The Role Of Community Health Practitioners On Injection Safety

Project and Seminar Material for Public Health

The Role Of Community Health Practitioners On Injection Safety


Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of “Safe Injection Global Network (SIGN)” was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.


The WHO(2004) research shows that over 12 billion of injections administered are unsafe injection. Health care workers are exposed to the risk of blood-borne diseases such as HIV, Hepatitis B and C in their daily encounter with infected patients and materials through unsafe injections. Injection is an important health care procedure used worldwide for administration of drugs. Billions of injections are used worldwide for curative care and for immunization. In developing countries, approximately 16 thousand million injections are administered – a rate of 3.4 (range 1.7-11.3) injections per person per year. Majority of the injections are unnecessary and are not used safely. Reuse of injection equipment in the absence of sterilization is common.

Table of Contents

  • Title Page
  • Attestation
  • Certification
  • Dedication
  • Acknowledgement
  • Abstract
  • Introduction
  • Table Of Contents

Chapter One:


  • 1.1 Background Information
  • 1.2 Statement of the Problem
  • 1.3 Justification of the study
  • 1.4 Objectives of the Study

Chapter Two:

Literature Review

  • 2.1 Definition of injection, safe injection, unsafe injection
  • 2.2 Steps of giving safe injection
  • 2.3 Safe Choices matter
  • 2.4 Interventions and challenges for save injection practice
  • 2.5 Safe disposal of used injections equipments
  • 2.6 Training community health practitioners on injection safety
  • 2.7 Advocacy for injection safety
  • 2.8 Roles of other health progammes in promoting injection safety

Chapter Three:


  • 3.0 Methodology

Chapter Four:


  • 4.0 Discussion

Chapter Five:

Conclusions and Recommendation

  • 5.1 Conclusions
  • 5.2 Recommendation
  • References

Chapter One


1.1 Background Information

Injection safety, or safe injection practices, is a set of measures taken to perform injections in an optimally safe manner for patients, healthcare personnel, and others. The Standard Precautions section of the 2007 Guideline for Isolation Precautions provides evidence- based recommendations for safe injection practices and reflects the minimum standards that healthcare personnel should follow to prevent transmission of infections in healthcare settings.(Brokensha,1999). Despite these recommendations, outbreaks and patient notifications resulting from healthcare personnel failing to adhere to Standard Precautions and basic infection control practices continue to be reported.(Bhattarai,2000). Unsafe injection practices that have resulted in disease transmission have most commonly included:(Brokensha,1999; Bhattarai,2000).

Using the same syringe to administer medication to more than one patient, even if the needle was changed or the injection was administered through an intervening length of intravenous (IV) tubing(Drucker,2001).

Accessing a medication vial or bag with a syringe that has already been used to administer medication to a patient, then reusing contents from that vial or bag for another patient Using medications packaged as single-dose or single-use for more than one patient Failing to use aseptic technique when preparing and administering injections For these reasons, CDC reminds healthcare personnel of thefollowing practices that are critical for patient safety(Reeler,1990):

Never administer medications from the same syringe to more than one patient, even if the needle is

  1. Changed or you are injecting through an intervening length of IV tubing.
  2. Do not enter a medication vial, bag, or bottle with a used syringe or needle.
  3. Never use medications packaged as single-dose or single-use for more than one patient. This includes ampoules, bags, and bottles of intravenous solutions.
  4. Always use aseptic technique when preparing and administering injections.

1.2 Statement of the Problem

According to the WHO(2004), the most recent study indicates that each year, unsafe injections cause an estimated 1.3 million early deaths, a loss of 26 million years of life, and an annual burden of USD 535 million in direct medical costs. Unsafe injection practices are a powerful engine to transmit blood-borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Because infection with these viruses initially presents no symptoms, it is a silent epidemic. However, the consequences of this are increasingly recognized.

Hepatitis B virus: HBV is highly infectious and causes the highest number of infections: in developing and transitional countries 21.7 million people become infected each year, representing 33% of new HBV infections worldwide WHO(2004).

Hepatitis C virus: Unsafe injections are the most common cause of HCV infection in developing and transitional countries, causing two million new infections each year and accounting for 42% of cases. WHO(2004).

Reuse of syringes and needles in the absence of sterilization exposes millions of people to infections. Assessments carried out in numerous countries have revealed that syringes and needles are often just rinsed in a pot of tepid water between injections. WHO(2004).

Many injections around the world are unnecessary and often unsafe. Unsafe injections put lives at risk and every year cause 1.67 million hepatitis B infections, up to 315 120 hepatitis C infections and up to
33 877 human immunodeficiency virus (HIV) infections.(WHO,2015)1,2 The World Health Organization (WHO,2015) Guidelines recommend rational use of injections, safe injection practices and the exclusive use of safety-engineered syringes for all types of injections by 2020. Safety- engineered syringes exist for both immunization and therapeutic use and have mechanisms preventing re-use of the device [re-use prevention(RUP) syringe] and/or protecting health care providers from needle-stick injuries [sharp injury protection (SIP) feature]. Prescribers and health care providers have a key role to play in making the right choices that support safe injections and reduce unnecessary injections.

1.3 Justification of the Study

The study was conducted to highlight and show the clearly the important of safe injection practice and also show the implications and risks of practicing unsafe injection procedures to other community health practitioners that did not adhere safe injection practice.

1.4 Objectives of the Study

The objectives of this study are to:

  1. Review the status of safe injection practice
  2. Highlight importance of safe injection practice and
  3. Mention interventions and highlight the challenges towards safe injection practice in Nigeria.
  4. To examine the injection safety measures put in place by the community health practitioners.

Chapter Five

5.0 Conclusion and Recommendation

5.1 Conclusion

Injection safety concerns all health workers, supervisors, managers and the general public. While the use of Auto- disable syringes and safety boxes by immunization programmes will greatly reduce the risk of transmitting bloodborne infections, their introduction alone will not ensure immunization safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of Auto – disable syringes. Finally, the experience gained in ensuring injection safety in immunization services should be used as a model to ensure that allmedical injections, including those for preventive and therapeutic services, are safely administered and that the used injection equipment is safely disposed of after use(WHO2004).

Injections have saved many lives but at the same time carry the risk of infections. So the current concern is how to make this practice more safe and beneficial. Various strategies such as educational, managerial and regulatory have been discussed but challenges have to be overcome for their successful implementation. Rational use of injections, proper management and disposal of injectable products can lead to safe injection practice and for this commitment and participation is required from service provider, recipient and community with support from policy makers(WHO,2004).

5.2 Recommendation

Based on the findings of this study, following recommendations were made

To the Government
  1. The government at all levels should ensure sustainance and judicious supplies of injections commodities and logistics example Auto – disable syringe, safety box, cotton wool swabs, hand sanitizerse.t.c.
  2. Also Government should ensure that only trained community health practitioners will be administering injections in the community.
  3. Provide periodic training to the community health practitioners concerning injection safety and waste management.
To community health practitioners
  1. Community health practitioners should ensure total avoidance of re – use of syringe.
  2. They should always explain the purpose and procedures before giving any injection
  3. They should also create awareness to the community about the implications of unsafe injections/ unnecessary injections.
  4. Different recommendations, including those for skin preparation and the use of gloves, exist for:
    1. Intravenous administration of medication and fluids
    2. Blood cultures
    3. Needle- free injections
To the community

Community moblizations should be carried out in order to make individual and entire members of the community be aware on the dangers associated with unsafe injections, all sharps waste generated from the health facilities, re – use of syringe and unnecessary injections.

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