Epidemiology of Unsafe Injection practices and the use of Auto Disable Syringes

1
Epidemiology of Unsafe Injection practices and
the use of Auto Disable Syringes 

• Name of presenter
• Dr Fred Were
• University of Nairobi

2
Unsafe Injections

• Injections that harm the recipient, the provider,
  or that result in waste that is dangerous for
  other people are regarded as unsafe.
•  
• Unsafe injections can cause disease, injury and
  death.

3
Key Facts about Injections 

• World Health Organization estimates
• 12 billion injections administered each year
• 50 (6 Billion) are unsafe
• 25 to 95 of outpatient visits resulted in an
  injection (95 are therapeutic)
• Most injections may be unnecessary, ineffective
  or even inappropriate
• Jodar L et al, Vaccine, 2002 19 1594-1605
•  

4
Key Issues About Injections 

• About 1 billion injections are given every year
  for immunization
•  
• There are 8-12 curative injections for every
  immunization
•  
• This adds to between 1.5 and 2 injection/person
  /year with an estimated range of 0.9-7.5
•  
• Jordar L et al, Vaccine, 2002 191594-1605

5
Unsafe Injections, More Facts  

• Has been reported to constitute as high as 80 of
  all injections in Pakistan
•  
• Estimated in at least 50 in a cluster of 14
  widely distributed 3rd world countries
•  
• Even some of the intermediate wealth-countries
  report up-to 15 rates of unsafe injections
•  
• Simonsen L et al, Bulletin of the WHO, 199977
  801-804

6
Key Statistics in Unsafe Injections

• In a year, unsafe injections may be responsible
  for
• 8 to 16 Million cases of Hepatitis B
• 2 to 5Million cases of Hepatitis C
• 80,000 to 160,000 cases of HIV
• Others Parasitic (Malaria), bacterial (abscess),
  fungal and other infections
• Kane A et al, Bulletin of the WHO, 1999 77
  805-807

7
HBV Burden from Unsafe Injections

• Region Unsafe Inj Number (106)
• Asia/Pacific 50
  4.4-8.8
• China 50
  2.0-4.0
• Sub Saharan
• Africa 50
  0.8-1.6
• Middle East 15
  0.5-1.0
• Eastern
• Europe 15
  .45-0.9
• Kane A et al, Bulletin of the WHO, 1999 77
  805-807

8
HCV Burden of Unsafe Injections

•  Region Unsafe Inj Number
  (103)
• China 50
  1100-2200
• Asia/Pacific 50
  800-1600
• Sub-Saharan
• Africa 50
  250-500
• Middle East 15
  70-140
• Eastern
• Europe 15
  60-120
•  
• Kane A et al, Bulletin of the WHO, 1999 77
  805-807
•  

9
HIV Burden of Unsafe Injections

• Region Unsafe Inj Number
• Sub-Saharan
• Africa 50
  50-100000
• Asia/Pacific 50
  17-35000
• Eastern
• Europe 15
  12-24000
• China 50
  300-600
• Middle East 15
  120-240
• Kane, A et al, Bulletin of the WHO, 1999 77
  805-807

10
Global Challenge of Unsafe Injections

• There are close to 21 million cases of HBV, HCV
  and HIV infections attributable to unsafe
  injections in the world yearly
• This is expected to be associated with 1.3
  million deaths
• The cost of medical care of the cases is
  estimated at about 600 million USD, mainly in
  poor countries
• Unsafe injections constitute a public health
  issue
• Miller M, Pisani E, Bulletin of the WHO, 1999
  77808-811

11
The Usual Victims of Unsafe Injections

• The Recipient
• Due to syringe and needle reuse or careless heath
  worker injection practices
• The Health Worker
• Due to syringe reuse and inappropriate practices
• The Community
• Inappropriate disposal practices

12
Rules of Safety

• Avoiding any reuse of needles and syringes
•  
• Hygienically sound health worker practices during
  injections
•  
• Establishing acceptable sterilization and
  disposal of all injection related equipment
•  
• Health Worker to assume leadership responsibility
  of all stages of use and disposal of injection
  equipment

13
By far the most important factor associated with
infections from unsafe injections is reuse
 
The most effective method of reuse control the
use of AUTODISABLE syringes and needles
 
14
Why Re-Use Occurs 

• Re-use of contaminated syringes/needles
• Inadequate supply
• Lack of understanding of danger
• Unmonitored/inadequate sterilization
• Inadequate disposal and distribution (public
  access to contaminated equipment)

15
Auto Disable (AD) Syringes and Needles 

• Reuse of injection equipment is responsible for
  most of the infections that result from
  immunizations
• WHO, UNICEF and UNFPA jointly recommend the
  universal use of single disposable syringes for
  administering vaccines by the end of 2003.
•  Joint statement of the WHO, UNICEF UNFPA

16
Other Advantages of AD Injection Equipment 

• Dosage accuracy
• Available equipment have reduced waste volume,
  1/3 of the traditional varieties
•  More economical Minimize vaccine wastage
•  Easy to use

17
Pre-Vaccination Aspiration 

• Millions of IM vaccinations using AD syringes
  without aspiration have not demonstrated any
  problems
•  
• There is no evidence to justify aspiration when
  giving subcutaneous or intra-dermal vaccinations
•  

18
Pre-Vaccination Aspiration

• The recommended vaccination injection sites do
• not have large vessels
•     IM, Center of the Deltoid (bellow shoulder)
• Vastus Lateralis (lateral mid thigh)
•    SC, Upper Arm
• No aspiration is required at these sites
•  

19
Available AD Syringes and Needles

• BD SoloshotTM syringe
• Fixed needle can't be detached for reuse
•  
• BD SoloshotTM FX syringe
• Detachable needle, can't fit on any other syringe
•  
• BD UnijectTM Prefill injection device
• Prefilled single dose, the lowest waste

20
Other Important Issues in Prevention of
Injection In-safety

• Storage and transport of injection equipment
  after use
•  Care of the outreach area the health worker's
  ultimate responsibility
• Destruction and disposal of the used equipment
  Burial, Burning or incineration