Safe Injection Practices

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Safe Injection Practices : 

Safe Injection Practices Presentation by Dr. D.S.Chandel CMO Hamirpur

Use of injections : 

Use of injections World—12 crore /year. India---300 crore / year. 63%---unsafe. 90%--inadequate sterilization. 53%--reuse of disposable syringe/needles. 53 %--wrong techniques.

Risk involved : 

Risk involved Injection abscess. Blood born infections—Hepatitis B & C, HIV etc.

BMWM : 

BMWM More injections—more BMW. Delhi—65 tons / year due to injections. India- satisfactory disposal of injection waste-institutional level—61 %, terminal level—45 %

Ethical use -? : 

Ethical use -? India –83% injections for treatment. 48%-- in OPD. Un necessary use in fever, cough, diarhoea, malaria.

What to do ? : 

What to do ? Safe practices. Safe BMWM. Directions to use injections—stay after injection etc. IEC activity.

? Safe injection--WHO : 

? Safe injection--WHO Harmless to patients/provider. Doesn’t produce BMW which is unsafe to community.

Safe injection technique : 

Safe injection technique Minimum chances of blood born diseases. Minimum chances of local infection, injury, reaction. Minimum danger to service provider.

Steps for SIP : 

Steps for SIP Preparation to give injection. Filling the syringe. Selection of site. Preparation of skin. Giving injection. Proper disposal.

Preparation for injection : 

Preparation for injection Syringe and needle of proper volume and gauge. 0.5 ml drug not in 5/10 ml capacity. I/M –23/24, cut/i.d.—25/26. Swab-spirit (not for vaccine), alcohol, boiled water. Check the vial/ampoule for expiry/color change.

Contd. : 

Contd. Multi dose vial—don’t leave the needle in the cap. Proper solvent as prescribed. Hub cutter. Use Auto disabled syringe. Color coded bins. Hand Washing. Wear gloves. Trimmed nails.

Filling the drug : 

Filling the drug Check the label for correct name , foreign material, expiry color change. Cutting of glass ampoule-particles should not fall into the ampoule / on ground. Use phials—knife. Hold the ampoule in left hand and phial in right hand. Use the collar band. Remove the metal piece form the cap.

Filling the syringe : 

Filling the syringe Open the syringe packet form upper end. Remove the cap from the needle. Hold the vial in left hand up side down and syringe in the right, fill equivalent air, push it into the vial cap at 90 degree. Less air– vacuum, more air—leakage of liquid. Ensure the tip dipped into the liquid. Do not fill air into the AD syringe.

contd. : 

contd. Take out the needle, keep the vial on table. Hold syringe with needle upward, tap with fingers. Do not recap the syringe– may cause injury. In case needed—recap single handedly. Do not wipe the needle. Do not touch the needle.

Site selection : 

Site selection Basic principle—minimum possibility of injury to nerves and vessels. Clean skin. Open display of the part. Patient comfortable.

Intra muscular : 

Intra muscular Deltoid. Gluteus. Thigh—middle 1/3.antero lateral middle-vastus lateralis /rectus femoris.

Intra dermal/ sub cutaneous : 

Intra dermal/ sub cutaneous As above. Anterior abdominal wall (s/c)—5 cm area around umbilicus ( except 1cm.) Flexor aspect fore arm.

Intravenous : 

Intravenous Cubital/ wrist Scalp in children. Dorsum of hand foot.

Preparation of skin : 

Preparation of skin Clean the skin inside out circularly. Spirit 30 seconds . Betadine 5 minutes. Swab single use.

Precautions in children : 

Precautions in children Table should be made free of items/ away fro it. Hold the child’s legs and hands making it stable.

Intradermal : 

Intradermal Angle 10 –15 degree. Stretch the skin. Bevel upside. Push 2-3 mm. Push the drug.—wheal Do not rub. Do not touch with spirit. BCG, tuberculine test, test dose.

Sub cutaneous : 

Sub cutaneous Hold like pencil in right hand. Hold a fold of skin with left hand to seprate it from muscles. push at 90 degree / in thin built or children 45 degree. Leave the skin fold slowly. Push the drug slowly 5 –10 seconds. Used for slow absorption of drugs—less blood supply.

Intra muscular : 

Intra muscular Hold like pencil. Stretch the skin. Push at 90 degree. Pull back the plunger to ensure the needle is not in the vessels. Push the drug 10 seconds. Press x 1 minute. Rich blood supply –quick absorption.

Intravenous : 

Intravenous Directly into the blood so precautions. Make the vein prominent. Hold the syringe 10 –15 degree. Bevel upwards. Valvular pathway. Blood leakage—press 1-2 minutes.

Most common mistakes : 

Most common mistakes No hand washing/use of gloves----------93%. Placing the syringe in tray after filling or after giving the injection--------------33%. Recapping with both hands---------------30%. Touching the needle------------------------25%. Reuse of syringe/ needle------------------23%. Flushing the syringe before filling-------11%. Wiping the needle --------------------------11%. Over the clothes-----------------------------7%

Model injection room : 

Model injection room One way traffic. Facility to lie down. Privacy. Sitting arrangement.bed to lie down in case of any reaction. Proper training of staff. Proper BMWM. PPE’s. Hand washing facility.

Contd. : 

Contd. Wash basin. Examination table. Bed. Almirah. Refrigerator. Stool,bench. Chair & table for staff. Color coded bins &hub cutter. Drip stand, oxygen cylinder, ambu bag.

Contd. : 

Contd. Emergency tray: syringe, inj. Avil, hydrocortisone, adrenaline, atropine, dextrose, normal saline. IV cannula, cotton, gauze, mouth gag, tongue depressor.

Slide 29: 

Thank you