SAFE INJECTION

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THIS IS USEFUL FOR PATIENTS AND HEALTHCARE WORKER SAFETY

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PATIENT & HEALTHCARE WORKER SAFETY (NUR 2002):

PATIENT & HEALTHCARE WORKER SAFETY (NUR 2002) SAFE INJECTION By: Christopher Ekpo

Reference definition :

Reference definition An injection that does no harm to the recipient Does not expose the health worker to any avoidable risk and Does not result in any waste that puts the community at risk (WHO/SIGN, 1998).

Safe injection:

Safe injection And injection safety includes all actions that are needed to ensure safe injection. Safety glide needle, courtesy, cardinalhealth.com

Safe injection :

Safe injection Definition translated into list of critical steps for which best practices should be followed: I n order not to harm the patient, T he injection should be administered with a sterile syringe and needle using the right medication, etc.

Safe injection:

Safe injection 2.In order not to expose the healthcare worker to any avoidable risk, The needle should be placed in a puncture-proof container immediately after use

Safe injection:

Safe injection 3. In order not to result in any waste that is dangerous to other people(community), Sharp waste should be discarded appropriately.

Safe injection:

Safe injection Dos and don'ts courtesy, dearnurses.blogspot.com

PowerPoint Presentation:

WHO/SIGN safe injection strategies

The origin :

The origin WHO in 1998 set up an approach for achieving injection safety that would encompass all elements from: Patient’s expectation, Doctors prescribing habits and Waste disposal.

The origin :

The origin Same year, WHO report acknowledged unsafe injection practices as a major health problem leading to the transmission of blood-borne pathogens (WHO/SIGN, 1998).

The origin :

The origin 30%-50% of injections may be unsterile In a year, unsafe injections may be responsible for: 8-16 million cases of Hepatitis A.

The origin :

The origin 2-5 million cases of Hepatitis C 80,000-160,000 cases of HIV and others are malaria, abscesses, fungal and other infections (WHO/SIGN, 2010).

The origin :

The origin The Unites States Agency for International Development(USAID) began an initiative late in 1998 which prepared a plan to set up a Safe Injection Global Network (SIGN).

Aim of SIGN strategy:

Aim of SIGN strategy To develop and implement: Policies and Programs, In collaboration with countries and other partners which will raise awareness to the gravity of unsafe injection practices.

Aim of SIGN strategy:

Aim of SIGN strategy To ensure: Safe and Rational use of injections and Reduce death and diseases spread by unsafe injection practices.

SIGN strategies:

SIGN strategies Make hepatitis testing services available/affordable at health facilities. Vaccinate at least 80% of all healthcare workers with Hepatitis B vaccine by 2015. Ensure the use of appropriate medical devices including syringes.

SIGN strategies:

SIGN strategies Conduct community awareness programs to educate the public about: Risk factors for transmission of blood-borne diseases from unsafe injection and Availability of testing for such diseases.

SIGN strategies:

SIGN strategies Establish infection prevention/control programs at healthcare facilities. Adopt standard precautions and proper management of sharps/injection waste. Educate staff on safe injection standards and procedures.

PowerPoint Presentation:

Best practices for injection safety

Best practices for injection safety :

Best practices for injection safety Perform hand washing before and after injection administration. Disinfect the skin with 70% alcohol-based (ethanol) solution on a single-use swab. Wipe from the centre of the injection site without going over the same area.

Best practices for injection safety :

Best practices for injection safety Apply the alcohol solution and let dry for 30 seconds completely before administering the injection. Avoid pre-soaked cotton wool swabs in a container.

Best practices for injection safety :

Best practices for injection safety Avoid alcohol skin disinfection for administration of vaccines. Use a new injection device for each injection. Use sterile injection equipment always.

Best practices for injection safety :

Best practices for injection safety Image courtesy www.oneandonlycampaign.org

Best practices for injection safety :

Best practices for injection safety Prevent contamination of injection equipment and medication. Prevent needle stick injuries to provider. Use a single-dose vial if possible

Best practices for injection safety :

Best practices for injection safety Avoid using one mixing needle and syringe to reconstitute several vials. Do not combine left over medications

Best practices for injection safety :

Best practices for injection safety Avoid the use of a multi-dose vial if sterility is compromised, the expiry date has passed, not stored properly, is more than 24 hours of opening and of course if it is not dated (Perry & Porter, 2006; WHO/SIGN, 2010).

Best practices for injection safety :

Best practices for injection safety

National standards :

National standards At country level, the best injection practices document should be adapted into national standards. These should be developed through a participatory approach that involves all stakeholders e.g. those who administer injections, those who prescribe them, those who are in charge of logistics, etc.

PowerPoint Presentation:

The bedrock of safe injection strategies

Behaviour change :

Behaviour change For any technology or procedure, knowledge and skills need to be updated to make sure that behaviour is consistent with current best practice. Any strategy for improving injection safety must be based on a thorough understanding of all elements contributing to such behaviour.

