WHO/EPI Safe Injections Ana Maria Henao World Health Organization EPI/V&B.

WHO/EPI

Safe Injections

Ana Maria HenaoAna Maria HenaoWorld Health OrganizationWorld Health Organization

EPI/V&BEPI/V&B

WHO/EPI

Every countryEvery country should: should:

• ensure the quality & safety of its vaccines

• ensure the safety of immunizations

• be able to rapidly detect immunization safety issues

• be prepared to effectively deal with immunization safety issues when they arise

WHO/EPI Patient with cirrhosis in Africa

What is the magnitude of the problem ?What is the magnitude of the problem ?

• Burden of disease– HBV infections: 8-16 millions– HCV infections: 2.3 - 4.7 millions– HIV Infections: 80,000 to 160,000

• CostCost– 1.3 million future early deaths1.3 million future early deaths– 26 million of years of life lost26 million of years of life lost– US$535 million direct medical costsUS$535 million direct medical costs

One sterile needle and One sterile needle and syringe for each dose ….syringe for each dose ….

WHO/EPI

Not always ensured..!Not always ensured..!

Unsafe practice ?

WHO/EPI

Injections Administered with an unsterilized Syringe and/or a Needle

0% 10% 20% 30% 40% 50% 60%

China

India

Sub-Saharan AfricaSub-Saharan Africa

Middle East crescent

Former socialist economies of Europe

Simonsen et al, Bull WHO 1999

Other Asia and Pacific

Estimated proportion

WHO/EPI

Injection safety equipment & Supplies

• Ensuring quality

• Increasing access

• Improving knowledge

Auto-Disable Syringe

By 2001, A-D syringes for allBy 2001, A-D syringes for allinjections in routine programmeinjections in routine programme

Needles should not be Needles should not be recapped …..recapped …..

WHO/EPI

Estimated Risk of Infection Following a Estimated Risk of Infection Following a Needlestick from an Infected Source-PatientNeedlestick from an Infected Source-Patient

0.30%3%

30%

0%

5%

10%

15%

20%

25%

30%

35%

Hepatitis B Virus Hepatitis C Virus HIV

Source: Needlestick injuries studies among healthcare workers

Is the risk higher enough ?

WHO/EPI

Sharps Waste ManagementSharps Waste Management

• Policy

• Integrated,

comprehensive approach

• Implementation-plan

• Training

• Monitoring

Children playing with syringes in Asia

Is the problem real ?

Be able to rapidly Be able to rapidly address immunizationaddress immunization

safety issuessafety issues

WHO/EPI

AdverseAdverse events: events: programmatic errorprogrammatic error

Insulin vial Vaccine vials

TT DTP

WHO/EPI

Mass campaignsMass campaigns

An opportunity to strengthenAn opportunity to strengthenimmunization safety ?immunization safety ?

WHO/EPI

INJECTION SAFETYINJECTION SAFETY

Key steps during mass campaignsKey steps during mass campaigns

Auto-disable syringes should be provided together with high quality vaccine for ALL elective and emergency immunization masscampaigns

WHO/EPI

One syringe should be used for each dose administered.Measles vaccine should be administered subcutaneouslyNeedles should NOT be recapped.

INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns

WHO/EPI

Used syringes should be dropped in a safety box or puncture resistant container immediately after use

INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns

WHO/EPI

Used disposable and auto-destruct syringes should be stored in a safe place and incinerated soon after.

INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns

WHO/EPI

INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns

Where will the safety boxes disposed ?Who is collecting all the safety boxes after the campaign?How will they be transported ?Who is going to verify that it happens ?

WHO/EPI

Responding to reports of AEFIResponding to reports of AEFI

Media hear first

Crisis situation

Hasty regulatory action detrimental to the immunization program; loss of public confidence

WHO/EPI

WHO/EPI

Injection Safety at Country LevelInjection Safety at Country Level

• Initial assessment

• National coalition

• Implementation of a three-prong approach1- Behaviour change

2- Equipment and supplies

3- Sharps waste management

• Monitoring and evaluation

WHO/EPI

How to ensure all this ?How to ensure all this ?

• Prepare a work plan– what, where, when, who ?

• Train• Supervise-monitor

– before - during - after• Evaluate

Use experience to improve….Use experience to improve….

WHO/EPI

World Health Organization

The Safe Injection Global The Safe Injection Global Network (SIGN)Network (SIGN)

Weekly moderated E-mail list server ([email protected])Internet site (www.injectionsafety.org)

WHO/EPI

In the pipeline………..

Needle - free devices• New/modified JET INJECTORS• AEROSOL vaccination

VVM for measles

WHO/EPI

ConclusionsConclusions

• Injection safety should be considered as a priority

• Time has come to implement action

Timing has a lot to do Timing has a lot to do with the outcome with the outcome

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