who/epi safe injections ana maria henao world health organization epi/v&b
TRANSCRIPT
WHO/EPI
Safe Injections
Ana Maria HenaoAna Maria HenaoWorld Health OrganizationWorld Health Organization
EPI/V&BEPI/V&B
WHO/EPI
Every countryEvery country should: should:
• ensure the quality & safety of its vaccines
• ensure the safety of immunizations
• be able to rapidly detect immunization safety issues
• be prepared to effectively deal with immunization safety issues when they arise
WHO/EPI Patient with cirrhosis in Africa
What is the magnitude of the problem ?What is the magnitude of the problem ?
• Burden of disease– HBV infections: 8-16 millions– HCV infections: 2.3 - 4.7 millions– HIV Infections: 80,000 to 160,000
• CostCost– 1.3 million future early deaths1.3 million future early deaths– 26 million of years of life lost26 million of years of life lost– US$535 million direct medical costsUS$535 million direct medical costs
One sterile needle and One sterile needle and syringe for each dose ….syringe for each dose ….
WHO/EPI
Not always ensured..!Not always ensured..!
Unsafe practice ?
WHO/EPI
Injections Administered with an unsterilized Syringe and/or a Needle
0% 10% 20% 30% 40% 50% 60%
China
India
Sub-Saharan AfricaSub-Saharan Africa
Middle East crescent
Former socialist economies of Europe
Simonsen et al, Bull WHO 1999
Other Asia and Pacific
Estimated proportion
WHO/EPI
Injection safety equipment & Supplies
• Ensuring quality
• Increasing access
• Improving knowledge
Auto-Disable Syringe
By 2001, A-D syringes for allBy 2001, A-D syringes for allinjections in routine programmeinjections in routine programme
Needles should not be Needles should not be recapped …..recapped …..
WHO/EPI
Estimated Risk of Infection Following a Estimated Risk of Infection Following a Needlestick from an Infected Source-PatientNeedlestick from an Infected Source-Patient
0.30%3%
30%
0%
5%
10%
15%
20%
25%
30%
35%
Hepatitis B Virus Hepatitis C Virus HIV
Source: Needlestick injuries studies among healthcare workers
Is the risk higher enough ?
WHO/EPI
Sharps Waste ManagementSharps Waste Management
• Policy
• Integrated,
comprehensive approach
• Implementation-plan
• Training
• Monitoring
Children playing with syringes in Asia
Is the problem real ?
Be able to rapidly Be able to rapidly address immunizationaddress immunization
safety issuessafety issues
WHO/EPI
AdverseAdverse events: events: programmatic errorprogrammatic error
Insulin vial Vaccine vials
TT DTP
WHO/EPI
Mass campaignsMass campaigns
An opportunity to strengthenAn opportunity to strengthenimmunization safety ?immunization safety ?
WHO/EPI
INJECTION SAFETYINJECTION SAFETY
Key steps during mass campaignsKey steps during mass campaigns
Auto-disable syringes should be provided together with high quality vaccine for ALL elective and emergency immunization masscampaigns
WHO/EPI
One syringe should be used for each dose administered.Measles vaccine should be administered subcutaneouslyNeedles should NOT be recapped.
INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns
WHO/EPI
Used syringes should be dropped in a safety box or puncture resistant container immediately after use
INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns
WHO/EPI
Used disposable and auto-destruct syringes should be stored in a safe place and incinerated soon after.
INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns
WHO/EPI
INJECTION SAFETYINJECTION SAFETYKey steps during mass campaignsKey steps during mass campaigns
Where will the safety boxes disposed ?Who is collecting all the safety boxes after the campaign?How will they be transported ?Who is going to verify that it happens ?
WHO/EPI
Responding to reports of AEFIResponding to reports of AEFI
Media hear first
Crisis situation
Hasty regulatory action detrimental to the immunization program; loss of public confidence
WHO/EPI
WHO/EPI
Injection Safety at Country LevelInjection Safety at Country Level
• Initial assessment
• National coalition
• Implementation of a three-prong approach1- Behaviour change
2- Equipment and supplies
3- Sharps waste management
• Monitoring and evaluation
WHO/EPI
How to ensure all this ?How to ensure all this ?
• Prepare a work plan– what, where, when, who ?
• Train• Supervise-monitor
– before - during - after• Evaluate
Use experience to improve….Use experience to improve….
WHO/EPI
World Health Organization
The Safe Injection Global The Safe Injection Global Network (SIGN)Network (SIGN)
Weekly moderated E-mail list server ([email protected])Internet site (www.injectionsafety.org)
WHO/EPI
In the pipeline………..
Needle - free devices• New/modified JET INJECTORS• AEROSOL vaccination
VVM for measles
WHO/EPI
ConclusionsConclusions
• Injection safety should be considered as a priority
• Time has come to implement action
Timing has a lot to do Timing has a lot to do with the outcome with the outcome
of a rain danceof a rain dance