Infection Prevention

and Control.

Safe injection practices

To Reduce Infection And
Prevention Diseases
Through Blood.
PREPARATION:
Sana`a -Yemen
Dr. Abdul Baqi Al kamali OCTOBER 2023
 Outline
 Develop an overview of the problem of
unsafe injection.

 Master the WHO 7 steps for safe injection.

 Understand the basics of injection safety

recommended best practices .

 Gain knowledge of previous outbreaks

related to unsafe injection practices .
 What is a “safe injection ?

A safe injection does not harm the recipient,

does not expose the provider to any
avoidable risk and does not result in any
waste that is dangerous for others.
 Safe injection includes :
 under skin
 IM
 IV
 Catheterization
 Manipulating a catheter
 blood samples
 dental injection
 lumber puncture or injection
 PAIENT SAFETY : ( KEY FACTS ) -WHO

Unsafe injection practices. Each year, 16 billion injections

are administered worldwide, and unsafe injection practices
place patients and health and care workers at risk of
infectious and non-infectious adverse events. Using
mathematical modeling, a study estimated that, in a period
of 10 years (2000 - 2010 ), (1.67 million ) hepatitis B virus
infections, between 157 592 and 315 120
hepatitis C virus infections, and between (16 939) and
( 33 877 ) HIV infections were associated with unsafe
injections (20).
WHO Recommendation on Injection Safety
The guidelines recommend the exclusive use of safety
engineered syringes for all injections. These smart syringes
have a disabling mechanism which prevents reuse of both
syringe and needle.

WHO calls for worldwide use of "smart" syringes.

WHO and UNICEF strongly recommend the systematic and

exclusive use of auto-disable (AD) syringes for the delivery
of vaccines and reuse prevention syringes (RUP) for the
reconstitution of vaccines during routine immunization
services and mass vaccination campaigns.
Safety-engineered
Uses and features
injection device
Widely available sterile hypodermic syringe for single-use
Traditional single-use
injection when used properly. Disadvantages include chances of
syringe repeated re-use and risk of needle-stick injuries.
Auto-disable (AD) syringe Immunization syringe widely used for fixed-dose immunization
for immunization with a re-use prevention feature.
Re-use prevention (RUP) Widely available with full range of sizes, including special sizes.
syringe for therapeutic Helps in preventing re-use when the re-use prevention
injections mechanism is activated upon completion of dose.
RUP syringes can also prevent needle-stick injuries among HCWs,
waste handlers, and the community. Features include:
1. a plastic needle shield added to protect the needle;
Sharp injury protection
2. the needle is manually retracted inside the barrel after
(SIP) completion of the injection by pulling the barrel backwards.
3. the needle is automatically retracted inside the barrel after
pushing a button on the plunger.
 How can an injection be unsafe?
If any of the steps to make an injection safe are not
undertaken appropriately.
In particular, if :
• the injection is given in an environment that is not clean and hygienic.
• the needle or the syringe are used for more than one patient.
• the package is not sterile or new and sealed.
• the vial is used multiple times.
• the skin is not properly disinfected.
• the needle is not disposed of safely.
• an injection is unnecessary and may cause harm (e.g. antibiotics,
which can cause resistance (
• the injection is given incorrectly, which can cause
damage to the nerve and lead to paralysis of the area.
 Risks associated with unsafe injection practices
• Bloodborne pathogen
• Nerve damage
transmission
• with risk of paralysis
• hepatitis B virus ( HBV)
infection
• Other less common diseases
• hepatitis C virus ( HCV)
• such as malaria
infection
• HIV
• viral haemorrhagic fevers
• Abscesses,Septicaemia
• Septic
• aseptic
Unsanitary injection preparation area
 Risk of HIV, HBV and HCV
transmission in health care settings
 How long can HBV, HCV and HIV
survive outside the human body?
• HBV can survive for seven days outside the human body
and can cause infection if it enters the body of a person who
is not infected.
• HCV can survive for up to three weeks on environmental
surfaces at room temperature.

