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

1
Best Infection Control Practices for ID, SC, and
IM Injections

• Recommendations of the SIGN Working Group on Best
  Practices
• Geneva, 19-20 October 2000
• SIGN 2001

2
Injection Safety StandardsBackground

• No prior agreement on what is a safe injection.
• Review of training materials showed many
  dangerous or questionable practices being
  promoted. Research does not exist to support many
  common practices (e.g. aspiration).
• This group focused on actions of the injector
  that could spread infection.

3
A Best Practices Document

• Best pose minimum risk of disease
  transmission based on current evidence.
• Countries modify, or accept best practices
  based on risks and cost of adopting practices in
  their programs.

4
Process for Development of Best Practices for
Infection Control

• Broke an injection into a series of steps
• Conducted a literature review
• Drafted and discussed the document
• Revised draft for public comments
• Availability of a final document

5
Categories of Evidence 1, 2 or 3

• 1 Strongly recommended and supported by research
  with appropriate study design and analysis.
• 2 Strongly recommended on the basis of strong
  theoretical rationale and suggestive, descriptive
  evidence.
• 3 Recommended on the basis of expert consensus
  and theoretical rationale.

6
Four Scientifically-Supported Practice Areas

• Use of sterile injection equipment for each
  injection
• Preventing contamination of equipment and
  medication
• Preventing needlesticks by disposal at point of
  use
• Preventing contact or access to used needles
• reduces re-use
• reduces needlesticks

7
Issues Where Firm Conclusions Could not Be
Reached

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

8
Use Simple Sheets to Help Discuss Practices

• Dont expect guidelines or posters alone to
  change behavior
• People do things for a reason. Explore why.
• Knowledge is necessary but not sufficient to
  change practices.

9
Different Areas Have Different Problem Practices

• Decanting
• Aspiration
• Dosing
• Loading more than one dose in a syringe
• Placing syringes in disinfectant prior to re-use
• Storing syringes wet
• Placing a finger over the needle site

10
Use a Syringe and Needle with Proof of Sterility
for Each Injection (1)

• Inspect packaging or sterilization monitors.
• Use syringes with quality controls that staff and
  parents can see.

11
If Single-Use Equipment is Unavailable (1)

• Sterilize only equipment designed for
  steam-sterilization.
• Decontaminate syringes to make them safe to
  handle.
• Clean all visible dirt from syringes, remove
  plunger, flush needle, take apart.
• Use sterilization monitors.
• This critical task requires supervision and
  appropriate pay.

12
Prepare Injections in a Clean Area (2)

• Do not work in an area where blood, contaminated
  items or body fluids are or may be present.
• Water is available
• Soap is available
• Freshly prepared bleach and water or
  environmental disinfectant (not skin cleaner)

13
Use Single-Dose Vials if Possible (2)

• Single dose vials pose a lower risk for disease
  transmission.
• The risks of using single-dose vials will
  increase in programs where syringes are used more
  than once, and if reconstituted vaccine vials are
  not strictly discarded after 6 hours.

14
Use Tools or Barriers to Open Glass Vials (2)

• Staff frequently cut themselves opening glass
  vials. This is painful and contaminates the
  ampoule and work area.
• Purchase vials that do not need to be broken to
  open.

15
Follow Product-Specific Recommendations for Use,
Storage and Handling (3)

• Discard reconstituted vaccines that do not
  contain preservatives within 6 to avoid sepsis or
  toxic shock
• Never use normal saline or water in place of
  diluent.
• Avoid freezing vaccines

16
Discard Needles that Have Touched Non-Sterile
Surfaces (3)

• If if touched, discard.

17
Position Patients Prior to Injection (2)

• Anticipate and take measures to prevent sudden
  patient movement during and after injection.
• This may require making chairs available,
  revising clinic flow or reassigning staff.

18
Avoid Recapping and Manipulation of Needles (1)

• Reducing contact and manual handling of used
  syringes reduces needlesticks.

19
Questions and Comments?

• Contact the SIGN Secretariat for copies of
  images, materials and to share materials.
• SIGN_at_who.ch
• Safe Injection Global Network
• World Health Organization
• Avenue Appia 20
• Geneva 27
• Switzerland 1211
• Fax [phone]