Title: Safe Immunization Practices and Prevention of Hepatitis B and C
1Safe Immunization Practices and Prevention of
Hepatitis B and C
- Susan Mackay
- Behaviour Change Project
- Safe Injection Global Network (SIGN) Secretariat
- WHO, Geneva, Switzerland
2SIGN participants and SIGN secretariat
NGO
UN
Industry
Associations
Governments
3Injection Safety Definition
- No harm to the recipient
- No harm to the health-care worker
- No harm to the community
Challenges
4Injections given with sterile and unsafe
equipment worldwide
Global Burden of Disease, 2000
5Determinants of unsafe injection practices in
immunization services
- System incentive to achieving high coverage
- Vaccine usually funded through donors or lenders
- No system incentive to achieve safe injections
- Injection equipment is not costed, budgeted, or
funded - The sterilizable policy smoke screen
- Perception of injection safety as a logistics
issue rather than a prevention policy issue
6Reuse of disposable injection equipment
Injection preparation table, Pakistan, 1995
7No reuse of disposable injection equipment,other
breaks in safety
Injection preparation table, Romania, 1998
8Injection safety beyond the use of new,
disposable injection equipment
- Theoretical rationale
- Experience from the dialysis environment
- Persistence of HBV in the environment
- Ecological evidence
- HBV and HCV infection among injection drug users
participating in needle exchange programmes - Association between injection and HBV infection
in 1998 in Romania despite the absence of reuse
of equipment - Analytical studies
- Association between indirect sharing and HBV
infection among injection drug users - Bialek S. et al. US CDC EIS conference, 2001
9Proposed model for the transmission of HBV in
various healthcare setting
Outpatient setting in low prevalence area
Dialysis setting
High risk
Low risk
? Prevalence of infection ? Exposure to blood ?
Percutaneous exposures ? Prevalence of patients
with high viremia
10Proportion of new HBV Infections attributable to
unsafe injections, 2000
11Hepatitis B virus infection prevention
- Two prevention axis
- Immunization of infants(child cohorts)
- Prevention of exposure to the virus, including
injection safety(older age groups) - One common goal for GAVI
- Protecting the adult who is in every child
12Proportion of new HCV infections attributable to
unsafe injections, 2000
13Assisting countries in implementing policies and
plans
The Quality Cycle
14Assisting countries in implementing policies and
plans
15Outline of best practices
- 1. Use sterile injection equipment
- 2. Prevent contamination of injection equipment
and medication - 3. Prevent needlestick injuries to the provider
- 4. Prevent access to used needles
- 5. Other practice issues
16Assisting countries in implementing policies and
plans
17Rapid Assessment and Response Guide
System
Tool C available(Based upon best practices)
Providers
Tool D available(Template for epidemiological
studies)
Injection Overuse
Unsafe Injection Practices
Injection Adverse Event
18Assisting countries in implementing policies and
plans
19Safe and appropriate use of injectionsproposed
national strategy
- Initial assessment
- National coalition
- Three-element approach
- 1- Behaviour change
- 2- Equipment and supplies
- 3- Sharps waste management
- Monitoring and evaluation
20Assisting countries in implementing policies and
plans
21Assisting in the implementation of policies for
the safe and appropriate use of injections
- 1. Behaviour change
- Toolbox project in progress
22Assisting in the implementation of policies for
the safe and appropriate use of injections
- 2. Provision of supplies
- Purchasing guide to ensure quality and safety
- Inclusion in the essential drug list to ensure
access
23Assisting in the implementation of policies for
the safe and appropriate use of injections
- 3. Sharps waste management
- Integrated approach
- Policy
- Streamlining waste management
- Training
- Choice of disposal options
- www.healthcarewaste.org
24Assisting countries in implementing policies and
plans
25Monitoring impact
Outcomes Incidence of infections
26Injection safety in immunization services
- Challenges
- Unsuccessful past efforts
- History of narrow, technology oriented approach
- Costs of injection safety initiatives
- Conflict between the safety and coverage
objectives - EPI cannot be responsible for the safety of all
injections - Opportunities
- Successful comprehensive approaches
- Increasing recognition of holistic strategies
- Promotion of responsible budgeting for EPI
- Documentation of safe immunization coverage
- EPI can spearhead and catalyse injection safety
efforts
27Poor injection practices