Injection Safety: The Dangers of Unnecessary Medical Injections and Mishandling of Medical Waste
Introduction
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A waste handler loads a safety box with infectious sharps waste into an incinerator for final disposal.
Source: MMIS |
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Of the 16 billion medical injections given annually worldwide according to World Health Organization estimates, too many are unnecessary and unsafe. In fact, medical injections are the most common health care procedure worldwide. When performed correctly, they can save lives – but if performed incorrectly, medical injections can transmit harmful infectious disease pathogens, including HIV. The risk of spreading HIV and other pathogens (such as hepatitis B and C) in this manner can be drastically reduced by lowering the number of unsafe and unnecessary injections. Safe medical injection practices protect not only patients, but also local community members and health care workers who are routinely exposed to needles and other medical sharps.
USAID Engagement with President’s Emergency Plan for AIDS Relief
In support of the President’s Emergency Plan for AIDS Relief, USAID works in partnership with other agencies and stakeholders to support the Making Medical Injections Safer project, which works in 11 countries throughout Africa and the Caribbean. Goals of the project are to train health care workers to administer only necessary injections safely, using appropriate safe injection devices, as well as to ensure that health care waste is efficiently managed using methods that are safe for the community and the environment. USAID MMIS provides support for sustainable approaches for injection safety, including:
Training, support and capacity building — to ensure only safe and necessary injections become a professional and social norm within health systems and among ancillary services personnel;
Safe injection commodity management — to improve the availability of safe injection equipment (syringes with re-use prevention and/or needlestick prevention features and safety boxes);
Advocacy and behavior change — to establish high quality services and reduce the risk of needle stick injury among health personnel and to reduce the provision of unnecessary injections;
Sharps waste management — to establish the most effective, practical and safe means of waste disposal in health care settings; and
Monitoring and evaluation — to address key constraints and opportunities along the path toward the overall goal of prevention new infections of HIV and hepatitis B and C.
In Uganda, Collaboration Between PEPFAR Partners Improves Health Care Waste Management
When used syringes and needles are not properly disposed of, they can expose health workers, patients, and communities to HIV, hepatitis B and C, or other bloodborne diseases. However, Uganda health care waste management (HCWM) has historically been a low priority and was not well articulated in the country's second National Health Sector Strategic Plan. In addition, PEPFAR projects that generated infectious waste did not have specific policies on HCWM but rather managed medical waste using prevailing practices in the various health facilities where they were operating. Unfortunately, waste management in those health facilities was often inappropriate and carried potential risks of infection.
Although efforts were in place to address HCWM, they were fragmented, uncoordinated and had limited impact at facility level. Compounding the situation, health facilities had to manage increasing volumes of infectious waste resulting from HIV-related activities routinely performed at facilities. A study conducted by Makerere Mbarara University in Uganda revealed that over 90 percent of reported exposures to infectious fluids were related to sharps medical waste, including contaminated needles used for medical injections. To address the situation, the Ministry of Health (MOH) developed a policy for all programs that generate medical waste to include waste management as part of their interventions. In response to this policy, the Uganda PEPFAR Country Team requested that all PEPFAR partners address medical waste management in their planning. The Making Medical Injections Safer (MMIS) project in Uganda was tasked with the responsibility of providing technical assistance in HCWM to the PEPFAR projects. MMIS provided technical assistance to PEPFAR implementing partners and the MOH to initiate HCWM interventions to improve health care providers' work environments. As part of this effort, PEPFAR Partners agreed to include a budget line item for HCWM, and through a national PEPFAR stakeholders meeting, Partners agreed to an approach that addresses HCWM based on MMIS's field experience. Targeted interventions were implemented according to HCWM plans developed by each project in collaboration with MMIS. The MOH also accommodated adjustments in the budgeting guidelines and facilitated all guideline dissemination meetings at district-level. As a result of these efforts, HCWM is now well-articulated in the National Heath Sector Strategic Plan and is reflected in the guidelines for district and health facility annual planning. Guidelines for health facility supervision are being revised to reflect new indicators to measure improved HCWM practices. More resources are now allocated to HCWM by different PEPFAR stakeholders, resulting in activities to reduce the risk posed by unsafe practices.
The U.S. Agency for International Development works in partnership with the U.S. President's Emergency Plan for AIDS Relief.
July 2009
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