Injection Safety.
1 Injection is one of the most common health care procedures. Each year at least 16 billion injections are administered i developing and transitional countries. The vast majority, around 95%, are given in curative care. Worldwide, up to 40% of injections are given with syringes and needles reused without sterilization. severe infections can result, putting human lives at risk. …………………… WHO.
http://www.who.int/mediacentre/factsheets/fs231/en/index.html
2 Protecting Healthcare Workers: Preventing needle stick injuries toolkit 1. needle prick from a used syringe.
http://www.who.int/occupational_health/activities/pnitoolkit/en/index7.html
3SafePoint trust, a UK based charity, launched a week-long campaign recently across 14 cities in India to raise awareness about dangers of unsafe injections.
http://www.expresshealthcare.in/200812/market08.shtml

4. Enough is Enough: Healthcare Leaders Unite to Launch Injection Safety Campaign Spurred by Hepatitis Outbreaks Caused by Reused Syringes, Campaign will Educate Providers and Patients American Association of Nurse Anesthetists
http://www.aana.com/news.aspx?id=19348

5. WHO continues to support several countries to promote safe injection practice and rational use of injections for clinical treatments
http://www.wpro.who.int/health_topics/injection_safety

6. Reuse of injection devices without sterilization is of particular concern as it may transmit hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus(HIV), accounting for 30%, 41% and 5% of new infections
http://apps.who.int/medicinedocs/en/d/Js4886e/

Needle Prick Injury



Despite their seriousness as a medical event, needle stick injuries have been neglected: most go unreported and ICD-10 coding is not available. The frequency of such events has been estimated to be about 800,000 cases in the USA alone. Estimates of the risk of a single injury indicate a risk of 300 HBV infections (30% risk), 30 HCV infection (3% risk) and 3 HIV infections (0.3% risk) per 1,000 respective exposures
http://en.wikipedia.org/wiki/Needlestick_injury

Needle prick injury is a well known hazard for surgeons and their assistants.
http://www.ncbi.nlm.nih.gov/pubmed/7861343

NSIs are under reported, but nearly half of nurses may have had such an injury. NSIs occur in many clinical areas, often when nurses are busy or tired, and most are caused by conventional hollow-bore needles
http://www.ncbi.nlm.nih.gov/pubmed/21537271

The highest incidence of episodes of needle stick injury occurred in Obstetric & Gynaecology postings, followed by Medicine and Surgery. For clinical procedures, venepuncture had the highest incidence followed by setting up drips and giving parenteral injections.
http://www.jstage.jst.go.jp/article/joh/45/3/45_172/_article/-char/en

Most injuries occurred during disposal of used needles (23.7 percent of all injuries), during the administration of parenteral injections or infusion therapy (21.2 percent), drawing blood (16.5 percent), recapping needles after use (12.0 percent), or handling linens or trash containing uncapped needles (16.1 percent).
http://www.amjmed.com/article/0002-9343(81)90558-1/abstract

HIV-1 transmission by a needle-stick injury despite rapid initiation of four-drug postexposure prophylaxis.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102188852.html

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting.279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079524/


To lower down the incidence of needle stick injuries in nurses, one should establish an overall protection and carry out an occupational safety education before getting a job. One should strengthen the consciousness of protection, perform some safety
http://en.cnki.com.cn/Article_en/CJFDTOTAL-SXHZ200303010

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post exposure Prophylaxis
http://aidsinfo.nih.gov/contentfiles...ExpoGL_PDA.pdf

Every year 600,000 to 1,000,000 needlestick injuries occur in the United States. Needlestick.com was created to help educate healthcare workers on needlestick prevention.
http://needlestick.com/

A Needle Stick injury is reported every 30 seconds, which means that there are over 1 million such cases per year.
http://www.sharpscontainer.com/article/needle-stick-injury-facts-published-by-personal- injury-lawyers/

The circumstances leading to a needle- stick injury depend partly on the type and design of the device used www.cdc.gov/niosh/docs/2000-108/pdfs/2000-108.pdf



Our process was to identify priorities and determine the medical devices that would have the greatest impact on preventing occupational exposure.
www.cdc.gov/niosh/topics/bbp/safer/nursinghome2-step4.pdf

You never think it is going to happen to you. Sticking yourself with a needle. You think that, because you are always EXTREMELY careful. But, you just never know.
http://www.needlestick.com/forum/showthread.php?t=2

