Auto-disable Syringes Research Articles

Health facilities readiness for standard precautions to infection prevention and control in Nepal: A secondary analysis of Nepal Health Facility Survey 2021.

Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (β) coefficients and 95% confidence interval (95% CI). The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (β = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (β = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (β = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts.

Needle stick injuries and their safety measures among nurses in Erbil Hospitals

Background: Needle stick injuries are serious professional hazards in the transfer of certain types of blood borne diseases such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus among healthcare workers. Objective: Firstly, to determine the prevalence and factors related to needle stick injuries. Secondly, to assess related safety measures among nurses in Erbil hospitals. Patients and Methods: A hospital based cross sectional study including a sample of 452 nurses. A representative supple sample size was calculated by using Epi info version 7.The sample was proportional to the population of nurses in each hospital. A convenient sampling technique was adopted in selection of studied sample from different teaching hospitals in Erbil city. Data were collected by using self-administered questionnaire, which included socio-demographic characteristics of participants and questions regarding needle stick injuries and preventive measures. (SPSS, Chicago, IL, USA), version 26) was applied for data entry and analysis. P value of ≤ 0.05 was considered as statistically significant. Results: Out of a total (452) study population, 56.9% were females and 43.1% were males. The mean ± SD of age was 36.2 ± 5.41, ranging from 21 to 54 year. The prevalence of needle stick injuries was 87.4% among nurses, and the widespread activity leading to NSIs was recapping of needles (81%). The average of non-reporting to supervisor of infection control was 77.2%. The majority of NSIs took place in the morning (70.5%). There was a statistically significant association between NSIs and use of PPE, secure disposal of needle in the safety box, and use of auto-disable syringe during injection, in which NSIs were highest among those who not use or sometimes use the above mentioned safety measures, (P<0.001, P=0.002, and P=0.003 in respectively). Conclusion:This study showed that transverse needle stick injuries among nurses are very high and pose a rise in hazards for professional exposure to diseases transmitted by blood. The majority of nurses are not reporting the needle stick injuries to the supervisor of the infection control unit.

Health Facilities Readiness to Implement Standard Precautions for Infection Prevention and Control in Tanzania: Lesson Learnt from SARA Reports

Introduction: Standard Precautions are a set of measures applied in the care of all individuals/patients regardless of their infectious status aiming at preventing healthcare workers and patients from infections, preventing environmental contamination and spread of infections to the community. Many health facilities have not implemented them to an acceptable level. The purpose of the study is to report progress of improvement in health facilities readiness to implement standard precautions for infection prevention and control based on SARA reports. Methods: We generated mean scores of all standard precautions each year and calculated their standard deviations, variances and confidence intervals. One-way ANOVA was used to determine if the mean scores were equal. Finally, the trend of improvement in health facilities readiness to implement the standard precautions was generated. Results: A total of nine standard precautions were reported in SARA reports for 2012, 2017 and 2020. The mean scores of the standard precautions were 52.22% in 2012, 64.55% in 2017 and 69.66% in 2020. The overall trend showed an increase in health facilities readiness to implement standard precautions, although the mean scores were not statistically different (p-value 0.3217). Conclusion: SARA surveys conducted in Tanzania in 2012, 2017 and 2020 have shown an overall increase in health facilities readiness to implement standard precautions. Safe final waste disposal was being done in fewest facilities while single-use or auto-disable syringes were in most facilities that were sampled in all years. SARA surveys may be a useful way to evaluate Infection Prevention and Control adherence in health facilities.

Advanced packaging for distribution and storage of COVID-19 vaccines: a review.

The outbreak of the coronavirus disease 2019 global pandemic (COVID-19) has affected billions of lives, posing critical challenges to the healthcare system, vaccine manufacturers, packaging scientists, and daily public activity. Biotechnological advances have allowed to create rapidly vaccines, yet the success of an efficient immunization mainly depends on the safe and timely delivery of vaccines. In particular, packaging plays a crucial role in protecting, preserving, transporting, and distributing vaccines. Here, we review advanced packaging for distribution and storage of COVID-19 vaccines, with focus on innovative hybrid packaging materials, cyclic olefin polymers with nanolayer glass, and vials for vaccines. We present vaccine packaging, auto-disable syringes, stoppers, and closures. We discuss the chronology of the packaging system, and the labeling of the vaccine packages, with emphasis on bar codes, quick response codes, vaccine vial monitors, anti-counterfeiting and traceability measures.

