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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”.
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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. • SIGN@who.ch • Safe Injection Global Network • World Health Organization • Avenue Appia 20 • Geneva 27 • Switzerland 1211 • Fax 41-22-791-4836