Medical Injection Safety (Updated February 2008)

President George W. Bush's Emergency Plan for AIDS Relief is the largest commitment ever by any nation for an international health initiative dedicated to a single disease-- a five-year, $15 billion, comprehensive approach to combating the disease around the world. U.S. Department of State U.S. Agency for International Development U.S. Department of Defense U.S. Department of Commerce U.S. Department of Labor U.S. Department of Health and Human Services Peace Corps Mailing address: SA-29, 2nd Floor 2201 C Street, NW Washington, DC 20522-2920 www.PEPFAR.gov

Medical Injection Safety  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 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. The Power of Partnerships: In fiscal year 2007, the Emergency Plan supported: Training or retraining for approximately 78,000 people in medical injection safety, as well as providing commodities for safe medical injections. The U.S. President’s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) supports efforts to reduce the number of unnecessary medical injections and to make necessary injections safer. PEPFAR supports programs to improve provider practices; reduce community demand for injections; support the procurement of appropriate injection commodities to eliminate re-use of syringes and needles and improve safety; and facilitate the safe disposal of used injection equipment and supplies, especially sharps. In addition, the Emergency Plan supports training for health care workers in universal medical precautions to reduce the risk of blood-borne infections, and assists in procuring safety boxes for sharps, medical waste management gear, and protective clothing. Emergency Plan-supported activities are based on guidelines developed by the Safe Injection Global Network (SIGN), a technical advisory board sponsored by the World Health Organization (WHO). SIGN strategies inform countries’ decisions on injection safety standards, the structure of programs, training, assessments, and monitoring and evaluation. Injection safety strategies include: Encouraging countries without national safe injection policies to develop policies based on SIGN principles;   Support facilities to adopt and promote safe injection practices among health care workers and community members;   Support countries to purchase safe injection equipment and supplies;   Support facilities to safely manage the disposal of sharps waste.   The Emergency Plan supports post-exposure prophylaxis (PEP) treatment for health workers who suffer a needle-stick injury. This intervention aims to prevent people exposed to infected blood or other fluids from progressing to HIV infection. By protecting health care workers, the Emergency Plan helps to sustain the health care workforce of the developing world.

The Emergency Plan at Work: The following are examples of how the Emergency Plan is working in partnership with host nations to support and promote injection safety practices: In Namibia, the medical injection safety program provides training to reduce excessive use of injection medications in participating health facilities. The practice of discarding needles and syringes without recapping has also increased from 47 percent to 76 percent, decreasing the risk of needle-sticks.   In Tanzania, a partner organization supported the Tanzanian Ministry of Health’s initiation of Universal Safe Precaution and Injection Safety programs in five referral hospitals and 60 district facilities. The program is training a total of 1,289 health workers in safe injection supply management and proper waste handling.   In Uganda, a partner organization is using “video vans” to reach rural populations with a film on injection safety. The film is designed to raise public awareness about the dangers of unnecessary injections and address cultural beliefs about the power of injections. Through public education, the films seek to reduce patient demand for injections, especially when appropriate oral medications are available. The video is being used in six project districts and will later be introduced in other parts of the country.   In Kenya, a partner organization is supporting health care facilities to dispose of sharps waste safely with the construction of “needle pits.” These cost-effective pits are constructed by burying a plastic barrel, which acts as a liner. Two test pits were built in Bondo District after the pits were designed and construction guidelines were drafted. Most of the required materials were locally available. A local artisan built the pits with technical assistance from PEPFAR partners. The barrel-pits cost less than half as much as a cement pit for sharps disposal. After using the test pits, the design was revised and plans are in place to build needle pits at 20 facilities in the region. Resources: The following web sites on medical injection safety can be used as additional resources. Information about the World Health Organization’s Safe Injection Global Network (SIGN) is available online at: www.who.int/injection_safety/sign/en/   Information about preventing medical transmission of HIV is available from the CDC online at: www.cdc.gov/nchstp/od/gap/pa_prevention.htm   Information on injection safety is available from USAID online at: www.usaid.gov/our_work/global_health/aids/TechAreas/injection/