The cost of eliminating hepatitis C in Pakistan

The cost of eliminating hepatitis C in Pakistan

Immunogenicity of full and fractional dose of inactivated poliovirus vaccine for use in routine immunisation and outbreak response: an open-label, randomised controlled trial

Intradermal administration of fractional inactivated poliovirus vaccine (fIPV) is a dose-sparing alternative to the intramuscular full dose. We aimed to compare the immunogenicity of two fIPV doses versus one IPV dose for routine immunisation, and also assessed the immunogenicity of an fIPV booster dose for an outbreak response. We did an open-label, randomised, controlled, inequality, non-inferiority trial in two clinics in Dhaka, Bangladesh. Healthy infants were randomly assigned at 6 weeks to one of four groups: group A received IPV at age 14 weeks and IPV booster at age 22 weeks; group B received IPV at age 14 weeks and fIPV booster at age 22 weeks; group C received IPV at age 6 weeks and fIPV booster at age 22 weeks; and group D received fIPV at 6 weeks and 14 weeks and fIPV booster at age 22 weeks. IPV was administered by needle-syringe as an intramuscular full dose (0·5 mL), and fIPV was administered intradermally (0·1 mL of the IPV formulation was administered using the 0·1 mL HelmJect auto-disable syringe with a Helms intradermal adapter). Both IPV and fIPV were administered on the outer, upper right thigh of infants. The primary outcome was vaccine response to poliovirus types 1, 2, and 3 at age 22 weeks (routine immunisation) and age 26 weeks (outbreak response). Vaccine response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (≥1:8) or four-fold increase in reciprocal antibody titres adjusted for maternal antibody decay and was assessed in the modified intention-to-treat population (infants who received polio vaccines per group assignment and polio antibody titre results to serotypes 1, 2, and 3 at 6, 22, 23, and 26 weeks of age). The non-inferiority margin was 12·5%. This trial is registered with ClinicalTrials.gov, number NCT02847026. Between Sept 1, 2016 and May 2, 2017, 1076 participants were randomly assigned and included in the modified intention-to-treat analysis: 271 in Group A, 267 in group B, 268 in group C, and 270 in group D. Vaccine response at 22 weeks to two doses of fIPV (group D) was significantly higher (p<0·0001) than to one dose of IPV (groups A and B) for all three poliovirus serotypes: the type 1 response comprised 212 (79% [95% CI 73-83]) versus 305 (57% [53-61]) participants, the type 2 response comprised 173 (64% [58-70]) versus 249 (46% [42-51]) participants, and the type 3 response comprised 196 (73% [67-78]) versus 196 (36% [33-41]) participants. At 26 weeks, the fIPV booster was non-inferior to IPV (group B vs group A) for serotype 1 (-1·12% [90% CI -2·18 to -0·06]), serotype 2 (0·40%, [-2·22 to 1·42]), and serotype 3 (1·51% [-3·23 to -0·21]). Of 129 adverse events, 21 were classified as serious including one death; none were attributed to IPV or fIPV. fIPV appears to be an effective dose-sparing strategy for routine immunisation and outbreak responses. US Centers for Disease Control and Prevention.

Expanded Programme on Immunization in Bangladesh: A Success Story

Infections are responsible for the majority of loss of life in children and vaccination has made enormous contribution to public health, including the eradication of one dreaded disease, small pox, and elimination of poliomyelitis from all but a handful of countries. Globally, immunization currently averts an estimated 2 to 3 million deaths every year. In Bangladesh it has prevented an estimated 2 million deaths from 1987- 2000, and continues to prevent approximately 200,000 deaths each year. WHO introduced EPI (Expanded Programme on Immunization) in 1977 at Alma-Ata, the capital of Kazakhastan for the underdeveloped countries. Subsequently Bangladesh has launched EPI programme. Recently AD (Auto Disable) syringes and vaccination against Hepatitis B, H. Influenzae, Measles-Rubella (MR) and Pneumococcus has been introduced in vaccination programme. In Bangladesh, immunization coverage of DPT/PENTA3 was only 16% in 1988 increased significantly to 69% in 1990, 81% in 2000, 90% in 2011and 92% in 2013 which was higher than global coverage of 84% in 2013 and comparable to first world countries. In Pakistan fully immunization coverage in 2010 was only 50%.9 Indian national full immunization coverage was 56% in 1990, 59% in 2000, 74% in 2010 and 74% in 2012 whereas in our country it was 52% in 1991, 53% in 2000, 79% in 2010, 80% in 2011and 81% in 2013 which signifies our excellent success for prevention of communicable diseases in successive years. So, EPI in Bangladesh has been recognized for its sustained high coverage and great contribution to the reduction of childhood morbidity and mortality and it received two ‘GAVI best performance award’ in 2009 and 2012.Bangladesh J Child Health 2015; VOL 39 (2) :93-98

Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV)

IntroductionIntradermal delivery of a fractional dose of inactivated poliovirus vaccine (IPV) offers potential benefits compared to intramuscular (IM) delivery, including possible cost reductions and easing of IPV supply shortages. Objectives of this study were to assess intradermal delivery devices for dead space, wastage generated by the filling process, dose accuracy, and total number of doses that can be delivered per vial. MethodsDevices tested included syringes with staked (fixed) needles (autodisable syringes and syringes used with intradermal adapters), a luer-slip needle and syringe, a mini-needle syringe, a hollow microneedle device, and disposable-syringe jet injectors with their associated filling adapters. Each device was used to withdraw 0.1-mL fractional doses from single-dose IM glass vials which were then ejected into a beaker. Both vial and device were weighed before and after filling and again after expulsion of liquid to record change in volume at each stage of the process. Data were used to calculate the number of doses that could potentially be obtained from multidose vials. ResultsResults show wide variability in dead space, dose accuracy, overall wastage, and total number of doses that can be obtained per vial among intradermal delivery devices. Syringes with staked needles had relatively low dead space and low overall wastage, and could achieve a greater number of doses per vial compared to syringes with a detachable luer-slip needle. Of the disposable-syringe jet injectors tested, one was comparable to syringes with staked needles. DiscussionIf intradermal delivery of IPV is introduced, selection of an intradermal delivery device can have a substantial impact on vaccine wasted during administration, and thus on the required quantity of vaccine that needs to be purchased. An ideal intradermal delivery device should be not only safe, reliable, accurate, and acceptable to users and vaccine recipients, but should also have low dead space, high dose accuracy, and low overall wastage to maximize the potential number of doses that can be withdrawn and delivered.

Observance of the Standard in Safe Injection: a Survey in the Inpatient Units of Teaching Hospitals

Introduction: Safe injection is a kind of injection that not hurts the one who receives service, not injures the providers and its leftovers won't make harm or damage to the society and environment. The purpose of this study was to investigate the rate of the observance of the standards with safe injection in the inpatient units of teaching hospitals in Tabriz. Materials and Methods: In this cross-sectional study, 399 samples were examined by Cochran formula. Samples were selected randomly as clusters from each hospital and inpatient units and data were gathered in all three working shifts. The data collection tools used in this study was a checklist which its reliability has been proved. Data were analyzed by using the SPSS 21 and were reported by relevant analytic and descriptive statistics. Results: 73.4% of subjects were woman. 63.90% of people in the past year have been passed the course related to infection and safe injections. The observance of the standards of safe injection in “preparation phase”, “during the injection” and “after injection” was 64.84, 58.95, and 63.95%, respectively, which had in fairly good condition. Conclusions: Performing the retraining programs in injections and nosocomial infections, employing people with work experiences in teaching hospitals, providing individual protection equipment such as glasses and mask, educations about hand washing, providing and using auto disable syringes and safety boxes and immunizing the staffs against hepatitis B and C can be the most important actions in doing safe injection.

