WHO ACTIVITIES ON

INJECTION SAFETY AND

RELATED INFECTION CONTROL

EHT / BTS
 Outline
z Introduction

z Four objectives of the area of work of injection safety and

the development of technical tools

z Scaling up injection safety activities: initiatives and

challenges

z Perspectives
Overuse of injections and unsafe injection
practices
z 16 thousand million injection annually*

z Unsafe injection practices, annually*

21 million hepatitis B infections (30% of new cases)
2 million hepatitis C infections (41% of new cases)
260 000 HIV/AIDS infections (5% of new cases)

z Up to 70% of injections are given with reused syringes

and needles in the developing world

z Over 70% of injections are unnecessary in some

regions
*Hutin et al,2003; Hauri et al,2004
 BBP transmitted through Needle Stick
Injuries in Health Care Workers Worldwide

z 35 million HCW worldwide

z Each year: 3 million experience NSI and exposure to:

2 million to HBV resulting in 70 000 possible HBV infection
0.9 million to HCV and 15000 possible HCV cases
170000 to HIV with approximately 1000 getting infected

z 90% of these infections occur in developing countries

WHO, World Health Report, 2002

Strategy for the safe and appropriate
use of injections
z Behaviour change among patients and health care
workers to decrease injection overuse and achieve
injection safety

z Availability of necessary and of good quality injection

devices and supplies

z Management of sharps waste

 Objectives for the safe and
appropriate use of injections

1. Policy

2. Quality

3. Access

4. Use
1. Policy Strengthening national capacities to
manage injection safety policies

z Policy management tools

Aide memoires
Injection safety
Waste management
Health care worker protection
Infection control
Managing an injection
safety policy
1. Policy Strengthening national capacities to
manage injection safety policies (2)

z Data for decision making

Assessment tools
Global burden of
disease
Proportion of unsafe
injections by regions
Cost effectiveness
analysis

z SIGN alliance
1. Policy SIGN Participants and
SIGN Secretariat

NGO UN

Associations WHO Industry

SIGN Secretariat

Governments
 The SIGN secretariat
(sign@who.int)

Provided by WHO Essential Health Technologies

department
Co-ordinates the development of SIGN strategic
framework and communication strategies
Manages an e-mail list server: SIGNpost and
SIGN Internet site (tool box)
Issues newsletters
Organizes the SIGN meetings and working groups
The Safe Injection Global Network (SIGN)
(www.injectionsafety.org)

z Participants agree to collaborate in:

Developing a common strategic framework
Information exchange:
Annual SIGN meeting (consensus recommendations)
Email list server: SIGNpost and Internet site
Working groups
Advocating, Proposing communication strategies
Encouraging innovative, cost effective solutions
2. Quality Ensuring quality and safety of
and safety injection devices
z ISO standards / specifications for single use injection devices
ISO 7886-3 (Immunization AD syringes)
ISO 7886-4 (single-use syringes with reuse prevention features)

z WHO pre-qualification procedure

z Tool to evaluate injection devices in the field

Field trial in Karachi, Pakistan (2004)

z Field assessment of needle removers

Field trial in Madagascar and Myanmar
3. Access Ensuring access to injection
devices
A WHO Guiding Principles
was developed outlining :

z Injection device security

z Procurement for single use

syringes and safety boxes
4. Use Promote appropriate, rational
and cost-effective use of injections
z Injection safety standards: best practices

z CD Rom toolkit, including:

Resources for physicians, nurses,
public health specialists, community
Behaviour change strategy
Pictograms bank
Image bank
4. Use Promoting the safe and
appropriate use of injections

z Interactional Group Discussions between patients and

prescribers in 3 pilot countries: Cambodia, Tanzania,
Pakistan

z International Conference on Improving the Use of

Medicines, Thailand, March 2004:
5 abstracts and a special session on the rational use of
injections.
ICIUM recommendations

z Toolkit developed by the

Occupational and Environment Health Unit

4. Use Promoting the safe and
appropriate use of injections

z Template Communication campaign developed and

conducted in Mongolia, Tanzania, Egypt
4. Use Promoting the safe and
appropriate use of injections

z Template Communication campaign developed and

conducted in Mongolia, Tanzania, Egypt
4. Use Promoting the safe and
appropriate use of injections

z Template Communication campaign developed and

conducted in Mongolia, Tanzania, Egypt
4. Use Promoting the safe and
appropriate use of injections

z Template Communication campaign developed and

conducted in Mongolia, Tanzania, Egypt
 Achievements so far.
z Safe and appropriate use of injections has
gained visibility internationally

z SIGN participants have moved the agenda

forward with creation of national SIGN coalition
(India, Pakistan, Cambodia)

z Strong ownership and networking activities

 Recent initiatives for scaling up
injection safety plans
z Consensus over WHO testimony at the US Senate July 2003
Injection safety causes a small proportion of HIV infections
However, injection safety is a feasible and cost effective intervention

z US presidential initiative for HIV/AIDS Relief and injection safety

14 countries in Africa and the Caribbean

z Indian assessment
World bank financed national assessment
Strong evidence based for national switch to safer injection
technologies
National injection safety policy finalized and approved (switch to AD
syringes for immunization programmes)
 Challenges for scaling up
injection safety activities
z Countries and health care systems should design and deploy
multifaceted interventions to improve injection use:
education (provider, patient, and mass media)
managerial approaches (e.g. greater availability of single-use
devices)
Methods that increase communication between providers and
consumers about injections also are recommended

z Health care systems and health professionals should empower

patients:
express a preference for oral medications
demand single-use injection equipment
ICIUM 2004 recommendations
 Perspectives

z Broaden injection safety and SIGN activities to broader infection

control activities
BBP transmission through other injection routes ( Phlebotomy)
Integrated infection control strategies
appropriate management of sharps waste
Health care worker protection
Elaboration of Standard Precautions to prevent BBP
transmission in health care settings

z Reinforce partnership with all other WHO clusters/departments

involved in injection safety and related infection control
 SIGN within WHO
z Communicable diseases
Surveillance
z Evidence and Information for Policy
Burden of disease estimates,
guidelines, health services,
nursing
Global Patient Safety Challenge
z Family and Community Health
injected contraceptives
Immunization safety
z HIV / AIDS
Injection drug use
z Water, Sanitation and
Environment
Waste management
z Occupational Health
HCW Safety
z Health, Technology, and
Pharmaceuticals (HTP)
Blood safety, injection
safety and rational use of
drugs
z Non Communicable Diseases
Diabetes injections
Mental health
 Perspectives

z Reinforce partnerships ( UNICEF, PEPFAR, CDC,

ICN,ILO .)

z Strengthen integrated injection safety activities at regional

level (Injection Safety Regional focal points )

z Innovative approaches in assessment, implementation

and monitoring ( including immunization) at country level
- Evidence based measurement of improvement during the last
few years

z Provide technical support to countries

 For more information...

Injection safety and Related

Infection Control
EHT/BTS

And also:

The SIGN Secretariat

EHT/BTS

Email: sign@who.int

www.injectionsafety.org