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A National Program for Promotion of Infection Control and Safe Injections In Egypt . Annual Meeting of the Safe Injection Global Network SIGN, 2002. Ministry of Health and Population. Partners USAID WHO Ford Foundation Namru-3.

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A National Program for Promotion of Infection Control and Safe Injections In Egypt


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    1. A National Program for Promotion of Infection Control and Safe Injections In Egypt Annual Meeting of the Safe Injection Global Network SIGN, 2002

    2. Ministry of Health and Population Partners USAID WHO Ford Foundation Namru-3

    3. A National Program for Promotion of Infection Control and Safe Injections In Egypt • Background • Goals and objectives of the program • Findings of baseline assessment • Strategic approach of the program • Communication Strategy to prevent BBPs transmission • Objectives • Target audiences • Messages • Means • Material

    4. Blood-borne pathogens transmission in Egypt • Major public health problems • 10-15% of the population have HCV infection • Prevalence of HBV is 4% • Three epidemics of Aids were reported in Egypt since 1993 • Treatment of infected persons is a burden on the economy of Egypt

    5. Nosocomial Infections • Emerging as important public health problem throughout the world - increase in antimicrobial resistance • - high cost of health care - increased morbidity and mortality • Particular problem in countries with rapid development of health care services and introduction of new technology - infection control is not a well recognized discipline

    6. Risk Factors Associated with HCV Transmission in Egypt

    7. Risk Factors Associated with HCV Transmission in Egypt

    8. Framework of the national program to promote infection control and safe injection practices in Egypt • Promotion of safe injection practices in the community • Promotion of infection control practices in health care facilities • Safe blood transfusions • Pilot project in 2 governorates - transition to a national program

    9. Program Goals Program to promote infection control • Reduce HCV transmission and hepatitis related chronic liver disease • Reduce transmission of hospital-acquired infections in the health care setting • Improve quality of health care services through promotion of infection control

    10. Program Objectives Program to Promote Infection Control • Promotion of infection control in Health Care Facilities - Implement standard precautions for infection control - Promote safety of injections - Reduce occupational risk of BBP infection •  Prevention of transmission of BBP’s in theCommunity - Promote safe injection practices - Educate the general public on BBP transmission

    11. Methods Community-based survey • Standard questionnaires • 6 rural villages • 2 urban cities • 720 households • 4197 persons interviewed

    12. Baseline AssessmentInjection practices at community level Aim of the Survey

    13. Baseline Assessment Infection Control Practices in HCF • Governorate-wide random sample of public and private health care facilities (98 health facilities) • 53 public health care facilities • 16 private hospitals • 29 private dentalclinics

    14. Baseline AssessmentInfection Control Practices in HC Aim of the Survey

    15. Proportion of Households Reporting at Least One Person Who Received an Injection in the Previous Three Months; Survey in Sharkia and Qena, 2001

    16. Frequency of Injections among Residents of Qena and Sharkia, 2001 No. persons No. (%) reporting Site surveyed injection in past 3 mos Sharkia 2599 720 (27.7%) Qena 1598 381 (23.8%) Total 4197 1101 (26.2%)

    17. Estimated Number of Injections/ Person/ Year Survey in Sharkia and Qena, 2001 Site Mean No.of No. of injections injections/person per person per year in the past 3 mos Sharkia 1.2 4.8 Qena 0.9 3.6 Total 1.05 4.2

    18. Type of Injections Received Survey Sharkia and Qena, 2001

    19. Who administers injections in Community-based survey

    20. Prescribers of injectionsCommunity-based Survey

    21. Findings of Baseline assessment Population-based Survey Challenges: • 70% household prevalence rate of injections (3mos) • 26% individual based prevalence rate of injection ( 3 mos) • 84% therapeutic injections • 4.2 injections/person/year • 281millions of injections yearly in Egypt • 8.4% of injections are unsafe (23 millions injections) • 20-40% of injections provided by the informal sector • 37-49% of injections are prescribed by doctors

