Title: Best Infection Control Practices for ID, SC, and IM Injections
1Best 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
2A 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
3WHO Objectives for Safe and Appropriate Use of
Injections
- Policy
- Quality and safety
- Access
- Use
4WHO 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
5Injection 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
6A 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
7Process 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
8Process 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
9Process 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
10Grading 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.
11Process 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
12Composition 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
13Process 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
14Four Scientifically-Supported Practice Areas
- Use of sterile injection equipment
- Preventing contamination of equipment and
medication - Preventing needlesticks
- Preventing access to used needles
15Five 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
16Plans 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