Usability evaluation of intradermal adapters (IDA)

Intradermal adapter device technology minimizes the complexity of the Mantoux technique, thereby providing predictable, reproducible intradermal (ID) injections and removing the concerns regarding the ease and reliability of Mantoux technique when using conventional needle and syringe. The technology employs a simple device with geometry designed to gently deform the skin surface and the subcutaneous tissue, providing the ideal angle and depth of needle insertion for consistently successful intradermal injections. The results of this development were presented at the First, Second and Third Skin Vaccination Summits in 2011, 2013 and 2015 respectively [1,2,3].The current publication addresses the performance of intradermal adapters (IDA) evaluated in three preclinical studies. The evaluations were based on the assessment of bleb formation in a skin model, an accepted indicator of ID injection success. All evaluated devices share the same proprietary dermal interface technology. Devices instituting this design are easy to use, require minimal training, and employ conventionally molded parts and cannula.These studies evaluated IDAs of initial design integral with luer lock needles, IDAs for use with conventional syringes, and intradermal adapters for use with auto disable syringes (ADID adapters). The evaluated ID adapters were intended to consistently place the lancet of the needle at a depth of 0.75mm from the skin’s surface. This placement depth addresses the variation in the skin thickness at immunization sites for the majority of patients independent of many other variables.Most participants preferred the intradermal adapter method over the traditional Mantoux and identified a need for the adapter at their workplace. Evaluation of IDAs by registered nurses indicated these devices increase success of bleb formation. The use of IDA increased the success of forming blebs by about 30%. Nurses felt the injections were much easier to perform, in particular by novices.

Clinical performance and safety of adapters for intradermal delivery with conventional and autodisable syringes

Although the number of vaccines and diagnostic tests currently delivered intradermally is limited, this route of administration offers potential advantages due to the high concentration of antigen-presenting cells in the skin. One factor which may in part be limiting development and use of intradermal (ID) administration is concern about the ease and reliability of the needle and syringe-based Mantoux technique. A phase I clinical study was conducted to evaluate two ID adapters that have been developed as injection-delivery aids to increase the safety, simplicity, and reliability of ID injection: a prototype autodisable, intradermal (ADID) adapter for autodisable (AD) syringes, and a marketed side-merge adapter (SMA). Thirty healthy adult volunteers each received six injections of 0.1mL of sterile saline solution. Each adapter was used to give injections into the upper deltoid, forearm, and suprascapular regions of each volunteer. The needle-bevel orientation during injection was random. Injection performance was determined by measuring wheal size and fluid leakage. Wheals were similar in size for the ADID adapter (mean 9.9±0.17mm) and SMA (mean 9.8±0.15mm). In all of the injections completed with the SMA, and 98% of those completed with the ADID, fluid leakage was less than 10% of the intended injection volume. Minor skin abrasions were the only adverse events. Based on self-reporting of pain, injections were well tolerated (mean pain score of 2 on a 0–10 scale). ID delivery using the SMA and ADID adapters appears safe and effective.

Syringe-type and needle gauge have no role in adverse events following DTwP immunization: a randomized multicenter trial.

Auto-Disable syringes are recommended for immunization because of their greater safety and preventing reuse. In this study, the role of the syringe and needle gauge on the adverse events following Diphtheria, Tetanus toxoids and whole-cell Pertussis immunization was studied. In this study, 1000 children from 2 months to 6 years of age, eligible for Diphtheria, Tetanus toxoids and whole-cell Pertussis immunization and who referred to 4 health centers, were randomized into 2 groups of regular syringe users (the Auto-Disable syringe with a 23 gauge and 25 mm needle) and new syringe users (the disposable syringe with a 24 gauge and 25 mm needle). Adverse events following immunization were evaluated on days 2, 4 and 6 after immunization by visiting the children at their home and examining them. The occurrence of the primary endpoint (severe local reaction) was found to be 2.1% in all the children, 2.0% in the children vaccinated with the Auto-Disable syringe and 2.2% in the children vaccinated with the new syringe. This difference is not significant (P = 0.818). The evaluation of other milder adverse events (secondary endpoints) showed that the syringe type has no effect on the occurrence of these adverse events. Syringe types and needle diameter played no role in precipitating the adverse events following immunization of the Diphtheria, Tetanus toxoids and whole-cell Pertussis vaccine.