• HIV can survive in dried blood at room temperature for up to

three days.
 Length of time a virus can Risk of transmission
Disease survive outside the body from re-used syringe

Hepatitis B 1 week 30%

3 weeks
Hepatitis C (on environmental surface at 3%
room temperature)
3 days
HIV (in dried blood at room 0.3%
temperature)
Is this the making of a safe injection?
Eliminating unnecessary injections cont.
 Eliminating unnecessary injections should be a high priority
for preventing infections associated with unsafe infections.
 Injections should only be prescribed and administered
when medically indicated.
 If a medication is prescribed, consider
the method of administration.
 Ask yourself : is an injection really needed ,
or is there an oral alternative?
The seven steps to safe injections.
1. Clean work space.
2. Hand hygiene.
3. sterile injection equipment.
4. Sterile vial of medication and diluent.
5.Skin cleaning.
6.Appropriate collection of sharps.
7
7. Appropriate waste management.
Step 1 : clean work space :
A clean work space or workstation :
is necessary to avoid contamination and allow safe
injection preparations.
 Step 2 : hand hygiene
Always perform hand hygiene:
before preparing injection material, before giving
an injection, and after giving an injection.
Step 3 : sterile injection equipment
 WHO recommends syringes with RUP
features for all injections.
 RUP syringes with a sharps injury protection
feature are highly recommended wherever
possible.
 Reuse of syringes and needles is violation of
patient safety.
 Always use a new syringe and a needle from
a new and sealed package..
 Using sterile injection equipment

 Discard the needle or syringe if the

package has been punctured, torn,
damaged or moisture found inside.

 Punctures, tears and damage constitute

breaks in sterile packaging.

 Breaks in a sealed package can lead to

contamination.
 Some packaging may not include every
piece of information listed here.

6- Method of Sterilization.
1-Type of
2- Volume.
Syringe.

5- Expiry Date. 3- Needle Size.. 7-Type of

4- Loot Number. Packaging.
 Step 4 : sterile vial of medication
and diluent .
 Use single-dose rather than multidose
vials.

 Many outbreaks have been associated

with use of multidose medication
vials.

 Preservatives are effective but do not

eradicate microbial contamination in
multidose vials.
Risks - Contamination
 Preventing contamination-vial usage:
 Always pierce the septum of the vial with a
sterile needle.
 Avoid leaving the needle in the stopper.
 A needle left in the septum of a multidose
vial is a door open to contamination.
 This practice, associated with reuse of
injection equipment on another or even
the same patient, leads to cross - infection.
 How multidose vials can be used :
 Multidose vials should be dedicated to
a single patient whenever possible.

 If a multidose vial is found in a patient

treatment area, it should be dedicated for
single-patient use only.

 A treatment area could be an operating or

procedure room.
For reconstituted medication in a multidose
vial, use the following label details :
1. Date and time of preparation.
2. Expiry date and time.
3. Type and volume of reconstitution liquid
( if applicable )
4. Name and signature of the person
reconstituting the medication.
 Step 5 : skin cleaning :
 Apply 60-70% alcohol-based solution (isopropyl
alcohol or ethanol) on a single-use swab or cotton
wool ball.
 Wipe the area from the center of the injection site
working outwards, without going over the same
area.
 Apply the solution for 30 seconds, then allow it to
dry completely.
 DO NOT use cotton balls stored wet in
 a multiuse container.
 Step 5 : skin cleaning :
The skin should be prepared in different ways depending
on the type of injection.
For routine intradermal, subcutaneous or intramuscular
injections, disinfection with alcohol or another
disinfectant is not required.

