What is a Safe Injection?

In short: A “safe injection” neither harms the recipient, exposes the health worker to any avoidable risk, nor result in waste that is dangerous to the community. We explain the risks in some more detail in this blog post.

This is the first in a series of blog posts on this topic. The follow-up post is entitled:

Have you thought about how a safe injection could be defined? Not easy, but the World Health Organization (WHO) estimates that reusing syringes leads to more than two million new infections, with diseases including Human Immunodeficiency Virus (HIV) and hepatitis each year.

Use of the same syringe or needle to give injections to more than one person is driving the spread of a number of deadly infectious diseases worldwide.

WHO calls for worldwide use of “smart” syringes (Feb 2015).

Below we discuss some of the risks that make achieving safe injection practices a challenge, but nevertheless achievable by 2020, as the WHO suggests.

Prevalent high-risk practices

The WHO estimates that there are 16 billion injections administered every year. It also points out that around 5% of these injections are for immunizing children and adults. Another 5% are for other procedures, such as blood transfusions.

The remaining 90% of injections are given into muscle (intramuscular route) or skin (subcutaneous or intradermal route) to administer medicines.

According to the WHO, there are four prevalent unsafe, high-risk practices. One of these is unnecessary injections that could be replaced by oral medication, but we focus on the other three.

WHO wants exclusive use of the new “smart” syringes by 2020

Risks Description
1. Re-use of syringe In 2000, the WHO estimated that 40% of the 16 billion injections given (see above) were done with re-used injection equipment, leading to
– 21 million new Hepatitis B Virus (HBV) cases (32% of all new cases),
– 2 million new Hepatitis C Virus (HCV) cases (40% of all new cases), and around
– 260,000 Human Immunodeficiency Virus (HIV) cases (5% of all new cases).
Other diseases that can also be transmitted through the re-use of injection equipment include viral haemorrhagic fevers, such as Ebola.
Bottom line: The WHO would like all countries to ensure only re-use prevention syringes (RUPs) are in use by 2020.
2. Accidental needlestick injuries of health workers Needlestick injuries are wounds caused by needles that accidentally puncture the skin. In 2003, the WHO produced data that showed there were 3 million accidental needlestick injuries (see WHO guideline on the use of safety-engineered syringes, p. 15).

We also need to better protect health workers against accidental needle injury and consequent exposure to infection.

The WHO recommends that a sheath or hood slide over the needle after an injection is completed. This would protect health workers from being injured accidentally by the needle and potentially exposed to an infection.

Bottom line: By safely retracting contaminated needles using a novel pneumatic technology, LomMedical helps reduce the risk for accidental injuries of health workers.

3. Unsafe sharps management For instance, a crown prosecutor who suffers from Type 1 Diabetes may use a syringe in court. Being in court all day may require that they adjust their insulin levels in a less-than-ideal environment. The challenge is where to put the used needle in the absence of a sharps container.

Unsafe handling of used syringes – also called unsafe sharps management – increases the risk for accidental injuries and exposure to a possible infection.

Bottom line: Sharp injury protection (SIP) is useful for patients and health professionals. Where SIP devices are introduced, nine fewer healthcare workers out of every 1000 are likely to suffer a needlestick injury in a one year period (see WHO guideline on the use of safety-engineered syringes, p. 10).

References used to put together the above Table

Hauri, Anja M., Armstrong, Gregory, L., & Hutin, Yvan J.F. (2004). Contaminated injections in health care settings. In Majid Ezzati, Alan D. Lopez, Anthony Rodgers and Christopher J.L. Murray (Eds.), Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attribution to Selected Major Risk Factors. Volume 2, Chapter 22, pp. 1804-1850. Retrieved June 26, 2017 from http://www.who.int/publications/cra/chapters/volume2/1803-1850.pdf

No Author (2016). WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings. Retrieved June 25, 2017 from http://apps.who.int/iris/bitstream/10665/250144/1/9789241549820-eng.pdf?ua=1

In short, a safe injection does not:

  • harm the recipient,
  • expose the provider to any avoidable risks, or
  • result in waste that is dangerous for the community.

Have your say – join the conversation

Source: What is a Safe Injection?

  • Do you remember the last time you got an injection at your medical clinic?
  • Did it ever hurt when the nurse removed the needle used to administer the required drug?
  • Do you know of an incident where a health worker was injured by a needle?
  • How does your friend keep used needles safe – diabetes, etc.?

Looking forward to your comments.

Showing 3 comments
  • Peter Manzell
    Reply

    Dear LomMedical Team

    Thanks for this helpful post. I read this with great interest.

    I hope that we will soon use these type of syringes only…. The 3 risks you mention above should then be pretty much eliminated.

    That will be very good.

    • Urs E. Gattiker
      Reply

      Dear Peter

      First, thanks so much for this comment.
      Second, I split my answer in 2 Parts.

      PART 1
      If the World Health Organization has it its way, all governments will have to mandate the use of smart syringes wherever applicable / possible. The WHO puts it as follows:

      Government
      By 2020 transition to the exclusive use, where appropriate, of safety-engineered
      injection devices with re-use prevention and sharps (needle) injury prevention.
      These devices should meet WHO quality standards.
      Set health-system-wide policies and standards for procurement, use and safe
      disposal of disposable syringes in situations where they remain necessary,
      including in syringe programmes for people who inject drugs.
      Develop an implementation strategy for procurement of safety-engineered
      syringes, training and education of health workers and sound waste
      management. Establish a targeted communications programme and a framework
      for evaluating overall progress.

      As stated in “Making all injections safe, p. 5”, WHO

      This will hopefully help us in eliminating the use of multiple use syringes.
      Thanks so much for sharing.
      Urs

      • Urs E. Gattiker
        Reply

        PART 2
        So here comes the rest. Another WHO document pointed out that single-use syringes themselves do not always solve the problem if we talk about HIV or other diseases:

        Canadian studies have found that strict “one-for-one” policies don’t work in areas with high numbers of stimulant injectors. People who inject cocaine or amphetamines often do so 10 or more times in a night. These drug users are at high risk, therefore, of acquiring and passing on HIV and require substantially more needles and syringes than opioid users. The explosion of HIV among drug-users in Vancouver (a city with a substantial NSP) in the late 1990s has been attributed to several causes, including a “one-for-one” exchange policy

        Cited in “Guide to starting and managing needle and syringe programmes”. See p. 19, Original study the World Health Organisation attributes this finding to and cites is: P.M Spittal, W Small, E Wood, C Johnston, J Charette, N Laliberté, M.V O’Shaughnessy, M.T Schechter et al. How otherwise dedicated AIDS prevention workers come to support state-sponsored shortage of clean syringes in Vancouver, Canada. International Journal on Drug Policy, 2003, 15: 36-45. Retrieved, June 27, 2017 from http://www.sciencedirect.com/science/journal/09553959/15/1
        Summary with interesting references by Spittal can be found here: http://www.ijdp.org/article/S0955-3959(05)00101-5/pdf

        This indicates that whilst single-use syringes also called disposable syringes are surely useful. However, drug users may require several syringes to assure that if they need to inject several times over night, they do not put themselves under unnecessary risk due to re-using needles.
        Have a great evening.
        Urs

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