriate. Some models include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back while in others the needle retracts into the syringe barrel at the end of the injection.
Syringes are also being engineered with features to protect health workers from “needle stick” injuries and resulting infections. A sheath or hood slides over the needle after the injection is completed to protect the user from being injured accidentally by the needle. These syringes also generally have a re-use prevention feature.
- WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings
Stakeholder support: What needs to happen, who needs to do it
The injection safety policy and global campaign is a three to five year initiative that engages many public and private sector stakeholders such as Ministries of Health, international donor programmes, industry players and umbrella organizations representing injection device manufacturers and health care workers.
Some critical goals of the initiative include:
- By 2020 transition to the exclusive use, where appropriate, of safety-engineered injection devices with re-use prevention and sharps (needle) injury prevention. These devices should meet WHO quality standards.
- Set health-system-wide policies and standards for procurement, use and safe disposal of disposable syringes in situations where they remain necessary, including in syringe programmes for people who inject drugs.
- Develop an implementation strategy for safety syringes’ procurement, training and education of health workers and sound waste management. Establish a targeted communications programme and a framework for evaluating overall progress.
- Donors and development partners
- Only fund procurement of safety-engineered injection devices in all projects that include administration of injectable medicines.
- Provide funding for ancillary needs, including appropriate quantities of single-dose diluents and safety boxes, sharps waste management and health worker training.
- Begin or expand production as soon as possible of safety-engineered injection devices while maintaining sufficient production of single-use disposable syringes.
- Seek WHO Performance, Quality and Safety prequalification for their products.
WHO is beginning to pilot test elements of the injection safety policy and global campaign throughout 2015 and will announce and integrate lessons learned.