Injection Safety and Practices

• The "Injection safety and safe injection practices" module supports the WHO guideline on safety-engineered syringes at national and health care facilities for intramuscular, intradermal, and subcutaneous injections.
• This module targets IPC individuals and teams, especially IPC focal points, and requires basic IPC experience and competence.
• The training complements a basic package for front-line health care workers.

Module Objectives

• Explain unnecessary and unsafe injection practices.
• Describe risks of unsafe injections and epidemiological data of related infections.
• List WHO recommendations for injection safety.
• Understand safety-engineered syringe mechanisms.
• List the seven steps to safe injections.
• Explain safe needle and sharps collection, handling, and disposal.
• Detail needle-stick injuries and prevention strategies.
• Describe multimodal strategies for injection safety implementation.

Student Handbook Purpose and Content

• The module blends PowerPoint presentations, videos, and group work, with case studies and interactive sessions.
• The student handbook supports learning with supplementary information, handouts, and reflective reading for homework.
• The PowerPoint slides and handbook form a valuable resource for students.

Session 1: The Problem of Unsafe Injections Resources

• Handout 1: Anthropological perspective on injections
• Handout 2: Profit-driven overuse of injections and infusions in China's market-based health care system
• Handout 3: Public health guidelines for managing occupational exposure to hepatitis B, hepatitis C, and HIV
• Handout 4: Evolution of the global burden of viral infections from unsafe medical injections, 2000–2010
• Group work 1: NZ Janjua et al. paper with questions

Session 2: IPC Best Practices and Guidance for Safe Injections Resources

• Handout 5: Educational leaflet and health card for patients and communities
• Handout 6: Infographic on injection safety and poster promoting oral medicines
• Handout 7: WHO guideline on safety-engineered syringes for intramuscular, intradermal, and subcutaneous injections
• Handout 8: The seven steps to safe injections and best injection practices guidelines
• Handout 9: Hand hygiene
• Handout 10: Use of gloves and injections
• Handout 11: Skin preparations for different types of injection
• Handout 12: Health care waste management

Session 3: Needle-Stick Injury Prevention Resource

• Handout 13: Preventing needle-stick injuries
• Group work 2 involves reading a scenario and answering questions.

Session 4: Injection Safety Implementation Strategies

• Handout 7 (from session 2) is also applicable to this session
• Group work 3 involves answering specific questions.

Handout 1: Anthropological Perspectives on Injections

• This handout summarizes the reasons behind the demand for injections by consumers and the administration of unnecessary or unsafe injections by different types of providers based on the Reeler article.
• The prescriber, the provider, and the patient are the three drivers of unsafe and unnecessary injections in developing countries.
• While most injections are given by trained professionals, sometimes they are not administered safely, or the administrator isn't trained.
• The most dangerous aspect of injections is the reuse of equipment, which can transmit infections.

Handout 2: Over-prescription and use of injections and infusions in China

• Injections and infusions are widely used in China with the belief that they are therapeutic, however this can lead to irrational prescriptions and is also a result of the health system remuneration structure.
• Some doctors believe that administration of injections and infusions visibly demonstrates professional skills which is an important factor in building a successful practice
• Patients may self-medicate and seek injectable treatment from health workers in addition, justifying that "pills have failed".

Handout 3: Public health guidelines for the management of occupational exposure to hepatitis B, hepatitis C and HIV

• Hepatitis C is not transmitted efficiently through occupational exposure to blood, but the chances of transmission increase when equipment is reused between patients.
• Hepatitis B can survive in dried for at least one week, meaning that if a syringe and needle is used on a person with HBV infection and is later used on another patient, the chances of transmission are high.
• The risk of HIV is comparitively low but increases if the syringe is used in a vain or artery and if the patient had a higher titre of HIV in the blood.

Handout 4: Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010

• Progress between 2000 and 2010 in reducing viral infections transmitted through unsafe injections.
• In 2000, the WHO estimated unsafe injections accounted for 5%, 32%, and 40% of new infections with HIV, HBV, and HCV, respectively, in developing and transitional countries.
• In 2010, unsafe injections caused 16,939-33,877 HIV infections, 157,592-315,120 HCV infections, and 1,679,745 HBV infections.

Handout 5: Educational Leaflet and Health Card

• The educational leaflet informs patients and communities about safe injection choices, consequences of unsafe injections, and the importance of prevention.
• Patients are educated to ask prescribers about the need for an injection and to request oral medicines when possible.
• The patient health card highlights three questions to ask a health care provider before an injection: whether the injection is necessary, if the syringe is new and opened from a new packet, and if a smart syringe is used

Handout 6: Injection Safety and Oral Medicine Poster

• Two information, education, and communication materials are for patients and communities to raise awareness about injection safety and the importance of oral medicines.
• The infographic describes (with illustrations): the risks of infections from unsafe injections, what makes an injection unsafe, how patients can determine if the injection is necessary, and the responsibilities for health care workers
• The poster promotes oral medicines to patients and communities.

Handout 7: WHO Guideline

• Intended for intramuscular, intradermal, and subcutaneous injections in health care settings.
• The recommendation is exclusive use of WHO prequalified safety-engineered injection devices by 2020, including auto-disable (AD) and reuse prevention (RUP) syringes and sharps injury protection (SIP) devices, and develop related national policies.
• The guideline aims to reduce reuse, avoid needle-stick injuries, and avoid overuse of injections and unsafe sharps handling.

Handout 8: Seven Steps to Safe Injection

• Includes a clean workspace, hand hygiene, sterile safety-engineered syringe, sterile medication vial and diluent, skin cleaning, sharps collection, and waste management.

Handout 9: Hand Hygiene

• Provides information on the five moments for hand hygiene

Handout 10: Use of Gloves and Injections

• Gloves are not needed for routine intradermal, subcutaneous and intramuscular injections if the health worker or patient's skin is intact.

Handout 11: Types of Skin Preparation

• Soap and water are sufficient for intradermal, subcutaneous, and immunization injections.
• For intramuscular injections, soap and water and 60–70% alcohol is to be used.
• 60–70% alcohol is required for venous access.

Handout 12: Health care waste management

• This summarizes wastes produced in health care activities, from needles to syringes, and discusses the inadequate management that leads to public health consequences
• The database for local suppliers should follow the following steps: select the country, select the technology, calculate the approximate capacity and hit search.

Handout 13: Needle-Stick Injury Prevention

• This handout describes all the types of needles that can cause injury, when and why they occur and what to do if it happens.