WHO estimates that in developing and transitional Member States, 16 billion health care injections are administered each year – an average of 3.4 injections per person per year. This figure, along with reports indicating inappropriate use of injections, suggests that injections are overused as a means of administering medications. In addition to being overused, injections may also be administered through unsafe procedures and cause infections.
A safe injection should not harm the patient, the health care worker or the community. Injections may harm the patient when injection devices are reused in the absence of sterilization. Injections may harm health-care workers when dirty needles are not collected in safety boxes. Injections may also harm the community at large when health-care facilities are surrounded by sharp health-care waste – mostly dirty syringes and needles.
Reuse of injection devices in the absence of sterilization is of greatest concern, since it leads to the heaviest burden of disease. A mathematical model developed by WHO suggests that in 2000, in developing and transitional Member States, reuse of injection devices accounted for an estimated 22 million new infections with Hepatitis B virus (one-third of all such infections), 2 million new infections with hepatitis C virus (40% of all such infections) and 260 000 new HIV infections (5% of all such infections). The infections acquired in 2000 alone are expected to lead to an estimated 9 million years of life lost (adjusted for disability) between 2000 and 2030.
Evidence shows that death and disability associated with unsafe injections are highly preventable. First, interventions that aim at improving communication between patients and doctors and at improving prescriptions through monitoring of providers have effectively decreased injection overuse. Second, interventions to make single-use syringes regularly available in each health care facility effectively prevent reuse of injection devices.
In addition to being highly effective, policies and plans for the safe and appropriate use of injections are a sound investment in health. WHO estimates that interventions implemented in 2000 for the safe and appropriate use of injections cost US$102 per year of life saved (adjusted for disability). This cost is less than the threshold value of 1 year of average per capita income in developing Member States used by the WHO Commission on Macroeconomics and Health as a criterion for an intervention to be considered very cost-effective.
WHO assists Member States in benchmarking, assessing, planning, implementing and evaluating national policies for the safe and appropriate use of injections through four key strategies:
- increasing population awareness regarding the risk of HIV and other infections associated with unsafe injections;
- making sure there are sufficient quantities of single-use injection devices and safety boxes in every health-care facility where injections are administered;
- ensuring that donors and lenders supporting the supply of injectable substances in developing and transitional Member States also support the provision of injection devices with reuse-prevention features and safety boxes;
- managing the waste associated with dirty syringes and needles in a safe and appropriate way.