Best Infection Control Practices for ID, SC, and IM Injections
Recommendations of the SIGN Working Group on Best Practices
Geneva, 19-20 October 2000
SIGN 2001
Injection Safety Standards:Background
• No prior agreement on what is a “safe injection”.
• Review of training materials showed many dangerous or questionable practices being promoted. Research does not exist to support many common practices (e.g. aspiration).
• This group focused on actions of the injector that could spread infection.
A “Best Practices” Document
• “Best” = pose minimum risk of disease transmission based on current evidence.
• Countries modify, or accept “best” practices based on risks and cost of adopting practices in their programs.
Process for Development of Best Practices for Infection Control
• Broke an injection into a series of steps • Conducted a literature review • Drafted and discussed the document • Revised draft for public comments • Availability of a final document
Categories of Evidence 1, 2 or 3
1 Strongly recommended and supported by research with appropriate study design and analysis.
2 Strongly recommended on the basis of strong theoretical rationale and suggestive, descriptive evidence.
3 Recommended on the basis of expert consensus and theoretical rationale.
Four Scientifically-Supported Practice Areas
• Use of sterile injection equipment for each injection
• Preventing contamination of equipment and medication
• Preventing needlesticks by disposal at point of use
• Preventing contact or access to used needles– reduces re-use– reduces needlesticks
Issues Where Firm Conclusions Could not Be Reached
• Use of engineered technology
• Hand hygiene
• Use of gloves for providing injections
• Swabbing vials or ampoules
• Skin preparation prior to injection
Use Simple Sheets to Help Discuss Practices
• Don’t expect guidelines or posters alone to change
behavior
• People do things for a reason. Explore why.
• Knowledge is necessary but not sufficient to change
practices.
Different Areas Have Different Problem Practices
• Decanting• Aspiration• Dosing• Loading more than one dose in a syringe• Placing syringes in disinfectant prior to re-use• Storing syringes wet• Placing a finger over the needle site
Use a Syringe and Needle with Proof of Sterility for Each Injection (1)
• Inspect packaging or sterilization monitors.
• Use syringes with quality controls that staff and parents can see.
If Single-Use Equipment is Unavailable… (1)
• Sterilize only equipment designed for steam-sterilization.
• Decontaminate syringes to make them safe to handle.
• Clean all visible dirt from syringes, remove plunger, flush needle, take apart.
• Use sterilization monitors.• This critical task requires
supervision and appropriate pay.
Prepare Injections in a Clean Area (2)
• Do not work in an area where blood, contaminated items or body fluids are or may be present.
• Water is available• Soap is available • Freshly prepared bleach and
water or environmental disinfectant (not skin cleaner)
•
Use Single-Dose Vials if Possible (2)
• Single dose vials pose a lower risk for disease transmission.
• The risks of using single-dose vials will increase in programs where syringes are used more than once, and if reconstituted vaccine vials are not strictly discarded after 6 hours.
Use Tools or Barriers to Open Glass Vials (2)
• Staff frequently cut themselves opening glass vials. This is painful and contaminates the ampoule and work area.
• Purchase vials that do not need to be broken to open.
Follow Product-Specific Recommendations for Use, Storage and
Handling (3)• Discard reconstituted
vaccines that do not contain preservatives within 6 to avoid sepsis or toxic shock
• Never use normal saline or water in place of diluent.
• Avoid freezing vaccines
Discard Needles that Have Touched Non-Sterile Surfaces (3)
• If if touched, discard.
Position Patients Prior to Injection (2)
• Anticipate and take measures to prevent sudden patient movement during and after injection.
• This may require making chairs available, revising clinic flow or reassigning staff.
Avoid Recapping and Manipulation of Needles (1)
• Reducing contact and manual handling of used syringes reduces needlesticks.
Questions and Comments?
• Contact the SIGN Secretariat for copies of images, materials and to share materials.
[email protected] Safe Injection Global Network
World Health Organization Avenue Appia 20
Geneva 27 Switzerland 1211
Fax 41-22-791-4836