The risk of seroconversion following needlestick injury may be reduced by knowledge of body fluids that are high risk and knowledge of post-exposure prophylaxis following possible HIV-contaminated needlestick injury.

http://bja.oxfordjournals.org/content/84/6/767.abstract

Updated U.S. Public Health Service Guidelines for the Management of Occupational exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

Percutaneous injuries caused by needlesticks, pose a significant risk of occupational transmission of bloodborne pathogens. Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non existent problem.
www.icmr.nic.in/ijmr/2010/march/0306.pdf

Needle stick safety should always be a priority. The following suggested steps regarding how to handle a needle stick injury were first published in the American Journal of Nursing.
http://www.inviromedical.com/SAFETYRESOURCES/WhattoDoifYouGetaNeedleStick/ tabid/230/Default.aspx

The nurse who sustained the needle stick injury hardened refusal representing HIV with the intention of day, except she hardened HIV affirmative some months later. This is not the solitary case.
http://www.bloodtestguide.com/needle-stick-injury-who-bears-the-brunt.html

An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needle sticks and other sharps-related injuries.
http://neuromonitoring.wordpress.com/2011/03/05/needle-stick-injury-a-silent-epidemic- osha-workbook-for-a-sharps-injury-prevention-program/


Needlestick injuries are of increasing concern to healthcare workers. Succesful prophylaxis requires careful planning in advance.
http://www.nature.com/bdj/journal/v190/n12/full/4801064a.html

Estimating the probability of transmission following a needle-stick injury is difficult as there are many factors which contribute to the risk.
http://www.australianprescriber.com/magazine/24/4/98/100/

The rate of occupational transmission from an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.09% for a mucous membrane exposure.The rate of transmission from a hepatitis B-positive source to a nonimmunized host is 6-24% and 1- 10% for exposure to hepatitis C
http://emedicine.medscape.com/article/784812-overview#showall

With needle stick injuries being rather common in a healthcare set up and affecting all levels of healthcare workers, the Pune forum of the Hospital Infection Society (HIS) has decided to undertake a survey and record the number of such injuries in each hospital
http://www.expressindia.com/latest-news/survey-to-check-needlestick-injuries/233725/

Surgical students are frequently stuck by needles, but many students don’t bother reporting the injuries, a new study found.
http://well.blogs.nytimes.com/2009/12/03/a-silent-epidemic-of-needle-injuries/

At least five outbreaks of hepatitis B virus infection have been linked to acupuncture thus far, and the study’s authors also note that transmission of HIV and hepatitis C may also be associated with acupuncture needles.
http://www.emaxhealth.com/1275/6/36114/acupuncture-needles-may-transmit- disease.html

The risk of transmission of HBV is reduced by immunization against hepatitis B, which is 90% to 95% effective. The risk of transmission of HBV to susceptible HCWs via a needlestick injury varies from 1% to 40%.Needlestick injuries may also transmit hepatitis C. The risk factors for hepatitis C virus transmission in occupational settings is 1.8% (range 0% to 7%). http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html


Campaigns Being Conducted For Injuction safety


SafePoint trust, a UK based charity, launched a week-long campaign recently across 14 cities in India to raise awareness about dangers of unsafe injections. http://www.expresshealthcare.in/200812/market08.shtml According to Dr Abdul Kalam, ?In India, we have to ensure that there is no occurrence of


infection such as HIV/AIDS, Hepatitis B&C due to the re-use of syringe[s] and the needle.? http://www.indiainfoline.com/Markets/News/Archived/SafePoint-Trust-launches-Safe- Injection-campaign-on-a-pan-India-basis/941522505 To combat the menace of unsafe



injection practice among medicos, the Indian Medical Association (IMA) as well as the Indian Association of Paediatricians (IAP) would soon kickstart a national campaign. http://www.expresshealthcaremgmt.com/20050615/coverstory01.shtml


An awareness campaign on safe hospital practices, as part of the Safe-I project implemented in the district, was launched as the ‘Jyot-se-Jyot' (flame to flame) programme by Mayor Tony Chammany http://www.hindu.com/2011/05/13/stories/2011051362320200.htm


The One & Only Campaign is a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices. http://www.oneandonlycampaign.org/about/default.aspx


The SafePoint Trust is a charity with a global remit to improve basic healthcare provision. We believe that every person across the world has the right to ask for - and receive - a sterile and safe injection. http://www.safepointtrust.org/about.htm


