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THE DANGERS OF UNSAFE, UNNECESSARY MEDICAL INJECTIONS AND MISHANDLING OF MEDICAL WASTE
Of the 16 billion medical injections given annually worldwide, according to World Health Organization estimates, too many are unnecessary and unsafe. In fact, medical injections are the most common health care procedure worldwide. When necessary and performed correctly, medical injections and related procedures, such as blood-drawing; intravenous procedures; use of multidose vials; etc., can save lives. However, if performed incorrectly, medical injections and related procedures can transmit harmful infectious disease pathogens, including HIV. The risk of spreading HIV and other blood-borne pathogens (such as Hepatitis B and C) in this manner can be reduced drastically by lowering the number of unsafe and unnecessary injections. Injection safety is fundamental to a strong health system, and it is vital to incorporate in programs such as AIDS care and treatment, preventing mother-to-child transmission, testing and counseling, safe blood, laboratories and medical male circumcision. Safe medical injection practices protect not only patients but also local community members and health care workers who are routinely exposed to needles and other medical sharps.
Unsafe injections may result when:
- Injections are given with used syringes or needles that are not sterile.
- Poor injection technique is used, such as recapping used needles, using contaminated multidose vials or diluents or using inappropriate injection equipment.
- Needles, syringes and lancets, known as sharps, are improperly discarded.
Unnecessary injections examples:
- An injection is given instead of a medically equivalent, accepted and available alternative.
- An injection is given when not medically indicated.
In support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID) supports programs to make medical injections and related procedures safer and to foster safe waste management. From 2004 to 2009, USAID supported large, comprehensive safe injection programs in six sub-Saharan African countries (Ethiopia, Mozambique, Namibia, Nigeria, Uganda and Zambia) as well as in Guyana. Comprehensive programs include improving basic safety of therapeutic injections, infection prevention and control, standard precautions, hand hygiene, safe management of sharps, other infectious waste and blood-drawing, supporting standard treatment guidelines to avoid unnecessary injections, improving postexposure prophylaxis after sharps injuries, as well as promoting Hepatitis B vaccinations. These programs also included training and capacity building, policy advocacy, quality improvement, performance metrics, behavior change communications, strengthening safe injection commodity procurement and management (e.g., for reuse-prevention syringes, safety boxes and personal protective equipment for waste handlers) and reducing demand for injections.
These centrally-supported, focused injection safety programs were broadly successful in improving the quality of necessary injections, reducing unnecessary injections, improving patient and health provider safety and ensuring safer management of sharps and other infectious waste. After the major infusion of PEPFAR central support ended in 2009, in order to sustain injection safety standards and programs, field missions in Ethiopia, Namibia, Nigeria and Uganda prioritized maintaining focused, ongoing injection safety programs, notably within AIDS treatment programs. These programs incorporated activities such as improving safety of therapeutic injections, safe management of sharps and other infectious waste, increasing hand hygiene and more. In some cases, field missions have had to put all injection safety programs into AIDS treatment without the previously available specific focus to ensure quality and consistency. Success has been variable, and substantial injection safety programs remain necessary in virtually all PEPFAR-supported countries.
CURRENT PROGRAMMATIC HIGHLIGHTS
In addition to countries such as Nigeria and Uganda that continued focused PEPFAR injection safety programs, USAID, with central resources, has initiated modest injection safety programs based on needs assessments in countries that did not benefit from earlier PEPFAR support: Mali, Pakistan and, recently, Swaziland.
The AIDSTAR-One project
Through the AIDSTAR-One project, USAID Nigeria has continued an outstanding, innovative and comprehensive injection safety/waste management program, including training/capacity building and advocacy, to support continued expansion of overall HIV activities in Nigeria, partnering with the National Primary Healthcare Development Agency. AIDSTAR-One has fostered the procurement of safe injection commodities, such as reuse-prevention syringes and safety boxes, and pioneered safe blood-drawing practices. In partnering with Supply Chain Management Systems and the Government of Nigeria, AIDSTAR-One has also carried out a highly innovative program to safely dispose of 70 tons of expired ARV drugs, laboratory chemicals and HIV test kits in such a way that the residue was converted into bricks.
The Third National Strategic Plan and Medical Waste Disposal
Also through the AIDSTAR-One project, USAID Uganda has supported various initiatives to improve management of infectious and other sharps waste, for example, through recycling plastics waste in central Uganda, training health workers in successful waste management and fostering a sustainable health care waste management program in the third National Strategic Plan. In addition, through AIDSTAR-One, USAID has pioneered a public-private partnership with Green Label Services Limited, a private waste handling service provider, and the Ministry of Health that will cost-effectively dispose of medical waste in all health facilities in a large portion of eastern Uganda. The program is currently expanding from 6 to 16 districts.
The Health Care Improvement Project
With PEPFAR central support, USAID, through the Health Care Improvement Project, has successfully improved injection safety and waste management practices in Sindh, Pakistan, demonstrating impressive results in a short time on a wide range of measures.
Last updated: October 02, 2013