A National Program for Promotion of Infection Control and Safe Injections

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• A National Program for Promotion of Infection
  Control and Safe Injections
• In Egypt

Annual Meeting of the Safe Injection Global
Network SIGN, 2002
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Ministry of Health and Population

• Partners
• USAID
• WHO
• Ford Foundation
• Namru-3

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A National Program for Promotion of Infection
Control and Safe Injections In Egypt

• Background
• Goals and objectives of the program
• Findings of baseline assessment
• Strategic approach of the program
• Communication Strategy to prevent BBPs
  transmission
• Objectives
• Target audiences
• Messages
• Means
• Material

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Blood-borne pathogens transmission in Egypt

• Major public health problems
• 10-15 of the population have HCV infection
• Prevalence of HBV is 4
• Three epidemics of Aids were reported in Egypt
  since 1993
• Treatment of infected persons is a burden on the
  economy of Egypt

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• Nosocomial Infections

• Emerging as important public health problem
  throughout the world - increase in
  antimicrobial resistance
• - high cost of health care - increased
  morbidity and mortality
• Particular problem in countries with rapid
  development of health care services and
  introduction of new technology - infection
  control is not a well recognized discipline

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Risk Factors Associated with HCV Transmission in
Egypt
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Risk Factors Associated with HCV Transmission in
Egypt
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Framework of the national program to promote
infection control and safe injection practices in
Egypt

• Promotion of safe injection practices in the
  community
• Promotion of infection control practices in
  health care facilities
• Safe blood transfusions
• Pilot project in 2 governorates - transition
  to a national program

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Program Goals Program to promote infection
control

•  Reduce HCV transmission and hepatitis related
  chronic liver disease
• Reduce transmission of hospital-acquired
  infections in the health care setting
• Improve quality of health care services through
  promotion of infection control

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Program Objectives Program to Promote Infection
Control

• Promotion of infection control in Health Care
  Facilities
• - Implement standard precautions for infection
  control
• - Promote safety of injections
• - Reduce occupational risk of BBP infection
  
•  Prevention of transmission of BBPs in the
  Community
• - Promote safe injection practices
• - Educate the general public on BBP
  transmission

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Methods Community-based survey

• Standard questionnaires
• 6 rural villages
• 2 urban cities
• 720 households
• 4197 persons interviewed

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Baseline AssessmentInjection practices at
community level
Aim of the Survey
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Baseline Assessment Infection Control Practices
in HCF

• Governorate-wide random sample of public and
  private health care facilities (98 health
  facilities)
• 53 public health care facilities
• 16 private hospitals
• 29 private dental clinics

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Baseline AssessmentInfection Control Practices
in HC
Aim of the Survey
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Proportion of Households Reporting at Least One
Person Who Received an Injection in the Previous
Three Months Survey in Sharkia and Qena, 2001
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Frequency of Injections among Residents of Qena
and Sharkia, 2001
No. persons No. ()
reporting Site surveyed
injection in past 3 mos Sharkia 2599
720 (27.7) Qena 1598
381 (23.8) Total 4197
1101 (26.2)
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Estimated Number of Injections/ Person/ Year
Survey in Sharkia and Qena, 2001
Site Mean No.of No. of injections
injections/person per person
per year in the past 3
mos Sharkia 1.2
4.8 Qena 0.9
3.6 Total 1.05
4.2
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Type of Injections Received Survey Sharkia and
Qena, 2001
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Who administers injections in Community-based
survey
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Prescribers of injectionsCommunity-based Survey

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Findings of Baseline assessment Population-based
Survey

• Challenges
• 70 household prevalence rate of injections
  (3mos)
• 26 individual based prevalence rate of injection
  ( 3 mos)
• 84 therapeutic injections
• 4.2 injections/person/year
• 281 millions of injections yearly in Egypt
• 8.4 of injections are unsafe (23 millions
  injections)
• 20-40 of injections provided by the informal
  sector
• 37-49 of injections are prescribed by doctors

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Qualitative AssessmentPopulation-based Survey

• Challenges
• General rural population prefers injections
• - They cure faster
• - An Injection is easier
• to use than tablets
• - Injections dont cause
• stomach problems
• - They are useful in serious
• diseases
• - Injection providers are
• accessible
• - Lack of awareness of risks
• associated with injections

