It is
estimated that every year a billion injections are given to women and children
through national immunization programmes. Up to half of these injections are
currently thought to be unsafe. Reusing needles or syringes without proper
sterilization, or improperly disposing of used injection equipment, puts the
public and health workers at risk of cross infection with Hepatitis B or C, or
HIV.
Unsafe injection practices in
hospital and outpatient settings account for a significant proportion of cases
of viral hepatitis worldwide, said Harold Margolis, MD, Centers for Disease
Control and Prevention, Atlanta, Georgia.
"The incidence of viral hepatitis in
a given population is a good indicator of the effectiveness of hospital
infection control and injection safety practices in that setting," Margolis
said. "A significant proportion of cases of viral hepatitis is iatrogenic."
Note: "Iatrogenic" =
"Induced in a patient by a physician's activity, manner, or therapy. Used
especially of an infection or other complications of treatment." In
other words, it means "caused by the doctor".
As we review the successes and
failures in global health at the end of the twentieth century, an alarming
pattern emerges suggesting that the "first do no harm" principle may be being
violated on a grand scale as a result of unsafe injection practices.
"To a large extent the very high rate
of hepatitis B has to do with unsafe injections and excessive injection for
common illness during childhood," the United Nations Common Country Assessment
for China said in 1999.
......Chinese researchers found that
88 percent of injections in a large rural county were unsafe, most often because
doctors reused needles and syringes after inadequate or no cleaning.
The World
Health Organization (WHO) estimates that every year unsafe injections result in
80,000-160,000 new HIV-1 infections, 8-16 million hepatitis B infections, and
2·3-4·7 million hepatitis C infections worldwide (this figure does not include
transfusions).1
Together, these illnesses account for 1·3 million deaths and 23 million years of
lost life.1
Even under the auspices of WHO regional immunization programmes, which
constitute 10% of all mass vaccination campaigns, an estimated 30% of injections
are done with unclean syringes that are commonly reused. And, for other
medicinal injections, over 50% are deemed unsafe, with rates as high as 90% in
some campaigns.1
NEW DELHI: Billions of injections-a
vast majority of them unsafe and unnecessary-are being administered to patients
globally, leading toserious
disease and millions of deaths annually, a government scientist warned here at
the International Conference on Harm Reduction this week.
Years of screening means most of
China's blood supply is probably safe from hepatitis B, said Liu Chongbo, a
researcher at the China Academy of Medical Prevention. He said the most common
means of transmission is dirty needles, which are often reused by doctors in
poor rural areas to save money.
About 60 percent of those who have had disease caught it during childhood,
usually during routine vaccinations.
Thousands of millions of injections are delivered every year in developing
countries, many of them unsafe, and the transmission of certain bloodborne
pathogens via this route is thought to be a major public health problem.
A safe
injection is an injection that does not harm the recipient, does not expose the
health care worker to any risk, and does not result in waste that is dangerous
for the community. Unsafe injection practices have been linked to the
transmission of many pathogens between patients, including hepatitis, HIV,
dengue fever and malaria. Of all the adverse effects of unsafe injections,
transmission of hepatitis B and hepatitis C viruses causes the heaviest burden
of disease. In many countries where hepatitis B and hepatitis C are highly
endemic, unsafe injections account for a large proportion of infections.
Worldwide, most infections occur from infected mother to child, from child to
child contact in household settings, and from reuse of unsterilized needles and
syringes.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
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