Campaigns Being Conducted For Injection Safety


SafePoint trust, a UK based charity, launched a week-long campaign recently across 14 cities in India to raise awareness about dangers of unsafe injections. http://www.expresshealthcare.in/200812/market08.shtml


According to Dr Abdul Kalam, ?In India, we have to ensure that there is no occurrence of infection such as HIV/AIDS, Hepatitis B&C due to the re-use of syringe[s] and the needle.? http://www.indiainfoline.com/Markets/News/Archived/SafePoint-Trust-launches-Safe- Injection-campaign-on-a-pan-India-basis/941522505



To combat the menace of unsafe injection practice among medicos, the Indian Medical Association (IMA) as well as the Indian Association of Paediatricians (IAP) would soon kickstart a national campaign. http://www.expresshealthcaremgmt.com/20050615/coverstory01.shtml


An awareness campaign on safe hospital practices, as part of the Safe-I project implemented in the district, was launched as the ‘Jyot-se-Jyot' (flame to flame) programme by Mayor Tony Chammany http://www.hindu.com/2011/05/13/stories/2011051362320200.htm


The One & Only Campaign is a public health campaign, led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices. http://www.oneandonlycampaign.org/about/default.aspx


The SafePoint Trust is a charity with a global remit to improve basic healthcare provision. We believe that every person across the world has the right to ask for - and receive - a sterile and safe injection. http://www.safepointtrust.org/about.htm


How Long A Contaninated Needle Can Transmit Disease


Viable HIV-1 was cultured from syringes stored for as long as 28 days A 28-day survival time exceeds current estimates. (3) Load appears to be sufficient to effect transmission. (4) This survival time provides a scientific basis for needle exchange and supports the use of harm reduction techniques and the removal from circulation of used syringes and injection equipment.
http://hivinsite.ucsf.edu/insite?page=ask-01-06-11

The Othr Diseases Transmitted By Unsafe Injections


Needlestick injuries have transmitted many other diseases involving viruses, bacteria, fungi, and other microorganisms to health care workers, laboratory researchers, and veterinarian staff. The diseases include :
  • Blastomycosis
  • Brucellosis
  • Cryptococcosis
  • Diphtheria
  • Cutaneous gonorrhea
  • Herpes
  • Malaria
  • Mycobacteriosis
  • Mycoplasma caviae
  • Rocky Mountain spotted fever
  • Sporotrichosis
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Syphilis
  • Toxoplasmosis
  • Tuberculosis
Many of these diseases were transmitted in rare, isolated events. They still demonstrate, however, that needlestick injuries can have serious consequences
http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html


Disease Transmition Potentail of Needle Prick


At least five outbreaks of hepatitis B virus infection have been linked to acupuncture thus far, and the study’s authors also note that transmission of HIV and hepatitis C may also be associated with acupuncture needles. http://www.emaxhealth.com/1275/6/36114/acupuncture-needles-may-transmit- disease.html


The risk of transmission of HBV is reduced by immunization against hepatitis B, which is 90% to 95% effective. The risk of transmission of HBV to susceptible HCWs via a needlestick injury varies from 1% to 40%.Needlestick injuries may also transmit hepatitis C. The risk factors for hepatitis C virus transmission in occupational settings is 1.8% (range 0% to 7%). http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html


The rate of occupational transmission from an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.09% for a mucous membrane exposure.The rate of transmission from a hepatitis B-positive source to a nonimmunized host is 6-24% and 1- 10% for exposure to hepatitis C
http://emedicine.medscape.com/article/784812-overview#showall

What Occupations Have Increased Risk of Hepatitis B ?


The risk of acquiring hepatitis B from the workplace depends on the amount of exposure to:
  • Human blood or blood products, or other body fluids and tissues known to
    transmit the hepatitis B virus
  • Needle stick injuries or other puncture injuries from sharp instruments
    contaminated with blood
  • Close contact with people who carry the hepatitis B virus in family or institutional
    residence settings
Blood tests show that certain occupational groups have different risks of getting hepatitis
B.
Table 1
Risks to Occupational Groups
Percentage of people having
evidence of past hepatitis B
infection
Occupational Group
High (over 20%) Pathologists, biochemistry and hematology laboratory
personnel, dialysis staff
Intermediate (7-20%) Hospital nurses, laboratory personnel other than
those in high risk groups, staff of institutions for the
developmentally handicapped, dentists
Low (less than 7%) Administrative hospital staff, medical and dental
students, healthy adults

In general, occupational groups with increased risk include:
  • health-care workers repeatedly exposed to blood or blood products or those who
    are at risk of needlestick injury
  • dentists, dental assistants, and dental hygienists
  • certain staff members of institutions for the developmentally handicapped
  • staff of institutions where workers may be exposed to aggressive, biting residents
  • embalmers
http://www.ccohs.ca/oshanswers/diseases/hepatitis_b.html

HIV Why Mosquitoes Cannot Transmit HIV


viruses. A mosquito's proboscis (mouthparts) are a fraction of a millimetre across whilst a small needle is over ten times wider. This means that the volume of blood that can be carried within a needle, and hence the infectious viral load, will be far greater than a mosquito's proboscis.