Availability of essential supplies and equipment:

Availability of essential supplies and equipment Each technological development has implications for management systems, including procurement, storage, distribution and operational strategies for service delivery.

Availability of essential supplies and equipment:

Availability of essential supplies and equipment Systems for monitoring & auditing all these processes are required in order to demonstrate that these problems are being addressed satisfactorily.

. Management of waste safely and appropriately:

. Management of waste safely and appropriately If disposable syringes replace sterilizables, the huge increase in volume of supplies must be taken into account.

Management of waste safely and appropriately:

Management of waste safely and appropriately At the present, the greatest unsolved problems accompanying disposable technologies are safe disposal, environmentally acceptable destruction & final containment of the residual waste (WHO/SIGN, 1998).

Assuring injection safety:

Assuring injection safety Injection Safety education: Training & Re-training of health care workers is important to reduce errors and to ensure safe injections Communications and public education are also equally important to understand the risks and benefits of injections

Assuring injection safety:

Assuring injection safety Develop an injection safety plan: Assess the situation and identity needs and challenges Identify stake holders Develop a specific plan

Assuring injection safety:

Assuring injection safety Safe injections at the point of use: Proper supply of ADs and disposal boxes

Assuring injection safety:

Assuring injection safety Safe disposal of used injection equipment : Identify practical solutions Assess options Destruction points Monitor disposal

Assuring injection safety:

Assuring injection safety Monitoring and evaluation: Regular supervisory visits Final evaluation

PowerPoint Presentation:

Reasons for unsafe injection practices

Reasons for unsafe injection practices:

Reasons for unsafe injection practices Lack of knowledge of dangers of injection. False belief that injection are more effective than oral medications. Some healthcare workers may think that patients want an injection even when they do not.

Reasons for unsafe injection practices:

Some patients may demand injections even against the advice of their healthcare worker Some clinicians make more money if they give an injection (SIGN,2010). Reasons for unsafe injection practices

PowerPoint Presentation:

Practices that harm recipients

Practices that harm recipients:

Practices that harm recipients Use of unsterile needles and syringes. Storing medication and vaccine in same refrigerator. Applying pressure to bleeding sites with used swab or finger. Mixing two partially opened vials of vaccine.

Practices that harm recipients:

Practices that harm recipients Keeping freeze-dried vaccine more than six hours after constitution. Vaccinating infants in the buttocks.

PowerPoint Presentation:

Practices that harm healthcare workers

Practices that harm healthcare workers:

Practices that harm healthcare workers Reusing needles and syringes by trying to sharpen, etc. Carrying used needles or placing them on a surface prior to disposal. Recapping needles.

PowerPoint Presentation:

Practices that harm the public

Practices that harm the public:

Practices that harm the public Leaving needles and syringes in areas where children can take them. Giving or selling needles and syringes to vendors who will resell them. Leaving or disposing of needles and syringes inappropriately in the community.

Common causes of unsafe injection for pts:

Common causes of unsafe injection for pts Needle prick from a used syringe Infected syringe or needle which is the result of reuse of syringes after inadequate sterilization and repacking of used syringes by illicit groups Poor technique Infected vials

Common causes of unsafe inj for community & health worker:

Common causes of unsafe inj for community & health worker Improper or inadequate destruction of used syringes Unsafe disposal of sharps or needles Careless handling and unscientific management of used syringes and needles ( SIGN, 2010).

New technology devices that prevent potential infections:

New technology devices that prevent potential infections Auto-disable (A-D) syringe A specially modified plastic syringe with a fixed needle which is automatically disabled after a single use Auto-Disable Syringe (0.5ml).courtesy: chinamedevice.com

New technology devices that prevent potential infections:

New technology devices that prevent potential infections Syringe with reuse-prevention feature A specially modified plastic syringe that includes a mechanism to discourage reuse Courtesy: jxhd.en.alibaba.com

New technology devices that prevent potential infections:

New technology devices that prevent potential infections Jet injector A needle-free device that allows the injection of a substance through the skin under high pressure Intradermal Jet Injector Needleless, courtesy: micglobal.co.uk

Jet injectors:

Jet injectors Courtesy: micglobal.co.uk LectraJet® HS Injector, courtesy : dantonioconsultants.com

New technology devices that prevent potential infections:

New technology devices that prevent potential infections Safety syringe Modified, disposable plastic syringe designed so that the health care worker can disable it in such a way that the needle is protected and cannot be re-used Courtesy: syringex.com

New technology devices that prevent potential infections:

New technology devices that prevent potential infections Peanut Safe syringe Modified, disposable plastic syringe, new to the market designed so that the health care worker can disable both the needle and barrel after use and cannot be re-used. The product stands out because of cost effectiveness

PowerPoint Presentation:

Key training messages for injection safety in immunization program

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Use a sterile AD syringe and needle to vaccinate each child. Use a disposable syringe and needle to reconstitute each vaccine. Prevent contamination of injection equipment and vaccine.