Evaluation of immunization injection safety in China, 2010: Achievements, future sustainability

ObjectiveThe study objectives were to evaluate injection practices in China in the post GAVI project era and provide guidance for policy makers to update national standards for injection practices and further improve vaccination services. MethodsWe conducted a national stratified, cross-sectional survey in October 2010, according to WHO recommended sampling methods. First, we stratified China into three regions (Eastern, Central and Western) based on economic criteria. Second, in each region, we selected eight counties with a probability proportional to population size. Third, in each selected county, we selected (a) 10 townships at random among the list of townships of the county and (b) the one county level hospital. ResultsWith respect to the risk to the patient, we never observed open injection equipment lying around or needles left in the septum of multi-dose vials. We never observed sterilizable injection devices syringes in any of the facilities. The proportion of facilities using sharps containers was highest in the East (85%), intermediate in the West (79%) and lowest in the Central region (56%). In 2009, auto-disable syringes and safety boxes were used in 78% and 79% facilities in GAVI supported areas of the Western region, respectively. Only one facility presented evidence of attempts to re-sterilize disposable injection equipment in the Eastern region. ConclusionsUse of AD syringe and sharps containers increased in vaccination services in China, especially in GAVI supported areas, leading to sustainable progress in terms of elimination of reuse of injection devices. However, risk to patients still existed, including persisting use of standard disposable syringes and attempts to re-use disposable devices.

Key outcomes and addressing remaining challenges—Perspectives from a final evaluation of the China GAVI project

During the China GAVI project, implemented between 2002 and 2010, more than 25 million children received hepatitis B vaccine with the support of project, and the vaccine proved to be safe and effective. With careful consideration for project savings, China and GAVI continually adjusted the budget, additionally allowing the project to spend operational funds to support demonstration projects to improve timely birth dose (TBD), conduct training of EPI staff, and to monitor the project impact. Results from the final evaluation indicated the achievement of key outcomes. As a result of government co-investment, human resources at county level engaged in hepatitis B vaccination increased from 29 per county on average in 2002 to 66 in 2009. All project counties funded by the GAVI project use auto-disable syringes for hepatitis B vaccination and other vaccines. Surveyed hepatitis B vaccine coverage increased from 71% in 2002 to 93% in 2009 among infants. The HBsAg prevalence declined from 9.67% in 1992 to 0.96% in 2006 among children under 5 years of age. However, several important issues remain: (1) China still accounts for the largest annual number of perinatal HBV infections (estimated 84,121) in the WHO WPR region; (2) China still lacks a clear national policy for safe injection of vaccines; (3) vaccination of high risk adults and protection of health care workers are still not implemented; (4) hepatitis B surveillance needs to be refined to more accurately monitor acute hepatitis B; and (5) a program for treatment of persons with chronic HBV infection is needed. Recommendations for future hepatitis B control include: using the lessons learned from the China GAVI project for future introductions of new vaccines; addressing unmet needs with a second generation hepatitis B program to reach every infant, including screening mothers, and providing HBIG for infants born to HBsAg positive mothers; expanding vaccination to high risk adults; addressing remaining unsafe injection issues; and improving monitoring of acute hepatitis B. This paper describes findings and discusses perspectives from a final project evaluation, a national stratified validated cross-sectional survey done in October 2010.

Unnecessary &amp; Unsafe Injections Replace Disposable by Auto-Disable Syringes

Injections are a skin procedure performed with a syringe and needle to introduce a substance for prophylactic, curative, or recreational purpose. Injections can be given intevenously, intramuscularly, intradermally, or subcutaneously. Injections are among the most frequently used medical procedures, with an estimated 12 billion injections administered worldwide. A large majority (more than 90%) of these injections are administered for curative purpose (for every vaccination, 20 curative injections are administered). Injections have been used effectively for many years in preventive and curative healthcare. In preventive healthcare, injections have been used to administer vaccinations that have had major impact in reducing childhood mortality due to measles and other vaccine preventable diseases. While injections are still necessary today to administer most vaccination, the number of vaccination injections could be reduced through the use of combination vaccines. In curative healthcare, injections have been used to administer such antibiotics as Penicillin, Streptomycin, as well as many other life saving medications. Today, safe and effective alternatives to injected medications are available and most medications used in primary care can be administered orally. Injections are predominantly needed for treatment of severe diseases, mostly in hospital settings. Nevertheless, injections are overused to administer medications in many countries because of an ingrained preference for injections among health workers and patients. A safe injection does no harm to the recipient, does not expose the healthcare worker to any risk, and does not result in waste that is dangerous for the community. To achieve this, an injection needs to be prepared with clean hands in a clean area, using a syringe and a sterile needle. After administration, sharp equipments such as needle need to be discarded in a puncture proof container for appropriate disposal. When these rules are not followed, injections are unsafe and may expose recipients, healthcare workers, or the community to infections. Among unsafe practices, syringe or needle reuse between patients without sterilization is associated with a high risk of blood-borne pathogen transmission. Unsafe injections occur in many parts of the world and more particularly in developing countries where up to 50% of injections are administered with reused syringes and needles. To reduce the overuse of injections, and to assure safe injection practice, multidisciplinary strategies comprising of various elements have been discussed in this article. DOI: http://dx.doi.org/10.3126/jucms.v1i3.8770 Journal of Universal College of Medical Sciences Vol.1(3) 2013: 67-70

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal

BackgroundUnsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety.MethodologyA descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats.ResultsThe in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management.ConclusionsCertain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.