The reason that malaria (a protozoal infection) and certain viruses like dengue fever or Chikungunya can be transmitted by mosquitoes is that these infections have evolved to replicate within the body of the mosquito. This boosts the infectious load, compensating for the tiny number of organisms pulled into the mosquito's body when it first bit. This infectious load is transmitted with the next meal.
http://www.thenakedscientists.com/forum/index.php?topic=17809.0

Injection Safety And Preventive Measures


The essential elements of the prevention of HIV transmission in the Health Care Settings including injection safety are complementary and should be integrated in a comprehensive health sector response www.who.int/hiv/pub/toolkits/Injection%20safety.pdf


The purpose of this toolkit is to promote implementation of safe practices associated with the following medical procedures: http://www.who.int/injection_safety/en/


Improving access to safe injection technologies in developing countries ; Sterile, single use injection devices and safety disposal boxes must be available in every health care facility in sufficient quantities for the number of injections administered
http://www.theific.org/sigs2.asp

The International Sharps Injury Prevention Society, ISIPS, was formed to reduce the number of accidental needlestick and other sharps injuries that occur globally by promoting the use of safety-engineered products and services. http://www.isips.org/index.php


In every health facility, trained health care workers administer only necessary injections safely, using appropriate safe injection devices.
http://portalprd1.jsi.com/portal/page/portal/
MMIS_WEBSITE_PGG/MMIS_HOMEPAGE_PG/MMIS_HOME_TAB:MMIS_OVRVW_TAB



The "Safe Injection Global Network" (SIGN) has been established. SIGN is a voluntary coalition of stakeholders aiming to achieve safe and appropriate use of injections throughout the world.
http://www.who.int/injection_safety/sign/en/

CDC is alerting all persons who assist others with blood glucose monitoring and/or insulin administration of the following infection control requirements:
http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html

Injection Safety Protocols


Safe Injection Practices to Prevent Transmission of Infections to Patients http://www.premierinc.com/safety/topics/guidelines/downloads/Safe-Injection- Practices.doc


Injection safety is a set of measures taken to perform injections in an optimally safe manner for patients, health care personnel, and others
http://www.premierinc.com/safety/topics/safe_injection_practices/Downloads/CDC- Recommended-Injection-Practices-Patient-SafetyV2.pdf


In many countries, the problem of unsafe injections is further compounded by patients' and health care providers' perceptions, often culturally based, that injections are more effective than non injection alternatives.
www.aidstar-one.com/printpdf/focus_areas/.../pkb/.../injection_safety?tab...

Unsafe injection practices put patients and healthcare providers at risk of infectious and non-infectious adverse events and have been associated with a wide variety of procedures and settings. http://www.cdc.gov/injectionsafety/ Guidelines for the Management of Occupational Exposures to HIV and recommendations for Postexposure Prophylaxis http://www.premierinc.com/quality-safety/tools-services/safety/topics/guidelines/ downloads/mmwr-v54rr09-09-30-05.pdf


Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV
http://www.premierinc.com/quality-safety/tools-services/safety/topics/guidelines/ downloads/06_exposureHCW-HIVHBVHCV-01.pdf


Post Exposure Prophylaxis Gudelines


H hepatitis B BIG Unvaccinated persons should receive the hepatitis B vaccine series with the first dose administered as soon as possible after exposure, preferably within 24 hours. The vaccine series should be completed in accordance with the age-appropriate dose and schedule x HBIG x 1 and rhtml/
http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5516a3.htm

Vaccines can take weeks to build efficacy, which can protect for years. HyperHEP B S/ D provides immediate protection. This allows the vaccine the time needed to establish active immunity in high-risk situations, such as2,3: http://www.hypermunes.com/html/hcp_hyperhep_index.htm