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Key findingsHealth care facility Survey

• Infection Control Challenges
• No concept of infection control
• No hand washing or wearing gloves
• Unsafe injections provided
• Unsafe sharp disposal
• Lack of training
• Lack of supplies and material
• Inappropriate sterilization methods
• Overprescription of injections (23)
• Lack of waste management
• High exposure of HCWs to needlestick injuries

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Frequency of Needlestick Injuries Health Care
Worker Survey
No. with Annual Mean Group
Interviewed needlestick No. of
(3
months) needlesticks Allied HCW
64 27 1.8 Dentists 78 36
3.9 Nurses 683 38 4.5 Housekeepers
229 40 5.0 Doctors 339 31 5.9 Lab
techs 92 32
6.3 TOTAL 1485 36 4.9
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Behaviors Associated with Recent Needle Stick
Injury, Health Care Worker Survey 2001
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Hep B Vaccine Coverage among HCWs
No. No Percent Interviewed
vaccinated vaccinated Group Doctors
339 129 38 Dentists 78 30
38 Nurses 683 60 9 Lab techs
92 5 5 Housekeepers 229 8
3 Allied HCW 64 3
5 TOTAL 1485 235 16
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Strategic ApproachNational Program for Promotion
of Infection Control

• Organizational Structure
• Development of national guidelines for infection
  control
• Training and capacity building
• Surveillance of nosocomial infections
• Occupational safety health program
• Provision of critical supplies and equipment
• Advocacy
• IEC Communication Strategy to prevent
  transmission of BBPs

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IEC communication strategy to prevent
transmission of BBPs

• Objectives
• Target audiences
• Messages
• Means
• Material
• Implementation
• Evaluation

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IEC communication strategy to prevent
transmission of BBPs

• Objectives
• Raise the awareness of the public and health
  care providers to promote injection safety

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IEC communication strategy to prevent
transmission of BBPs Target Audiences

• All sectors of the rural population
• Health care providers
• Doctors
• Nurses
• Janitors

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IEC communication strategy to prevent
transmission of BBPs Messages

• Messages to the public
• - Reduce overuse of injections
• - Dont reuse a syringe
• Message to the doctors
• Rational use of injections
• Message to the nurses
• Provide a safe injection

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IEC communication strategy Means of conveying
messages

• Radio and TV programs
• Airing of TV spots in 2003
• Continuous Press Release
• Community outreach and mobilization for public
• Partnership and networking (NGOs and Government)
• Disseminate messages through an existing
  structure
• Leadership (community leaders)
• Community participation
• Volunteers
• Reach different social and cultural complexes

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Launching of a campaign for prevention of BBPs
transmission

• Launching started in September, 2002
• Slogan
• Safe injections save lives
• Local activities are focused in two governorates
• Sharkia
• Qena

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IEC communication strategy to prevent
transmission of BBPs Motivation of health care
workers

• Regular meetings with key personnel
• Primary health unit directors
• Head nurses of facilities
• Competition between facilities Safe sharp
  disposal
• Awards
• Recognition
• Certificates

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Communication StrategyCommunity outreach and
mobilization

• Community leaders target different groups
• Teachers
• illiterate (illiteracy programs)
• school children
• Women community leaders (house to house visits to
  illiterate housewives)
• Religious leaders (men in rural villages)
• Students unions in universities
• Events and meetings

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Communication Strategy IEC Material

• Process of development of IEC material
• SIGN consultant
• Development of image bank
• Field Testing of material
• Modification of material
• Printing and distribution of the material

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Communication Strategy IEC Material

• IEC material for the Public
• Community leaflet for the educated
• Power point presentation for the illiterate
• Posters
• Give aways (calendars and others)
• IEC material for health care providers
• - Good prescribers guide for doctors
• - Safe injection providers guide for nurses
• - Video film (Zahra)

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Good Providers Guide
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PROTECT YOURSELF
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Community Leaflet
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Communication Strategy to prevent BBPs
transmissionEvaluation

• Long term process
• Community-based indicators
• Injection use
• Safety of injections
• Health facility indicators
• Prescription rate of injections
• Qualitative surveys

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• Thank you