INTRODUCTION

Injection safety is a fundamental component of healthcare, involving the practices, procedures,

and equipment required to ensure that injections are administered without harm to patients,
healthcare workers, or the community. According to the World Health Organization (WHO), a safe
injection is defined as one that “does not harm the recipient, does not expose the provider to
avoidable risk, and does not result in dangerous waste for the community” (WHO, 2016).

Injections are among the most frequently performed medical procedures worldwide, with billions
administered annually for therapeutic purposes, immunization, and other clinical interventions.
Despite their routine nature, unsafe injections remain a major public health concern. Practices
such as reusing syringes, improper sterilization, or unsafe disposal of sharps can lead to the
transmission of serious infections, including HIV, hepatitis B, and hepatitis C, as well as other
bacterial infections (WHO, 2017).

Globally, unsafe injection practices are estimated to contribute significantly to the spread of blood-
borne infections, particularly in low- and middle-income countries. Ensuring injection safety is
therefore a critical component of infection prevention and control (IPC), protecting both patients
and healthcare workers from avoidable harm.

WHO emphasizes several core principles for injection safety:

1. Use of sterile, single-use equipment for every injection.
2. Strict hand hygiene and aseptic technique during injection administration.
3. Safe disposal of sharps in puncture-proof containers to prevent accidental injury and
reuse.
4. Training healthcare workers and raising public awareness about safe injection practices.

Through adherence to these guidelines, healthcare systems can reduce the risk of healthcare-
associated infections, improve patient safety, and strengthen trust in medical services. WHO
continues to provide global guidance, including safety-engineered syringes, infection prevention
protocols, and monitoring tools to ensure widespread adoption of safe injection practices (WHO,
2016; WHO, 2017).

DEFINITION OF INJECTION SAFETY

According to World Health Organization (WHO), a safe injection does not harm the recipient,
does not expose the provider to any avoidable risks, and does not result in waste that is dangerous
for the community.

INJECTION
Is the act of administering a liquid, especially a drug, into a person's body using a
needle (usually a hypodermic needle) and a syringe.[1] An injection is considered a
form of parenteraldrug administration; it does not involve absorption in the digestive
tract. This allows the medication to be absorbed more rapidly and avoid the first pass
effect.
TYPES OF INJECTION

1- INTRAVENOUS
Healthcare professionals use intravenous (IV) injections to give medications
directly into a vein. Because this type of injection delivers medication into the
bloodstream, it allows for rapid absorption, which causes an immediate response.

2-INTRAMUSCULAR
Doctors can use intramuscular injections to deliver medication into a person’s
muscle tissue. The muscles have a rich blood supply, which helps the body absorb
the medication quickly.

Healthcare professionals commonly useTrusted Sourceintramuscular injections to

administer:

 most vaccines
 select antibiotics, such as penicillin and streptomycin
 corticosteroids for inflammation or allergic reactions
 hormones, such as testosterone

3-SUBCUTANEOUS
Healthcare professionals administer subcutaneous injections into the fatty tissue
just under the skin and above the muscle tissue. They will use a smaller needle to
give subcutaneous injections to ensure that the medication enters the fatty tissue
and not the muscle.

4-INTRAOSSEOUS
Intraosseous injections involve using a special needle to puncture the bone marrow
to reach the veins. The bone marrow has a rich blood supply that connects straight
to the circulatory system.

PROCEDURE FOR ADMINISTRATION OF INJECTION

Pre-Administration Phase
These steps focus on verification, preparation, and safety checks before gathering the supplies.
1. Verify Order: Ensure the order exists and is valid.
2. WIIAPA (Introduction and Initial Assessment):
a. Wash hands (Initial infection control).
 b. Introduce self (Establishes rapport).
c. Identify patient (Use 2 identifiers - crucial for safety).
d. Allergies (Including food allergies - critical safety check).
e. Plan of care (Educate the patient on what will happen).
f. Assess patient (Baseline assessment, check suitability for the medication).
3. Check accuracy and completeness of MAR: Compare the Medication Administration Record
(MAR) with the original provider's written order (patient name, drug, dose, route, time).
4. Review medications: Understand the drug's action, purpose, normal dose, side effects, peak
onset, and nursing implications.
5. Check expiration date: Ensure the medication is potent and safe.
6. Perform hand hygiene.
Preparation and The Three Checks
These steps involve preparing the medication and performing the first two essential safety checks.
7. Prepare medications: Use aseptic technique and prepare for only one patient at a time. Ensure
correct timing.
8. Close room curtain or door: Provides patient privacy.
9. Apply the seven rights of medication administration: The fundamental safety check. (Right
patient, right drug, right dose, right route, right time, right documentation, right to refuse/reason).
10. Ensure patient name, DOB, and allergies. (Reinforcing Step 2c and 2d).
11. Compare at bedside (Third Check): Compare the MAR with the medication label and the
patient's name band.
12. Educate patient: Explain the medication action and side effects; allow questions. (Patient
education/Informed Consent).
13. Perform hand hygiene and apply clean gloves. (Preparing for the injection).
Injection Administration (IM/Z-Track)
These steps are specific to the technique of administering the intramuscular injection, including
the Z-track method.
14. Select appropriate site. (Common IM sites include deltoid, ventrogluteal, vastus lateralis).
15. Place patient in a comfortable position. (Ensures muscle relaxation).
16. Relocate appropriate site using anatomical landmarks. (Critical for avoiding nerves/blood
vessels).
17. Clean site: Use an antiseptic swab, center to outward (infection control).
18. Remove needle cap: Pull straight off (maintains sterility).
19. Hold syringe: Like a dart, palm down (correct grip for control).
20. Administer injection using Z track method:
Pull skin laterally 1-1.5 inches (the Z-track move).
Inject needle quickly at a 90-degree angle into the muscle (IM standard).
21. Aspirate (except for vaccines): Pull back on the plunger for 5-10 seconds. If no blood appears,
inject slowly. Do not aspirate for vaccines.
22. Withdraw needle and release skin: Wait 10 seconds, then withdraw smoothly and steadily.
Release the skin after the needle is out. Apply gauze gently.
23. Apply gentle pressure but do not massage. (Massaging can push medication into subcutaneous
tissue or irritate the site).
Post-Administration and Documentation
These are the final steps for safety, disposal, and record keeping.
24. Apply bandage/Help patient: Ensure comfort and site protection.
25. Discard uncapped needle/syringe: Immediate disposal into a sharps container (prevents
needlestick injury).
26. Remove gloves and perform hand hygiene.
27. Stay with patient: Observe for several minutes for any immediate allergic reactions.
28. Document: Record the drug, dose, route, time, site, and any patient reaction immediately.