    22. Qualitative AssessmentPopulation-based Survey Challenges General rural population prefers injections - They cure faster - An Injection is easier to use than tablets - Injections don’t cause stomach problems - They are useful in serious diseases - Injection providers are accessible - Lack of awareness of risks associated with injections

    23. Key findingsHealth care facility Survey Infection Control Challenges • No concept of infection control • No hand washing or wearing gloves • Unsafe injections provided • Unsafe sharp disposal • Lack of training • Lack of supplies and material • Inappropriate sterilization methods • Overprescription of injections (23%) • Lack of waste management • High exposure of HCWs to needlestick injuries

    24. Frequency of Needlestick Injuries Health Care Worker Survey No. % with Annual Mean Group Interviewed needlestick No. of (3 months) needlesticks Allied HCW 64 27% 1.8 Dentists 78 36% 3.9 Nurses 683 38% 4.5 Housekeepers 229 40% 5.0 Doctors 339 31% 5.9 Lab techs 92 32% 6.3 TOTAL 1485 36% 4.9

    25. Behaviors Associated with Recent Needle Stick Injury, Health Care Worker Survey 2001

    26. Hep B Vaccine Coverage among HCWs No. No Percent Interviewed vaccinatedvaccinated Group Doctors 339 129 38% Dentists 78 30 38% Nurses 683 60 9% Lab techs 92 5 5% Housekeepers 229 8 3% Allied HCW 64 3 5% TOTAL 1485 235 16%

    27. Strategic ApproachNational Program for Promotion of Infection Control • Organizational Structure • Development of national guidelines for infection control • Training and capacity building • Surveillance of nosocomial infections • Occupational safety health program • Provision of critical supplies and equipment • Advocacy • IEC Communication Strategy to prevent transmission of BBPs

    28. IEC communication strategy to prevent transmission of BBPs • Objectives • Target audiences • Messages • Means • Material • Implementation • Evaluation

    29. IEC communication strategy to prevent transmission of BBPs Objectives: Raise the awareness of the public and health care providers to promote injection safety

    30. IEC communication strategy to prevent transmission of BBPs Target Audiences • All sectors of the rural population • Health care providers Doctors Nurses Janitors

    31. IEC communication strategy to prevent transmission of BBPs Messages • Messages to the public - Reduce overuse of injections - Don’t reuse a syringe • Message to the doctors • Rational use of injections • Message to the nurses • Provide a safe injection

    32. IEC communication strategy Means of conveying messages • Radio and TV programs • Airing of TV spots in 2003 • Continuous Press Release • Community outreach and mobilization for public • Partnership and networking (NGOs and Government) • Disseminate messages through an existing structure • Leadership (community leaders) • Community participation • Volunteers • Reach different social and cultural complexes

    33. Launching of a campaign for prevention of BBPs transmission • Launching started in September, 2002 • Slogan • Safe injections save lives • Local activities are focused in two governorates • Sharkia • Qena

    34. IEC communication strategy to prevent transmission of BBPs Motivation of health care workers • Regular meetings with key personnel • Primary health unit directors • Head nurses of facilities • Competition between facilities “ Safe sharp disposal” • Awards • Recognition • Certificates

    35. Communication StrategyCommunity outreach and mobilization • Community leaders target different groups • Teachers • illiterate (illiteracy programs) • school children • Women community leaders (house to house visits to illiterate housewives) • Religious leaders (men in rural villages) • Students’ unions in universities • Events and meetings

    36. Communication Strategy IEC Material • Process of development of IEC material • SIGN consultant • Development of image bank • Field Testing of material • Modification of material • Printing and distribution of the material

    37. Communication Strategy IEC Material • IEC material for the Public • Community leaflet for the educated • Power point presentation for the illiterate • Posters • Give aways (calendars and others) • IEC material for health care providers - Good prescribers guide for doctors - Safe injection providers guide for nurses - Video film (Zahra)

    38. Good Provider’s Guide

    39. PROTECT YOURSELF

    40. Community Leaflet