Awareness on the impact of disposable syringes re-use and benefits of Auto-disable (AD) syringes in health care professionals and students in Karachi, Pakistan

Article history: Received on: 22/10/2012 Revised on: 09/11/2012 Accepted on: 25/12/2012 Available online: 29/12/2012 Karachi is the most advanced and populated city of Pakistan with approximately 20 million residents. The good health care practices awareness among health professionals especially use of syringes is an important role player for the control of disease spread by re-use of syringes. A quantitative approach involving a cross sectional survey based study, was carried out among four different categories of health personnel. A total of 200 participants were asked to fill a structured questionnaire (Doctors, Nursing staff, Lab technicians, and graduating health care students with a sample size of 50 for each group). A large proportion of participants were aware of the impact of re-use of disposable syringes and emphasized on the need for proper disposal system existence to eradicate the issue. The study results also showed that about 71 % of the health professionals had awareness on Auto-disable syringes use and around 29% had no knowledge about AD syringes. About 79 % of health care professionals agreed that AD syringe would reduce needle sharing and would help to cut down Hepatitis B, C and HIV.

Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence

Background:Unsafe medical injections are a prevalent risk factor for viral hepatitis and HIV in India.Objectives:This review undertakes a cost–benefit assessment of the auto-disable syringe, now being introduced to prevent the spread of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).Materials and Methods:The World Health Organization methods for modeling the global burden of disease from unsafe medical injections are reproduced, correcting for the concentrated structure of the HIV epidemic in India. A systematic review of risk factor analyses in India that investigate injection risks is used in the uncertainty analysis.Results:The median population attributable fraction for hepatitis B carriage associated with recent injections is 46%, the median fraction of hepatitis C infections attributed to unsafe medical injections is 38%, and the median fraction of incident HIV infections attributed to medical injections is 12% in India. The modeled incidence of blood-borne viruses suggests that introducing the auto-disable syringe will impose an incremental cost of $46–48 per disability adjusted life year (DALY) averted. The epidemiological evidence suggests that the incremental cost of introducing the auto-disable syringe for all medical injections is between $39 and $79 per DALY averted.Conclusions:The auto-disable syringe is a cost-effective alternative to the reuse of syringes in a country with low prevalence of blood-borne viruses.

Population-based hepatitis C survey in a rural block

Population-based hepatitis C survey in a rural block

Measles Supplementary Immunization Activities and GAVI Funds as Catalysts for Improving Injection Safety in Africa

In 2000, reuse of disposable syringes and inadequately sterilized syringes resulted in 39% of all injections being unsafe, causing 22 million infections. We describe the contribution of measles supplemental immunization activities (SIAs) and Global Alliance for Vaccines and Immunisation (GAVI) funding in replacing disposable and sterilizable syringes with auto-disable (AD) syringes to improve injection safety in 39 African countries. We assessed trends in nationwide introduction of AD syringes against measles catch-up SIAs and GAVI funding using World Health Organization/United Nations Children's Fund (UNICEF) Joint Reporting Form for Immunization and UNICEF supply data. In 19 (49%) of 39 countries, the measles program catalyzed the introduction of injection safety equipment, including AD syringes and safety boxes, training, and procurement of safety equipment during SIAs. GAVI was catalytic through financial support in 14 countries (36%) for including safe injection equipment in routine immunization. Additionally, GAVI funded 21 countries that had already introduced AD syringes in their national program. UNICEF AD syringe shipments to sub-Saharan Africa increased from 11 million to 461 million from 1997 to 2008. All 39 countries stopped using sterilizable syringes by 2004. The measles mortality reduction program and GAVI complemented each other in improving injection safety. All countries continued with AD syringes for immunization after measles catch-up SIAs and GAVI funding ended.