Guidelines for HIV PEP following occupational exposure have been developed for adults by the New York State Department of Health (NYSDOH), and the United States Public Health Service (USPHS).The NYSDOH has just published new guidelines on PEP following non-occupational exposures, including sexual assault in adults and adolescents. http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv-post- exposure-prophylaxis-for-children-beyond-the-perinatal-period/



These guidelines have been developed to help medical providers identify and treat pediatric patients with potential HIV exposures. http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv-post- exposure-prophylaxis-for-children-beyond-the-perinatal-period/



Occupational exposure refers to exposure to potential blood-borne infections (HIV, HBV and HCV) that may occur in healthcare settings during performance of job duties. Post exposure prophylaxis (PEP) refers to comprehensive medical management to minimise the risk of infection among Health Care Personnel (HCP) following potential exposure to blood-borne pathogens (HIV, HBV, HCV). This includes counselling, risk assessment, relevant laboratory investigations based on informed consent of the source and exposed person, first aid and depending on the risk assessment, the provision of short term (four weeks) of antiretroviral drugs, with follow up and support.
http://www.nacoonline.org/National_AIDS_Control_Program/PEP_full/

Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection http://www.who.int/hiv/pub/guidelines/PEP/en/


Recommendations and guidelines for prescribing PEP following non-occupational exposure to HIV including sexual assault. These guidelines will address PEP for significant risk exposures following sexual and needle-sharing activities, needlesticks outside of occupational settings, and trauma, including human bites.
http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv- prophylaxis-following-non-occupational-exposure-including-sexual-assault/


Non-occupational pep for hepatitis b and c
http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv- prophylaxis-following-non-occupational-exposure-including-sexual-assault/#


VIII. NON- OCCUPATIONAL PEP FOR HEPATITIS B AND C
Rights of Occupationaly Exposed


An employee may be compensated if he or she becomes infected with HIV as a result of an occupational accident, in terms of the Compensation for Occupational Injuries and Diseases Act.
http://www.labourprotect.co.za/hiv_aids.htm

Health care workers who are occupationally infected by HIV are at risk of being left without workers' compensation coverage. In some states, the definition of an occupational disease is so restrictive that infected health care workers are unlikely to qualify for benefits.
http://www.mendeley.com/research/occupationally-acquired-hiv-vulnerability-health- care-workers-under-workers-compensation-laws/

It remains difficult for infected workers to prove that their contraction of the disease resulted from the performance of their jobs. Moreover, even when these employees do successfully prove causation, workers' compensation coverage has generally proved to be inadequate.
https://litigation-essentials.lexisnexis.com/webcd/app? action=DocumentDisplay&crawlid=1&doctype=cite&docid=59+Vand.+L.+Rev.+937&s rctype=smi&srcid=3B15&key=65b168c420e5914ce89a3dde344b174b



Provided further that any person claiming occupational exposure to HIV, in an institution that does not comply with sub-section (4)(a) and (b), shall be presumed to have been occupationally exposed to HIV and shall be entitled to treatment and compensation without any requirement of further proof THE HIV/AIDS BILL 2007 INDIA www.lawyerscollective.org/files/Final%20HIV%20Bill%202007.pdf


Syringe Reuse Rackets


Huge quantities of used medical syringes, hypodermic needles and intravenous drip sets were seized by health authorities of the Kollam city Corporation from a scrap dealer's shop
http://www.hindu.com/2010/11/11/stories/2010111156240300.htm

The problem is not confined to the slums or rural areas. Even government and private hospitals use reused syringes. http://findarticles.com/p/news-articles/times-of-india-the/mi_8012/is_20090428/ unsterilised-reused-syringes-rampant-expert/ai_n39566035/


The World Health Organization estimates that 300 000 people die in India annually as a result of dirty syringes. Across the world, that figure is 1.3 million.
http://www.cmaj.ca/cgi/content/full/181/1-2/26

Evidence suggests that unsafe injections currently transmit hepatitis B virus, HCV, and HIV. Today, this burden of disease can be measured epidemiologically and efficiently prevented.
http://actx.beta.download.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09284- X/fulltext
All over India, children scavenge in the filth for discarded syringes to sell back to hospitals and quacks. The needles, used again and again, kill at least 300,000 people a year
http://www.timesonline.co.uk/tol/life_and_style/health/article5931974.ece

Several bag loads of used syringes, blood bags and drip sets were being loaded into a mini truck near the open playground of medical college
http://hindu.com/2006/04/03/stories/2006040318500300.htm

INJO THE BENEFICIARY ANGEL OF INJECTION SAFETY