Safe Injection
Practices
Infection and Prevention Week
Dr. Apurva S Kshirsagar
Overview
• Safe injection Practices
• Unsafe injection practices
• Risk associated with Unsafe injection practices
• 7 steps to safe injection
• Recommendations on single dose and multidose vials
• Needle stick injury
What is a “safe injection”?
A safe injection does not harm the recipient, does not expose the
provider to any avoidable risk and does not result in any waste
that is dangerous for others.
• Source: WHO injection safety glossary: [Link]
Safe Injection Practices
• A set of measures intended to prevent transmission of infectious
diseases between one patient and another or between a patient
and health care personnel (HCP) during preparation and
administration of injectable (e.g., intravenous, intramuscular
injection) medications.
How can an injection be
unsafe?
• If any of the steps to make an injection safe are not undertaken
appropriately.
In particular, if:
• the injection is given in an environment that is not clean and hygienic;
• the needle or the syringe are used for more than one patient;
• the package is not sterile or new and sealed;
• the vial is used multiple times;
• the skin is not properly disinfected;
• the needle is not disposed of safely;
• an injection is unnecessary and may cause harm (e.g. antibiotics, which can
cause resistance);
• the injection is given incorrectly, which can cause
damage to the nerve and lead to paralysis
of the area.
Why is injection equipment
reused?
• Lack of awareness or understanding of risks associated with
unsafe injections
• Lack of injection equipment and supplies
• in both public and private settings
• Saving money on syringes and needles
• mostly related to private settings
• Sources: Reeler AV. Anthropological perspectives on injections: a review. Bull World Health Organ. 2000;78(1):135–143;
Luby SP, Qamruddin K, Shah AA, Omair A, Pahsa O, Khan AJ et al. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan. Epidemiol
Infect. 1997;119(3):349–356;
WHO Western Pacific Region. Patient safety fact sheet ([Link]
Okwen MP, Ngem BY, Alomba FA, Capo MV, Reid SR, Ewang E. Uncovering high rates of unsafe injection equipment reuse in rural
Cameroon: validation of a survey instrument that probes for specific misconceptions. Harm Reduct J. 2011;8:4.
Risks associated with unsafe
injection practices
• Bloodborne pathogen transmission
• hepatitis B virus (HBV) infection
• hepatitis C virus (HCV) infection
• HIV
• viral haemorrhagic fevers
• Abscesses
• Septic
• aseptic
• Nerve damage
• with risk of paralysis Unsanitary injection preparation area
• Other less common diseases
• such as malaria
Risk of HBV, HCV and HIV transmission in health care settings
s o urce
re
Key
Is this the right place for making a safe
injection?
Safety-engineered syringes for therapeutic
injections
1
2
5
RUP and SIP RUP and SIP
3 4
RUP and SIP SIP RUP
The seven steps to safe injections
1 Clean work space
7
2 Hand hygiene
3 Sterile safety-engineered syringe
4 Sterile vial of medication and diluent
5 Skin cleaning
6 Appropriate collection of sharps
s o urce
7 Appropriate waste management Key
re
Appropriate collection of sharps
• Never recap needles.
• Place uncapped syringes and needles
directly into sharps containers
immediately after use.
• Sharps containers should be accessible,
at every point of care.
Single and Multidose Medication
Vials
• Single Dose Vials–A vial of liquid medication intended for
injectable administration (injection or infusion) that is meant for
use in a single patient for a single case, procedure, or injection.
Single-dose or single-use vials are labeled as such by the
manufacturer.
• Multidose Vials–A vial of liquid medication intended for injectable
administration (injection or infusion) that contains more than one
dose of medication. Multidose vials are labeled as such by the
manufacturer.
Unsafe Injection Practices that have
led to patient harm…
• Mishandling and inappropriate sharing of medication vials and
containers.
• Reuse of syringes and needles.
• Preparation of medications in close proximity to contaminated
supplies or equipment.
Unsafe Injection Practice
Safe Injection Practices –
Recommendations
• Medication containers (single and multidose vials, ampoules, and
bags) are entered with a new needle and new syringe, even when
obtaining additional doses for the same patient.
• Use single-dose vials for injectable medications when possible.
• Do not use single-dose (single-use) medication vials, ampoules, or
bags or bottles of intravenous solution for more than one patient.
• Do not combine (pool) leftover contents of single-dose vials for
later use.
Safe Injection Practices
Recommendations for Multidose
Vials
• Dedicate multidose vials to a single patient whenever possible.
• If multidose vials will be used for more than one patient, they should
be restricted to a centralized medication area and should not enter
the immediate patient treatment area to prevent inadvertent
contamination.
• If a multidose vial enters the immediate patient treatment area, it
should be dedicated for single-patient use and discarded immediately
after use.
• Date multidose vials when first opened. Discard within 28 days
unless the manufacturer specifies a shorter or longer date for that
opened vial.
Safe Injection Practices: Fluid
Infusion Recommendations
• Do not use fluid infusion or administration sets (e.g., IV bags,
tubings, connections) for more than one patient.
Needle-stick injury
prevention
Types of needle that cause
needle-stick injuries
• Hypodermic needles
• Blood collection needles
• Suture needles
• Needles used in intravenous delivery systems
How needle-stick injuries
occur
Sudden patient movement during the
injection
Recapping the needles
Transferring body fluids between
containers
Failing to dispose of used needles properly
in a puncture-proof safety box
If you get a needle-stick
injury
Take the following actions immediately
1. Wash the wound with soap and water.
2. Inform your supervisor and follow the needle-
stick injury reporting mechanism of your health
facility.
3. Identify the source patient, who should be tested
for HIV, hepatitis B and hepatitis C infections.
Note: tests should be carried out after patient
counselling and consent.
4. Be tested for HIV, hepatitis B and hepatitis C
infections.
• Source: [Link]