For General Healthcare Settings in West Africa: Preventing Injury from Injections and Sharps

Key Points

• Unsafe injection practices include reusing syringes and needles and improperly handling medication containers.
• Unsafe medical injections are preventable.
• Safe injection practices can prevent and control the spread of disease and keep patients and healthcare workers in West Africa from becoming infected.

Unsafe Injection Practices Are Preventable

Injected medicines are commonly used to prevent and treat various illnesses. Unsafe injection practices put both patients and healthcare personnel at risk of infection. Examples of unsafe injection practices include reusing syringes and needles and improperly handling medication containers.

During the year 2000, experts estimated that unsafe medical injections caused an estimated global total of 21 million new hepatitis B infections, 2 million new hepatitis C infections, and 260,000 new HIV infections¹. Unsafe injection practices have also contributed to Ebola transmission during outbreaks².

Harm from unsafe injection practices is entirely preventable. Safe injection practices are part of CDC’s Standard Precautions designed to protect patients and providers. As defined by the World Health Organization (WHO), a safe injection does not harm the recipient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous for the community³.

Safe Injection Practices Are Critical in Healthcare Settings

The following are recommended practices for preparing and administering injections. More detailed recommendations and rationale are available in the injection safety resources listed below.

Recommended Practices

• Eliminate unnecessary injections
  • Whenever possible, use oral, topical, or rectal medications instead of injectable medications.
• Prepare injections properly
  • Prepare injections in a designated clean area. The clean area should be free of clutter and in an area where contamination by blood and body fluids is unlikely.
  • Ensure lighting is adequate to prepare the injection safely.
  • Use aseptic techniques, including proper hand hygiene, when preparing or administering injections⁴.
  • Cleanse the access diaphragm of medication vials with 70% alcohol before inserting a needle into the vial.
• Don’t reuse injection equipment
  • Never administer medications from the same syringe to multiple patients, even if the needle is changed or the injection is administered through an intervening length of intravenous tubing.
  • Never reuse a syringe or needle when withdrawing medication or solutions from multiuse vials or other containers, even when obtaining additional doses for the same patient.
  • Never use fluid infusion or administration sets (intravenous tubing) for more than one patient.
• Use medication containers appropriately
  • Do not administer medications to more than one patient from single-dose or single-use vials, ampoules, or bags or bottles of intravenous solution.
  • Dedicate multidose vials to a single patient whenever possible.
    • If multidose vials must be used for more than one patient, the vials should be restricted to a centralized medication area and should not be brought into the immediate patient treatment area (e.g., operating room, patient area).
• Dispose of equipment safely
  • Dispose of used sharps at their point of use in a sharps container that is closable, puncture-resistant, and leakproof. Securely seal and replace sharps containers when they become three-quarters (3/4 or 75%) full.
    • ALWAYS discard used and uncapped needles immediately in a sharps container.
    • Do not reprocess injection equipment for reuse.
    • Do not remove used needles from disposable syringes.
    • Do not bend, break, or otherwise manipulate used needles by hand.
    • Ensure that sharps containers are placed in an area that is not easily accessible by visitors, particularly children.

Injection Safety Resources

General injection safety guidance:

• CDC Injection Safety Webpage
• WHO Best Practices for Injections and Related Procedures Toolkit [PDF – 69 pages]
• One and Only Campaign

Infection prevention and control training:

• Bloodborne Pathogens Training

Preventing and controlling Ebola infection in healthcare settings:

• WHO Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola [PDF – 24 pages]

References

1. Hauri AM, Armstrong GL, Hutin YJ. The global burden of disease attributable to contaminated injections given in health care settings. Int J STD AIDS 2004;15:7-16.
2. Report of an International Commission. Ebola haemorrhagic fever in Zaire, 1976. Bulletin of World Health Organization 1978, 56;271-293.
3. WHO best practices for injections and related procedures toolkit. World Health Organization. 2010. http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf [PDF – 69 pages]
4. Healthcare workers should follow recommendations for hand hygiene before AND after the injection session (either with soap and running water if hands are visibly soiled) or with alcohol rub (if hands appear clean).