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Prepare each injection in a designated, clean area where blood or body fluid contamination is unlikely. Always pierce the septum of multi-dose vials with a sterile needle. Do not leave a needle in the stopper.

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Protect fingers with small gauze pad when opening ampoules. Discard a needle that has touched any non-sterile surface (hands, environmental surfaces). Anticipate and take measures to prevent sudden patient movement during and after injection.

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Prevent needlestick injuries by not recapping and placing used needles directly in safety boxes. Collect used syringes and needles at the point of use in a safety box, that is sealed when full (do not transfer contents or overfill safety boxes).

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Seal safety(puncture proof) boxes for transport to a secure area. Do not open, empty or reuse them. Manage injection waste in an efficient and environment-friendly way. Prevent accidents to personnel in charge of waste disposal.

Key training messages for injection safety in immunization program:

Key training messages for injection safety in immunization program Do not place empty vials in the safety box, they may explode while burning. Put only potentially contaminated injection equipment in the safety boxes. Do not put cotton pads, compresses, etc. in the safety boxes.

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Disposal of injection wastes and sharps

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Sharp Containers should be: leak-proof puncture-proof clearly labelled with warning (easy for people to understand) Do not overfill (only 3/4th is safe) Do not transfer contents to other containers

Sharp containers:

Sharp containers unsafe safe

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Destroying syringes & needles Incineration- where available high temperature incineration is the best, but too costly to have it at every level. Therefore, other methods are- Burial Burning

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Incineration The high temperature kills microorganisms Completely destroys needles and syringes by burning at high temperature (800 0 C) Minimal toxic fumes from incinerator, less air pollution Reduce volume of waste to minimum But requires special facilities to be built Costly & complex to operate

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps incineration Incinerator Diagram, courtesy, kalpvruksh.com A conceptual diagram of the Incineration Plant, courtesy: gec.jp

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Open burning - cheapest option Combustion is at lower temperature May not destroy injection equipment completely More toxic emission, chances of more waste scatter Usually done in open pit or metal drums Fence off and clear area and warn people to stay away from site Make sure that fire is not left unattended Prevent waste from scattering & littering

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Open pit burning, courtesy: broward.org

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Burial Burial can be for unburnt injection waste or waste generated by burning The pit should be at least 1 meter in depth It should be cordoned off to prevent access to site by people/children Some even recommend covering pit with concrete when full

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps For a correct burial of injection waste, the depth of the burial pit should be sufficient Once it is filled, some even suggest it to be sealed with concrete However, this may not be possible in most peripheral health centres ( SIGN,2010).

Disposal of injection wastes and sharps:

Disposal of injection wastes and sharps Waste burial pit, courtesy SIGN

PowerPoint Presentation:

Hazards of unsafe injection practices

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Unsafe injection practices are a powerful engine to transmit blood borne pathogens, including: Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human immunodeficiency virus (HIV).

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Unsafe injections account for: 33% of new HBV infections in developing and transitional countries, A total of 21.7 million people infected each year.

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Courtesy, cdc.org

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Unsafe injections are the most common cause of HCV infection in developing and transitional countries, Causes two million new infections each year and accounting for 42% of cases.

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Graphic representation of transmission of HCV during unsafe injection practices. Courtesy, cdc.gov

Hazards of unsafe injection practices:

Hazards of unsafe injection practices

Hazards of unsafe injection practices:

Hazards of unsafe injection practices Globally nearly 2% of all new HIV infections are caused by unsafe injections. A total of 96 000 people infected annually. In South Asia up to 9% of new cases may be caused in this way.

References :

References Brunner, J. S. & Haste, H. ( 1987). Making Sense: The child’s construction of the world. New York: Methuen. Perry, A. G. & Porter, P. A. ( 2006). Clinical Nursing Skills and Techniques. (6 th ed.) St. Louis: Elsevier Mosby.

References :

References Quinn, F. M. & Hughes, S. J. (2007). Principles and practice of nurse education (5 th ed.). Cheltenham: Nelson Thornes Ltd Safe Injection Global Network ( 1998). Strategies for Safe Injection. Retrieved from http://www.injectionsafety.org

References :

References WHO ( 1998). Strategies for Safe Injection. Retrieved from http:// www.who.int/bulletin/archives/77(12 ). pdf

References :

References WHO ( 2010). Best practices for injections and related procedures toolkit. Retrieved from http://www.whqlibdoc.who.int/publications / 2010/9789241599252 eng.pdf

References :

References WHO (2010). Revised Injection Safety Assessment Tool. Retrieved from http://www.who.int/injection_safety/injection safety_final-web.pdf

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