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Immunization

Injection safety

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Annual number global injections: Estimated 16 billion
Injections for curative purposes: 90 to 95 per cent
Injections for vaccination: 5 to 10 per cent
Injections of blood and blood products: 1 per cent

Estimated number of annual infections due to unsafe injections
Hepatitis B: 21 million cases
Hepatitis C: 2 million cases
HIV: 250,000

Estimated annual deaths: 1.3 million

The Problem: First Do No Harm

The top priority in any routine or mass immunization campaign is to ensure that children are not subject to greater risks during these life-saving measures. In short, injections for preventative purposes such as immunization must “first do no harm.” Injections are used in vaccinations as most vaccines cannot be given orally.
Injections for curative purposes are not only unsafe, but are also frequently overused and misused worldwide. Doctors prescribe unnecessary injections when oral alternatives exist. Some believe their patients prefer injections. Others do so because it raises the fee they can charge for their services. 

Unsafe injections and disposal of waste occur in both preventative and curative scenarios and put children, health staff and communities at risk for infection with blood-borne diseases. The result: millions of children are needlessly exposed to infectious diseases, most notably hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV.) Diseases such as hepatitis B and hepatitis C may cause jaundice (yellowing of the skin and eyes) and then not present symptoms for decades, but after 40 years chronic liver disease and cancer may develop. The only way to guarantee the safety of an injection is to use one needle, one syringe for each child.

Auto-disable syringes (AD syringes) that block the plunger after a single use are the safest devices for injections because they can only be used once. However, many countries can’t afford these new devices and continue to use glass or standard disposable syringes. Often this equipment is reused, recycled or resold. A common reason is lack of needles and syringes combined with ignorance of the risks. Some may reuse needles or syringes simply to save money, not realizing the potential consequences. For example, health care staff may believe they can use the same syringe for family members or they may believe warm water and soap will sterilize the equipment.

A second risk is to the health workers administering the vaccine. In the past, health workers would recap a needle after injection to protect anyone who might handle or come in contact with this medical waste. However, research has shown that more than 80 per cent of health workers have had at least one needle-stick accident during the recapping, putting them at risk of infection. Lastly, if the syringes are not collected and disposed of properly, any member of the community can be at risk. Children may play with, or step on, infected devices and be exposed to diseases.

The solution: AD syringes, proper disposal and education

In 1999, the World Health Organization (WHO), UNICEF and the United Nations Population Fund (UNFPA) issued a joint statement outlining a strategy for encouraging safe injection and disposal practices. The organizations urged all countries to begin using auto-disable syringes to administer vaccines and puncture-proof containers to collect and dispose of used devices. Auto-disable syringes can only be used once and therefore present a very low risk of transmission of blood-borne diseases. Safety boxes decrease the likelihood of needle-stick accidents by health workers or the general public and prevent environmental contamination. The policy of UNICEF and its partners is to “bundle” these supplies in routine and mass campaigns, to provide both components along with good quality vaccines.

Mass vaccination campaigns, such as National Immunization Days, pose unique injection safety challenges. At times, the disposal system in place is not sufficient to handle the massive volume of waste generated during these campaigns where millions may be vaccinated in a short period. In such instances, UNICEF works with partners, governments and local communities to create additional capacity, by digging new pits for waste burial or building incinerators for burning safety boxes. These facilities can then be used by the local health systems for waste management.

Another critical component of this strategy is advocacy. UNICEF works with partners to educate governments, health workers and the general public about the risks of unsafe injection and the benefits of using safe equipment. The short-term goal is that all immunization should be done using auto-disable syringes by 2003. Two developments make this a more attainable goal for poor nations. The price of auto-disable syringes has decreased considerably and the Global Alliance for Vaccines and Immunization (GAVI) has dedicated funds for all 74 GAVI-eligible developing countries that wish to buy AD syringes for the next three years.

Goal:

By 2003 WHO, UNICEF and UNFPA recommend that all immunization be provided in all countries using only auto-disable syringes.

Partnerships:

The Safe Injection Global Network (SIGN) is a coalition of United Nations organizations, non-governmental organizations, governments, donors and universities who work together to reduce the overuse of injections and prevent the adverse effects of unsafe injection practices:  www.injectionsafety.org

[Sources: SIGN, WHO revised Fact Sheet, WHO-UNICEF-UNFPA joint statement on use of AD syringes in immunization services]