www.injectionsafety.org safe immunization practices and prevention of hepatitis b and c susan mackay...
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![Page 1: Www.injectionsafety.org Safe Immunization Practices and Prevention of Hepatitis B and C Susan Mackay Behaviour Change Project Safe Injection Global Network](https://reader035.vdocuments.net/reader035/viewer/2022070409/56649e8e5503460f94b91b84/html5/thumbnails/1.jpg)
www.injectionsafety.org
Safe Immunization Practices and Prevention of Hepatitis B and C
Susan MackayBehaviour Change Project
Safe Injection Global Network (SIGN) SecretariatWHO, Geneva, Switzerland
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www.injectionsafety.org
NGO UN
Governments
IndustryAssociations WHO SIGN Secretariat
SIGN participants and SIGN secretariat
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www.injectionsafety.org
Injection Safety: Definition
• No harm to the recipient• No harm to the health-care worker• No harm to the community
Challenges
Reuse of equipmentUnsafe collection
Unsafe disposal
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Injections given with sterile and unsafe equipment worldwide
0 2 4 6 8 10 12
Middle East Crescent
South Asia
Eastern Europe andCentral Asia
East and Southern Africa
South East Asia
China and Pacific
West Africa
Central Europe
South America
Number of injections per person and per year
Injections given withequipment re-used in theabsence of sterilization
Injections given with sterileequipment
Glo
bal B
urd
en
of D
i sea
se, 2
00
0
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www.injectionsafety.org
Determinants of unsafe injection practices in immunization services
• System incentive to achieving high coverage– Vaccine usually funded through donors or lenders
• No system incentive to achieve safe injections – Injection equipment is not costed, budgeted, or
funded– “The sterilizable policy” smoke screen– Perception of injection safety as a “logistics” issue
rather than a prevention policy issue
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www.injectionsafety.orgInjection preparation table, Pakistan, 1995
Reuse of disposable injection equipment
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www.injectionsafety.orgInjection preparation table, Romania, 1998
No reuse of disposable injection equipment,other breaks in safety
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www.injectionsafety.org
Injection safety beyond the use of new, disposable injection equipment
• Theoretical rationale– Experience from the dialysis environment – Persistence of HBV in the environment
• Ecological evidence – HBV and HCV infection among injection drug users
participating in needle exchange programmes – Association between injection and HBV infection in 1998
in Romania despite the absence of reuse of equipment
• Analytical studies– Association between “indirect sharing” and HBV
infection among injection drug users ** Bialek S. et al. US CDC EIS conference, 2001
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www.injectionsafety.org
Proposed model for the transmission of HBV in various healthcare setting
Dialysis setting
Outpatient setting in low prevalence
area
? Prevalence of infection
? Exposure to blood
? Percutaneous exposures
? Prevalence of patients with high viremia
High risk Low risk
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www.injectionsafety.org
Proportion of new HBV Infections attributable to unsafe injections, 2000
0% 20% 40% 60% 80%
AMR B
EUR B
AFR D
AMR D
SEAR B
WPR B
AFR E
EUR C
SEAR D
EMR D
World: 35%, N= 22.5 million
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www.injectionsafety.org
Hepatitis B virus infection prevention
• Two prevention axis– Immunization of infants
(child cohorts) – Prevention of exposure to the virus,
including injection safety(older age groups)
• One common goal for GAVI– Protecting the adult
who is in every child
Patient with cirrhosis in Africa
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www.injectionsafety.org
Proportion of new HCV infections attributable to unsafe injections, 2000
0% 20% 40% 60% 80% 100%
AMR B
AFR D
AMR D
EUR B
AFR E
SEAR B
WPR B
EUR C
SEAR D
EMR D
World: 55%, N= 2.7 million
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Assess
PlanImplement
Evaluate
The Quality Cycle
Benchmarking
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Benchmarking
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www.injectionsafety.org
Outline of best practices
1. Use sterile injection equipment
2. Prevent contamination of injection equipment and medication
3. Prevent needlestick injuries to the provider
4. Prevent access to used needles
5. Other practice issues
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Assess
Benchmarking
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www.injectionsafety.org
Rapid Assessment and Response Guide
Injection AdverseEvent
Injection Overuse
Unsafe InjectionPractices
Providers
System
Tool A available (focus group guide)
Tool B available(injection frequency survey)
Tool D available(Template for
epidemiological studies)
Tool C available(Based upon best practices)
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Assess
Plan
Benchmarking
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www.injectionsafety.org
Safe and appropriate use of injections:proposed national strategy
• Initial assessment• National coalition• Three-element approach
1- Behaviour change2- Equipment and supplies3- Sharps waste management
• Monitoring and evaluation
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Assess
PlanImplement
Benchmarking
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www.injectionsafety.org
Assisting in the implementation of policies for the safe and appropriate
use of injections• 1. Behaviour change
– Toolbox project in progress
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www.injectionsafety.org
Assisting in the implementation of policies for the safe and appropriate
use of injections• 2. Provision of supplies
– Purchasing guide to ensure quality and safety– Inclusion in the essential drug list to ensure access
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www.injectionsafety.org
Assisting in the implementation of policies for the safe and appropriate
use of injections• 3. Sharps waste management
– Integrated approach:• Policy• Streamlining waste management• Training• Choice of disposal options
– www.healthcarewaste.org
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www.injectionsafety.org
Assisting countries in implementing policies and plans
Assess
PlanImplement
Evaluate
Benchmarking
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www.injectionsafety.org
Monitoring impact
Outcomes Incidence of infections
ProcessesInjection frequency
Injection safety
Inputs Resources and activities
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www.injectionsafety.org
Injection safety in immunization services
Challenges– Unsuccessful past efforts– History of narrow, technology oriented approach – Costs of injection safety initiatives – Conflict between the safety and coverage objectives– EPI cannot be responsible for the safety of all injections
Opportunities – Successful comprehensive approaches– Increasing recognition of holistic strategies– Promotion of responsible budgeting for EPI– Documentation of safe immunization coverage– EPI can spearhead and catalyse injection safety efforts
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www.injectionsafety.org
Poor injection practices …