Injection Type Method

Intradermal and sub-cutaneous
Soap and water
injections
Intramuscular injections Soap and water, or
(therapeutic) ( 60-70% alcohol)
Intramuscular injections
Soap and water
(immunization)
Venous access ( 60-70% alcohol )
 Step 6 : appropriate collection of sharps :
 Never recap needles.
 Place uncapped syringes and needles directly into sharps
containers immediately after use.
 Sharps containers should be accessible,
at every point of care and always within arm’s reach.
 Do not bend, break, manipulate, or manually remove the
needle or syringe.
Appropriate sharps disposal prevents needle-stick
injuries and the spread of infections.
 Follow these steps if for any reason the medicine has been
drawn into the syringe, but the injection must be delayed:
1. Re-cap the needle using the one-handed ‘scoop’
technique. Do not use your other hand to re-cap
the needle; it is safer to place the needle cap on a
flat surface and scoop the needle inside the
needle cap. This protects your other hand from
an accidental needle-stick injury. Once the needle
is inside, you may use your other hand to secure
the cap in place. This image depicts this
technique.
2. Label and store the syringe according to the
manufacturer’s recommendations.
3. If the needle comes into contact with a non-
sterile surface, immediately discard the syringe.
 Step 7 : appropriate waste management :
 Many health care facilities in low- and
middle-income countries have
contaminated sharps in their surroundings.

 Sharps in the environment expose the

community to needle-stick injuries.

 In many settings children start to pick up

and play with sharps, as they are dumped
in community waste sites.
 Forbidden behavior that might harm the
HCW and the community :
 Recapping the needle , pending or breaking the
needle .

 Leaving the needles exposed or carrying it for

long distances before discarding .

 Leaving syringes and needles in reachable area

without observation .
 Incorrect behavior that may harm the patient :
 Changing the needle without the syringe
( same syringe )
 Loading more than one dose in the syringe for
multi - use for the same patient or more than
one patient .
 Using the fingers to press against the
bleeding site .
 Leaving a needle inside the medical container
to pull out more doses or to facilitate the flow
of the medication or fluids .
 Touching the needle .
 Re - use the syringe or the needle .
 The RIGHT’ WAYS TO GIVE A SAFE
INJECTION.
Right patient. Right route.
Right drug. Right storage.
Right formulation. Right method of
Right injection disposal.
equipment.
Right anatomical site.
Right dosage.
Right trained personnel.
Right time.
 INJECTION SAFETY  CHECKLIST
Practice If answer is No , document
Performed plan for remediation
N Injection Safety. If answer is No , document plan
Yes No for remediation.
Proper hand hygiene , using alcohol - based hand rub or soap and water , is performed
1 Yes No
prior to preparing and administering medications.
Injections are prepared using aseptic technique in a clean . area free from
2 Yes No
contamination or contact with blood , body fluids , or contaminated equipment.
Needles and syringes are used for only one patient ( this includes manufactured
3 Yes No
prefilled syringes and cartridge devices such as insulin pens (
4 The rubber septum on a medication vial is disinfected with alcohol prior to piercing. Yes No
Medication vials are entered with a new needle and a new syringe , even when
5 Yes No
obtaining additional doses for the same patient.
Single - dose or single - use medication vials , ampules , and bags or bottles of
6 Yes No
intravenous solution are used for only one patient.
7 Medication administration tubing and connectors are used for only one patient. Yes No
Multi - dose vials are dated by healthcare when they are first opened and discarded
within 28 days unless the manufacturer specifies a different ( shorter or longer ) date
8 Yes No
for that opened vial.
Note : This is different from the expiration date printed on the vial.
9 Multi - dose vials are dedicated to individual patients whenever possible. Yes No
Multi - dose vials to be used for more than one patient are kept in a centralized
medication area and do not enter the immediate patient treatment area ( e.g. ,
10 operating room , patient room / cubicle) Yes No
Note : If multi - dose vials enter the immediate patient treatment area , they should be
dedicated for single - patient use and discarded immediately after use.
 PREVENTING NEEDLESTICK INJURIES
DO NOT UNCOVER OR UNWRAP THE KEEP THE NEEDL STICK POINTED
NEEDLES UNTIL IT IS TIME TO USE AWAY FROM YOURSELF AND OTHER
IT. PEOPLE AT ALL TIMES..

NEVER RECAP OR BEND KEEP YOUR FINGERS AWAY FROM

A NEEDLE STICK. THE TIP OF THE NEEDLE.

