Best Infection Control Practices for ID, SC, and IM Injections

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Best Infection Control Practices for ID, SC, and
IM Injections

• Presentation of the Process and Outcome of the
  SIGN Working Group Meeting
• Geneva, 19-20 October 2000

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A safe injection does not harm the recipient,
does not expose the provider to any avoidable
risk, and does not result in any waste that is
dangerous for other people
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WHO Objectives for Safe and Appropriate Use of
Injections

• Policy
• Quality and safety
• Access
• Use

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WHO Objectives for Safe and Appropriate Use of
Injections

• Policy
• Quality and safety
• Access
• Use appropriate, rational, and cost effective
• Pilot interventions
• Injection practices standards
• Sharps waste management

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Injection Safety StandardsBackground

• No consolidated guidelines available on safe
  injection practices
• The safe injection definition does not
  translate into a list of critical steps
• Need to obtain a reference for behaviour change
  and IEC strategy
• Little evidence available
• Need to focus on infectious complications

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A Best Practices Document

• Best, not perfect practices
• Not a standard for regulatory purposes
• Not prescriptive guidelines
• May be adapted
• By programmes
• By countries
• Distil critical issues
• Not always practical, feasible, or cost-effective

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Process for Development of Best Practices for
Infection Control

• Break down of a safe injection into critical
  steps
• Identification of research questions for each
  step
• Literature review
• Formulation of a draft best practices document
• Discussion of the document (19-20 October 2000)
• Revised draft for public comments
• Availability of a final document

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Process for Development of Best Practices for
Infection Control

• Break down of a safe injection into critical
  steps
• Identification of research questions for each
  step
• 55 independent questions identified
• Literature review
• Formulation of a draft best practices document
• Discussion of the document (19-20 October 2000)
• Revised draft for public comments
• Availability of a final document

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Process for Development of Best Practices for
Infection Control

• Break down of a safe injection into critical
  steps
• Identification of research questions for each
  step
• Literature review
• Approximately 150 articles reviewed
• Evidence tended to be problem-focused
• Little research on impact of specific
  interventions
• Several areas where no evidence was available
• Formulation of a draft best practices document
• Discussion of the document (19-20 October 2000)
• Revised draft for public comments
• Availability of a final document

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Grading System for the Level of Evidence

• Category 1
• Strongly recommended and supported by
  well-designed analytical studies of observational
  or intervention nature.
• Category 2
• Strongly recommended on the basis of strong
  theoretical rationale and suggestive, descriptive
  evidence.
• Category 3
• Recommended on the basis of expert consensus and
  theoretical rationale.

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Process for Development of Best Practices for
Infection Control

• Break down of a safe injection into critical
  steps
• Identification of research questions for each
  step
• Literature review
• Formulation of a draft best practices document
• Discussion of the document (19-20 October 2000)
• Thoughtful two-day discussion
• Consensus on revised draft document reached
• Revised draft for public comments
• Availability of a final document

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Composition of the Working Group

• Subject matter experts (infection control, HCW
  protection, waste disposal)
• Programme specialists (e.g., immunisation,
  diabetes, injection drug use)
• Behaviour and system specialists
• Nursing generalists

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Process for Development of Best Practices for
Infection Control

• Break down of a safe injection into critical
  steps
• Identification of research questions for each
  step
• Literature review
• Formulation of a draft best practices document
• Discussion of the document (19-20 October 2000)
• Revised draft for public comments
• Four scientifically-supported practice areas
  addressed
• Five practice issues discussed where science
  inconclusive or requires clarification
• Availability of a final document

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Four Scientifically-Supported Practice Areas

• Use of sterile injection equipment
• Preventing contamination of equipment and
  medication
• Preventing needlesticks
• Preventing access to used needles

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Five Practice Issues Discussed where Science
Inconclusive or Requires Clarification

• Use of engineered technology
• Hand hygiene
• Use of gloves for providing injections
• Swabbing vials or ampoules
• Skin preparation prior to injection

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Plans for Review

• Distribution of draft document at annual SIGN
  meeting in Cairo, October 2000
• Post draft on SIGNpost (SIGN Internet forum) for
  comments
• Revise by February 2001
• Post final document
• Other methods for distribution are under
  consideration