STEPS FOR SAFE INJECTION

1. A safe injection program lead worker must be designated and given authority to plan,
implement and evaluate program.
2. A comprehensive, skill-based written injection safety policy is established and available to all
staff. The policy is updated annually.
3. All new employees will review the policy and receive comprehensive training on safe
injections.
4. All new employees will be observed while setting up, preparing and administering an injection
with documentation of the employee's competency completed.
5. All existing employees will participate in an annual competency check that includes set up,
preparation and administration of an injection with observation and documentation of competency.
6. All competency documentation shall be kept in the employee's personnel file or in a separate
file with documentation of all employee's competency checks.

SAFE INJECTION TECHNIQUES

• Choosing the correct vial of medication
• Checking the name on the medication vial against the written order to verify the correct
medication is given to the correct patient
• Checking the expiration date on the vial of medication
• Preparing injections only when they are ready to be administered
•Examining the vial for contamination including discoloration, particulates and if necessary,
ability to be re-suspended
•Removing the dust cover off the vial and cleansing the rubber stopper with a new single sterile
pre-packaged alcohol pad that is at least 60% alcohol
•Using one new, sterile, individually wrapped needle and syringe one time for one patient
•Performing hand hygiene before and after preparing and administering an injection even i
wearing gloves for the procedure
•Discarding the needle and syringe immediately after use in designated container
•Discarding a single dose vial after withdrawing one dose from the vial, even if there is some fluid
left in the vial

"NEVER’S" IN INJECTION SAFETY

• Never reuse needles, syringes, single dose vials of medication, IV tubing, or single use bags of
IV solution for more than one patient
• Never draw partial doses from separate vials to make one full dose
• Never transfer medication from one syringe to another syringe
• Never enter a vial with a used needle or syringe

COMPONENT OF SAFE INJECTION

Injection safety includes:
• Sterile Equipment
• Skilled Personnel
• Safe Technique
• Appropriate Indication (only inject when necessary)
• Safe Sharps Disposal
• Proper Storage of Vaccines and Drugs

WHY INJECTION SAFETY MATTERS

Injection Safety is important because:
• Prevents HIV transmission
• Prevents Hepatitis B & C
• Reduces needle-stick injuries
• Prevents local complications such as:
- Abscess
- Cellulitis
- Pain
- Tissue damage
• Protects the environment
• Ensures patient confidence

PREVENTING NEEDLES STICK INJURIES

• Do not recap needles
• Do not detach needles by hand
• Do not bend or break needles
• Do not carry sharps around
• Use puncture-proof sharps boxes
• Keep sharps boxes within arm's reach
• Close box at 3/4 level
• Report injuries immediately
• Start Post-Exposure Prophylaxis (PEP) if needed

OVERVIEW
Safe injection practices are actions healthcare providers should follow when
performing medical injections. A safe injection does not harm the recipient or expose
the healthcare provider to avoidable risks.

Healthcare providers should never reuse a needle or syringe on more than one patient.
Providers must discard both needles and syringes once used. Reusing the needle
and/or syringe is unsafe and can spread disease.
For example, unsafe injection practices can occur during:

 Administration of anesthetics (drugs to decrease the feeling of pain or eliminate it by

putting you to sleep) for outpatient surgical, diagnostic and pain management procedures.
 Administration of intravenous (IV) medications for chemotherapy, cosmetic procedures
and alternative medicine therapies.
 Use of saline to flush IV lines and catheters.
 Administration of vaccines.

AS A PATIENT:
Always ensure that your healthcare provider uses a new, sterile needle and syringe for every
injection. Reusing needles or syringes can lead to the spread of harmful infections such as HIV,
Hepatitis B, and Hepatitis C.
After use, needles and syringes should be disposed of in a proper sharps disposal container to
prevent injury and contamination.
Don't hesitate to ask your healthcare provider if the injection equipment being used is sterile and if
they follow safe injection practices. It's your right to feel safe and informed about the procedures
being performed.
After receiving an injection, be on the lookout for any signs of infection, such as redness,
swelling, or pain at the injection site. If you notice any unusual symptoms, contact your healthcare
provider immediately.
If you observe or experience any unsafe injection practices, report them to your healthcare
provider or local health department. Ensuring safe practices can prevent harm to others.