TELL THE PEOPLE YOU ARE

DISPOSE NEEDLE STICK PROPERLY
WORKING WITH WHEN YOU PLAN TO
TO CLOSED CONTAINER AFTER
SET NEEDL ESTICK DOWN OR PICK IT
YOU USE IT.
UP.
Needle stick injury
 Devices usually cause sharps injuries

Needles used in
IV delivery Suture needles
systems

Blood collection Ampoules

needles
 Increasing the risk of sharps injuries

Transferring a body
fluid between
containers
Recapping needles

puncture-resistant
sharps containers
Protective yourself from needle stick injuries
Tell your employer
do not Recap
about any sharps
hazards you observe needles

training Report all

needle stick
Plan for safe
handling and
disposal of sharps Get Hepatitis B
before use them vaccination
 Recapping a Needle

41
Examples of Safer Needle Devices
Needleless Connector Systems
Needleless connectors for IV delivery systems
 Examples of Safer Needle Devices
• Add-on Safety Features:
Hinged or sliding shields attached to
phlebotomy needles, winged steel needles and
blood gas needles.
Add-on sliding shield
Examples of Safer Needle Devices.
• Self Blunting Technology:
Self-blunting phlebotomy and
winged-steel “butterfly” needles.

Blunt-Tipped Blood
Drawing Needle

Winged Steel Needles

 Examples of Safer Needle Devices
• Retractable Technology:
Needles or sharps that retract into a syringe,
vacuum tube holder or back into the device.
 Examples of Safer Needle Devices
• Self-Sheathing Safety Feature:
Sliding needle shields attached to disposable
syringes and vacuum tube holders.

Before use

After use
2015 Blood borne Pathogen Incident
Analysis
 What are PEP
theSteps
next steps ?
• Treat the exposure site.

• Report and document.

• Evaluate the exposure.

• Evaluate the exposure source.

• Disease-specific PEP management.

Occupational Exposures
 Post ecxposure Management
Wound care
• Clean wounds with soap and water.
• Flush mucous membranes with water.
• No benefit to:
-applying of antiseptics or disinfectants.
-squeezing (“milking”) puncture sites.
• Avoid use of bleach and other agents
caustic to skin.
Post ecxposure Management
• Notify one of the attending faculty
of the incident.

• Both you and the attending faculty let

the patient know of the incident and
educate the patient of the importance
for blood testing and follow up.
Post ecxposure Management

• Go to the Clinical Affairs Office and get

the proper paperwork to fill out and
take to the ACB,
 Post exposure Management:
The Exposure Report :
• Date and time of exposure
• Procedure details…what, where, how, with
what device
• Exposure details...route, body substance
involved, volume/duration of contact.
• Exposure management details
- The reports are numbered for accounting
purposes and to ensure all follow-up
paperwork gets completed.
• All reports are kept confidential.
Post ecxposure Management

Go to the ACB for baseline testing

for exposed individual and patient.
 Average Risk of Transmission
after Percutaneous Exposure to Blood

Source Risk (%)

HIV 0.3
Hepatitis C 3.0
Hepatitis B (only HBeAg+) 30.0
HBeAg- 6.0
 References and resources, with web-links
WHO Guidelines on Core Components of Infection Prevention and
Control programs, 2016. https://www.who.int/infection-
prevention/publications/cc_summary.pdf?ua=1
WHO Interim Practical Manual Supporting Implementation of the
WHO Guidelines on Core Components of Infection Prevention and
Control programs, 2018. http://www.who.int/infection-
prevention/publications/core- components/en
WHO Guidelines Minimum Requirements for infection prevention and
control (IPC) programmes, 2019. https://www.who.int/infection-
prevention/publications/core-components/en
APIC Competency Self-Assessment and Professional Development
Plan. For Proficient and Advanced Infection Preventionists. 2013.
 THANK YOU
PREPARATION :

Dr. Abdul Baqi Mohammed Al kamali

Infection Control Manager, and MWM

Lecturer, Certified Trainer with MOHP , WHO , UNICEF ,

GAVI and TEPHIENT In IPC And MWM