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Injection Safety & Technology
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.
Conventional needle-free injectors,
which have been used with multidose vaccine vials for mass immunization
over the last fourty years, have been tested to determine the risk of
transmitting Hepatitis B and other bloodborne pathogens. Tests in
animals have shown significant contamination and, should these findings
be supported by human trials planned to be carried out this year in
Brazil, there will be a strong case for discontinuing the use of these
types of injectors.
The design of multidose needle-free
injectors is now being modified to reduce the risk of cross-infection to
below the level of the infectiveness of Hepatitis B. New models of
needle-free injector with pre-filled drug or vaccine containers and
disposable fluid drug or vaccine containers and disposable fluid
pathways are being developed and expected to make injections safer,
easier and less painful. A WHO Steering Group is currently working on
the development of needle-free injection for immunization worldwide.
An extensive review of articles and
WHO and
UNICEF country reports, published
this year, document the extent of unsafe injection practices in a large
number of countries. It also proposes a mathematical model to estimate
the number of infections with bloodborne pathogens that could be
expected should no effort be made to improve the safety of injection
practices.
To address this worrying issue in a
concrete and focused manner, three WHO programmes (EMC,
EHA and
V&B) and the programme and
supply Divisions of UNICEF have signed a new joint policy which
recommends that sufficient auto-destruct syringes (which cannot be
re-used) and safety boxes are automatically provided with high-quality
vaccine for all mass immunization campaigns, including measles control
operations. This 'bundling policy' was successfully implemented for all
mass immunization campaigns carried out in 1997, to control epidemic
meningitis and for a measles campaign in Fiji.
As UN and other agencies consolidate
their policies to ensure safe injections through training and
technologies to prevent re-use, WHO expects a corresponding increase in
the use of auto-destruct syringes, both for immunization and other
injections, and a sharp fall in the price of these syringes. The
industry has indicated its preparedness to introduce low-cost two-piece
auto-destruct syringes, now that the number of competing suppliers are
now able to provide auto-destruct syringes for intradermal injection of
BCG vaccine and other curative injections, in addition to the standard
intramuscular and subcutaneous injections for immunization.
EPI, recognizing that immunization
injections represent only 10% of all injections delivered, has drafted a
framework for a global strategy to improve the safety of all injections.
Key resource documents
- Safety of injections.
WHO/UNICEF joint statement on the use of auto-disable syringes in
immunization services.
WHO/V&B/99.25.
- WHO-recommended policy:Safety of
injections in immunization programmes.
WHO/EPI/LHIS/96.05 Rev.1
The document describes the different
types of injection material, and gives recommendations concerning
their use and disposal.
- Reducing the risk of unsafe
injections in immunization programmes: The financial and operational
implications of using various injection technologies.
WHO/EPI/LHIS/94.02.
This document includes a review of
the complications of unsafe injections, their potential risk of
disease transmission and the financial and operational implications of
using different types of injection equipment in the EPI.
- You may also wish to refer to the
relevant sections of the
Product Information Sheets, 2000 edition (Section E8: Equipment
for administration of vaccine and micronutrients; Section E10:
Injection accessories)
For
more information
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