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Giving Safe Injections

Giving Safe Injections. Presented by :Dr Esteghamat. Unsafe Injections. Injections that harm the recipient , the provider , or that result in waste that is dangerous for other people . Unsafe injections can cause disease, injury and death. Causes of Unsafe Injections.

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Giving Safe Injections

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  1. Giving Safe Injections Presented by :Dr Esteghamat

  2. Unsafe Injections Injections that harm the recipient, the provider, or that result in waste that is dangerous for other people. Unsafe injections can cause disease, injury and death.

  3. Causes of Unsafe Injections • World Health Organization estimates: • 12 billion injections administered each year • 50 % (6 Billion) are unsafe • 95% of injections are therapeutic • 25% to 95% of outpatient visits resulted in an injection • Many injections may be unnecessary, ineffective or inappropriate

  4. Causes of Unsafe Injections • In a year, unsafe injections may be responsible for: • 8 to 16 Million cases of Hepatitis B • 2 to 5 Million cases of Hepatitis C • 80,000 to 160,000 cases of HIV • Others: Parasitic (Malaria), bacterial (abscess), fungal and other infections • Some infections may not be obvious for years

  5. Causes of Unsafe Injections • Poorly administered injections can cause injuries or drug toxicities when: • Wrong injection site used • Incorrect drug used • Wrong diluents used • Incorrect dose used

  6. Rules of Safety • Assume all body fluids contain pathogens • Assume the skin and the environment contain microorganisms • Unsafe injections can spread pathogens more easily than inhalation, swallowing or sex • Do No Harm: Health Worker responsibility

  7. Body Fluids • Any body fluid may contain pathogens and spread disease • Treat all human and animal body fluids as contaminated by pathogens Wash hands thoroughly with soap and water until visible dirt is gone.

  8. Clean Skin

  9. Unsafe Injections Can Cause Infections • Unsafe injections can transport microorganisms into the body, that are: • transferred from fingers or objects to the needle • present on the skin and picked up by the needle • in the medication to be injected • inside the syringe or needle that has been previously used

  10. Unsafe Injections Can Cause Infections Unsafe Injections Can Kill

  11. Health Worker: Do No Harm • Give only necessary injections • Use sterile syringe and sterile needle for every immunization or DO NOT immunize • Arrange the workspace and institute disposal practices to prevent needlesticks to self and others

  12. Why Re-Use Occurs • Re-use of contaminated syringes/needles: • Inadequate supply • Lack of understanding of danger • Unmonitored/inadequate sterilization • Inadequate disposal and distribution (public access to contaminated equipment)

  13. Unsafe Injections Can Cause Infections Today: • Millions of people have weakened immune system • Billions of injections are given by untrained and unaware people. • New pathogens have been recognized

  14. Practices That Can HarmRecipients • Giving unnecessary injections • Loading syringes with multiple doses and injecting multiple people • Leaving the needle in the vial • Touching the needle

  15. Practices That Can HarmRecipients • Mixing two partially opened vials of vaccine • Keeping freeze-dried vaccine more than 6 hours. • Storing medication and vaccine in same refrigerator • Applying pressure to bleeding sites with used material or finger • Vaccinating infants in the buttocks

  16. Practices That Can HarmHealth Care Workers • Re-using needles and syringes. • Carrying needles or placing them on a surface prior to disposal • Recapping needles

  17. Practices That Can Harm the Community • Leaving needles and syringes in areas where children can take them • Leaving needles and syringes in areas accessible to the public

  18. Vaccines Safety

  19. Checking Vials and Labels 1. Label 2. Age of the vaccine (expiration) 3. Signs of contamination 4. Exposure to freezing 5. Exposure to excessive heat

  20. Assessing Contamination discard it if: • Leaks or cracks are present, • Change in appearance or floating particles are seen • Submerged in water • Pierced with used needle. • Vaccine was reconstituted more than 6 hours before. • Vial opened for more than 4 weeks.

  21. Assessing Exposure to Freezing • DPT, DT, Td, TT, hepatitis B, diluents and Hib should be discarded if you highly suspect or are certain that they are/were frozen • “Shake taste” DPT, DT, Td and TT (contain aluminum hydroxide adjuvant) when refrigerator log shows subfreezing temperatures. If failed, discard.

  22. Assessing Exposure to Freezing • Hepatitis B and Hib vials should be discarded if frozen or suspected of freezing. The “shake test” doesn’t work for them.

  23. Freeze Watch

  24. Freeze-tag Shelf life is 5 years.

  25. Assessing Exposure to Heat • Vaccine Vial Monitor (VVM) Present: • If VVM inner square is the same color or darker than the outside circle, discard the vial • Vaccine Vial Monitor (VVM) Not Present: • Check temperature log and cold-chain monitoring cards. If exposed to temperatures above 8º C, discard it.

  26. Checking Vaccine Vial Monitors • VVM is a label made of heat-sensitive material, placed on the vial to show cumulative heat exposure over time • VVM reduces waste of vaccine, ensuring that only good vaccine is used

  27. Storage Ice Packs in freezing compartment Oral Polio, Measles BCG, DPT, TT, diluent Thermostat Ice packs “Returned box

  28. Checking the Vaccine and Diluent Vials • Before use, check the following: • Is the label still attached to the vial? • Is the right vaccine and right diluent? • Expiration date? • Contamination (discard reconstituted vaccine 6 hours after reconstituted) • Cold sensitive vaccines show no signs of freezing • No signs of heat exposure

  29. Vaccines Which Require Specific Diluent • BCG vaccines • Measles-containing vaccines • Freeze-dried Haemophilus Influenza type b (Hib) vaccines • Yellow fever vaccines

  30. Reconstituting Vaccines Safely • Reconstituted vaccines should be kept cool, between 2º and 8º C to maintain their potency • Place reconstituted vaccines in slits made in a foam piece that sits in the top a vaccine carrier

  31. Reconstituting Vaccines Safely • Discard reconstituted vaccine after 6 hours. BCG, measles-containing vaccines, yellow fever vaccines and freeze-dried Hib vaccines do not have preservatives. Death may occur

  32. Reconstituting Vaccines Safely • Store only vaccines in the refrigerator. Medications can accidentally be administered instead of vaccines • Do not reconstitute vaccine until the person needing the vaccine injection is present

  33. Reconstituting Vaccines Safely • Use a new syringe and needle to reconstituteeach vial of vaccine • Check that the diluent is the one provided by the manufacturer

  34. Reconstituting Vaccines Safely • Discard the used mixing syringe and needle in a sharps container • Do not leave the mixing needle in the vial (contamination) • Mix the contents of vial by rolling the vialbetween your fingers. Note date and time of reconstitution

  35. Safe Disposal of Injection Equipment and Other Sharps • To further prevent needlesticks use leak-proof, puncture-proof containers for needles, syringes and other medical waste that might cut or puncture the skin (broken vials, etc) • Sharp containers • Safety boxes • Needle-disposal boxes

  36. Sharp Containers

  37. Sharp Containers • Leak-proof • Puncture-proof • Clearly labeled with warning (easy for the community to understand) • Do not overfill (only 3/4 is safe) • Do not transfer contents to other container

  38. Sharp Containers Safe Unsafe

  39. Unsafe Photo: Keith Sabin

  40. Unsafe

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