Transcript Giving Safe Injections

Giving Safe Injections
Presented by :Dr Esteghamat
Unsafe Injections
Injections that harm the recipient, the
provider, or that result in waste that is
dangerous for other people.
Unsafe injections can cause disease, injury
and death.
Causes of Unsafe Injections
• World Health Organization estimates:
– 12 billion injections administered each year
– 50 % (6 Billion) are unsafe
– 95% of injections are therapeutic
– 25% to 95% of outpatient visits resulted in an injection
• Many injections may be unnecessary, ineffective or
inappropriate
Causes of Unsafe Injections
• In a year, unsafe injections may be
responsible for:
– 8 to 16 Million cases of Hepatitis B
– 2 to 5 Million cases of Hepatitis C
– 80,000 to 160,000 cases of HIV
– Others: Parasitic (Malaria), bacterial (abscess),
fungal and other infections
• Some infections may not be obvious for
years
Causes of Unsafe Injections
• Poorly administered injections can
cause injuries or drug toxicities
when:
– Wrong injection site used
– Incorrect drug used
– Wrong diluents used
– Incorrect dose used
Rules of Safety
• Assume all body fluids contain
pathogens
• Assume the skin and the environment
contain microorganisms
• Unsafe injections can spread
pathogens more easily than inhalation,
swallowing or sex
• Do No Harm: Health Worker
responsibility
Body Fluids
• Any body fluid may contain pathogens and
spread disease
• Treat all human and animal body fluids as
contaminated by pathogens
Wash hands thoroughly with soap and
water until visible dirt is gone.
Clean Skin
Unsafe Injections Can Cause
Infections
• Unsafe injections can transport
microorganisms into the body, that are:
– transferred from fingers or objects to the
needle
– present on the skin and picked up by the
needle
– in the medication to be injected
– inside the syringe or needle that has been
previously used
Unsafe Injections Can Cause
Infections
Unsafe Injections Can
Kill
Health Worker: Do No Harm
• Give only necessary injections
• Use sterile syringe and sterile needle
for every immunization or DO NOT
immunize
• Arrange the workspace and institute
disposal practices to prevent
needlesticks to self and others
Why Re-Use Occurs
• Re-use of contaminated
syringes/needles:
– Inadequate supply
– Lack of understanding of danger
– Unmonitored/inadequate sterilization
– Inadequate disposal and distribution
(public access to contaminated
equipment)
Unsafe Injections Can Cause
Infections
Today:
• Millions of people have weakened immune
system
• Billions of injections are given by untrained
and unaware people.
• New pathogens have been recognized
Practices That Can Harm
Recipients
• Giving unnecessary injections
• Loading syringes with multiple doses and
injecting multiple people
• Leaving the needle in the vial
• Touching the needle
Practices That Can Harm
Recipients
• Mixing two partially opened vials of vaccine
• Keeping freeze-dried vaccine more than 6
hours.
• Storing medication and vaccine in same
refrigerator
• Applying pressure to bleeding sites with
used material or finger
• Vaccinating infants in the buttocks
Practices That Can Harm
Health Care Workers
• Re-using needles and syringes.
• Carrying needles or placing them on a
surface prior to disposal
• Recapping needles
Practices That Can Harm the
Community
• Leaving needles and syringes in areas
where children can take them
• Leaving needles and syringes in areas
accessible to the public
Vaccines Safety
Checking Vials and Labels
1. Label
2. Age of the vaccine (expiration)
3. Signs of contamination
4. Exposure to freezing
5. Exposure to excessive heat
Assessing Contamination
discard it if:
• Leaks or cracks are present,
• Change in appearance or floating particles
are seen
• Submerged in water
• Pierced with used needle.
• Vaccine was reconstituted more than 6
hours before.
• Vial opened for more than 4 weeks.
Assessing Exposure to Freezing
• DPT, DT, Td, TT, hepatitis B, diluents
and Hib should be discarded if you
highly suspect or are certain that they
are/were frozen
• “Shake taste” DPT, DT, Td and TT
(contain aluminum hydroxide adjuvant)
when refrigerator log shows
subfreezing temperatures. If failed,
discard.
Assessing Exposure to Freezing
• Hepatitis B and Hib vials should be
discarded if frozen or suspected of
freezing. The “shake test” doesn’t work
for them.
Freeze Watch
Freeze-tag
Shelf life is 5 years.
Assessing Exposure to Heat
• Vaccine Vial Monitor
(VVM) Present:
– If VVM inner square is the
same color or darker than
the outside circle, discard
the vial
• Vaccine Vial Monitor
(VVM) Not Present:
– Check temperature log and
cold-chain monitoring
cards. If exposed to
temperatures above 8º C,
discard it.
Checking Vaccine Vial Monitors
• VVM is a label made of heat-sensitive
material, placed on the vial to show
cumulative heat exposure over time
• VVM reduces waste of vaccine,
ensuring that only good vaccine is used
Storage
Ice Packs in
freezing
compartment
Oral Polio, Measles
BCG, DPT, TT, diluent
Thermostat
Ice packs
“Returned
box
Checking the Vaccine and Diluent
Vials
• Before use, check the following:
– Is the label still attached to the vial?
– Is the right vaccine and right diluent?
– Expiration date?
– Contamination (discard reconstituted
vaccine 6 hours after reconstituted)
– Cold sensitive vaccines show no signs of
freezing
– No signs of heat exposure
Vaccines Which Require Specific
Diluent
• BCG vaccines
• Measles-containing vaccines
• Freeze-dried Haemophilus Influenza type b
(Hib) vaccines
• Yellow fever vaccines
Reconstituting Vaccines Safely
• Reconstituted vaccines should be kept cool,
between 2º and 8º C to maintain their potency
• Place reconstituted vaccines in slits made in a
foam piece that sits in the top a vaccine carrier
Reconstituting Vaccines Safely
• Discard reconstituted vaccine after 6 hours.
BCG, measles-containing vaccines, yellow
fever vaccines and freeze-dried Hib
vaccines do not have preservatives. Death
may occur
Reconstituting Vaccines Safely
• Store only vaccines in the refrigerator.
Medications can accidentally be
administered instead of vaccines
• Do not reconstitute vaccine until the
person needing the vaccine injection is
present
Reconstituting Vaccines Safely
• Use a new syringe and needle to reconstitute
each vial of vaccine
• Check that the diluent is the one provided by
the manufacturer
Reconstituting Vaccines Safely
• Discard the used mixing syringe and needle
in a sharps container
• Do not leave the mixing needle in the vial
(contamination)
• Mix the contents of vial by rolling the vial
between your fingers. Note date and time of
reconstitution
Safe Disposal of Injection
Equipment and Other Sharps
• To further prevent needlesticks use leakproof, puncture-proof containers for needles,
syringes and other medical waste that might
cut or puncture the skin (broken vials, etc)
• Sharp containers
• Safety boxes
• Needle-disposal boxes
Sharp Containers
Sharp Containers
• Leak-proof
• Puncture-proof
• Clearly labeled with warning (easy for the
community to understand)
• Do not overfill (only 3/4 is safe)
• Do not transfer contents to other container
Sharp Containers
Unsafe
Safe
Unsafe
Unsafe