The annual SIGN meeting was hosted by the Ministry of Health of the Kingdom of Cambodia on 24-26 October 2002.
Substantial progress was noted during the two days of the SIGN meeting as many countries were able to share their experience in managing the safe and appropriate use of injections through a systematic approach that included assessment, planning, implementation and evaluation. On the third day, that was dedicated to a SIGN working group on injection equipment and waste management technologies, a field visit provided an opportunity to review operational issues in the use of auto-disable syringes and auto-combustion incinerators. In addition, discussion took place regarding the accelerated introduction of auto-disable syringes in immunization and other services and the available strategies to manage sharps waste.
With respect to assessment, the SIGN participants underlined the importance of engaging stakeholders so that assessment can be followed by action. At the planning phase, the need of well coordinated multidisciplinary coalitions that bridge public and private partners was emphasized. For the implementation of activities in the area of behaviour change, provision of supplies and sharps waste management, there is a need to build in monitoring strategies as part of routine activities. Finally, at the evaluation stage, a combination of input, process and outcome indicators must be examined, including the incidence of injection-associated infections. SIGN participants expressed satisfaction with respect to the partnership with the industry that is progressively allowing a systematic approach to ensure the quality and safety of injection equipment through national regulations enforcing international standards. However, for waste management, unresolved issues persist with respect to the potential role of plastic recycling combined with needle removal and with respect to the risk-benefit ratio of incineration as a waste management option.
SIGN participants agreed on a list of recommendations and proposed to hold the 2003 meeting in sub-Saharan Africa through an organization that would allow a stronger engagement of the international public health community in the role of safe and appropriate use of injections as a component of HIV prevention and care programmes.
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