RefManual Intro.doc - Reference manual for health workers

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					     Ministry of Health

Reference manual for health

 Injection safety saves lives


The Ministry of Health and J.S.I wishes to acknowledge the

significant support received from individuals whose

contribution made the writing of this manual possible.

Specifically we wish to thank all the training facilitators

from both the Ministry of Health and JSI whose teaching

materials and references provided the necessary resource

materials from which much of this manual was adopted.

This manual has also been adapted from existing materials

previously produced by World Health Organization (WHO) to

support Injection Safety project, John Hopkins University,

and the Program for Appropriate Technology in Health


                Injection safety saves lives
This reference manual for Health workers on Injection Safety

was produced by the Ministry of Health to provide a quick

reference on key issues relevant to health workers. It provides

easy to read information important to enhance health workers’

competence to ensure Injection safety practices. It is envisaged

that this manual will be used by all health workers to

supplement other materials that have been provided during the

training sessions on Injection Safety.

Lastly, I wish to thank all those who participated and

contributed in the development of this manual. The technical

support and financial support from J.S.I Injection Safety Project

is highly appreciated.

DR James Nyikal

Director of Medical Services

                Injection safety saves lives

Introduction                                     I

Foreword                                         III

Acknowledgement                                  IV

Background                                       VI

Injection safety practices                       1

Injection waste management                       24

Logistics management                             35

Behavior change communication                    55

Glossary                                         71

             Injection safety saves lives
  This manual is intended for use by
  health workers for the purpose of
  reducing risks due to unsafe injections

What is a reference manual for health

  • This is a collection of materials and activities that aims to
    highlight key useful practical points for health workers to
    enhance injection safety.
  • It is a set of critical information that providers need to
    remember in day-to-day practice compiled into a job aid
  • It includes exercises that help the health workers gain the
    skills needed in logistic management.
  • This manual supplements the lecture notes provided during
    the training session.

                Injection safety saves lives
What does this manual
This manual has notes on:
  1. Injection Safety Practices and clinical
  2. Universal precautions for infection
  3. Injection waste management
  4. Logistics management
  5. Behavioral change communication strategy
     to enhance injection safety.

Who should use this manual?
  • This manual is intended for use by any health
    worker working in public or private health

How to use this manual?
This manual can be presented by a trainer and /or
reviewed by health workers alone or in groups. To
gain the maximum benefit from the manual, it is
important to thoroughly read the materials and
complete the exercises where provided. Answers
to the exercises are provided in the same text

               Injection safety saves lives
1. What is a safe injection?

     A safe injection is defined as one that
     doesn’t harm the recipient, doesn’t expose
     the health worker to any avoidable risk, and
     doesn’t result in any waste that is
     dangerous to the community. (WHO)

2. Why the emphasis on injection safety now?

    • Unsafe practices are increasingly
      recognized as a major source of infection
      with blood pathogens such as:
       • HIV
       • Hepatitis B
       • Hepatitis C

    • Unsafe injection can also transmit
      parasites (malaria), bacterial and other
      types of infections. WHO estimates that, at
      least 50% of the developing world’s 12
      billion injections administered each year
      are unsafe and pose serious health risks to
      recipients, health workers and the public.

               Injection safety saves lives
  3. What factors are associated with unsafe

         Therapeutic overuse (i.e over prescription
         of injection for therapy even when not
         Reuse of injection equipment without
         proper sterilization.
         Unsafe sharp collection
         Unsafe management of injection waste

What is the current situation?
Global burden in 2000 due to past unsafe injection practices
  • 501,000 deaths
  • More than 75% of the burden among adults
  • 12 billion injections are given each year in developing
    countries. This poses a risk to many people.
  • 70% of these injections are unnecessary or could be prescribed
  • Kenya has an average of 2-3 injections per person per year
    (62-93 million injections)

  4. Who is at risk of needle stick injury?

  Any worker who may come in contact with
  needles is at risk including Nursing staff,
  Laboratory workers, Doctors, Sanitation workers,
  Supportive staff. The community is also at risk
  due to poor injection waste disposal practices.

                 Injection safety saves lives
5. How common are needle stick injuries?

In a recent study in Kenya, nearly 70% of health
care providers reported that they had suffered a
needle stick injury in the past 12 months. The
annual rate of needle stick injuries per provider
was 2.5

6. What kinds of needles usually cause needle
stick injuries?

        •   Hypodermic needles
        •   Blood collection needles
        •   Suture needles
        •   Needles used in IV delivery systems

  7. What strategy exists to achieve injection

  The triple approach is proposed:

       i. Change behavior of patients and health
          workers to reduce injection over-use
          and increase safety
      ii. Avail adequate injection equipment and
     iii. Manage sharp wastes safely

               Injection safety saves lives

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