Injections are the most common health care procedure worldwide. In developing and transitional countries alone, some 16 thousand million injections are administered each year.1 Most injections, more than 90%, are given for therapeutic purposes while 5 to 10% are given for preventive services, including immunization and family planning. The majority of therapeutic injections in developing and transitional countries are unnecessary.
A safe injection does not harm the recipient, does not expose the health care worker to any avoidable risk and does not result in waste that is dangerous for the community.2 When injections are medically indicated they should be administered safely. Unsafe injections place patients at risk of disability and death. 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 in 2000, respectively.3 In addition, inappropriate and unhygienic use of multi-dose vials may transmit bloodborne pathogens.2
Best infection control practices for intradermal, subcutaneous and intramuscular injections recommend the use of a new, single use injection device for each injection and for the reconstitution of each unit of medication.4 Sterile single use injection devices are widely available at low cost. The international retail price for a single use syringe and needle set ranges from 3 US cents (sterile hypodermic syringe 2 ml) to 6 US cents (auto-disable syringe 0.5 ml). Failure to systematically fund sufficient supplies of injection devices was identified as a key determinant of widespread reuse of syringes and needles in the absence of sterilization in immunization services.5 Interventions to increase the availability of injection devices in curative services have improved injection safety.6 Interventions to prevent infections with bloodborne pathogens through provision of single use devices are a very cost-effective investment in health.7
Sterile, single use injection devices include sterile hypodermic syringes, sterile hypodermic needles, auto-disable syringes for immunization purposes, syringes with a reuse-prevention feature for general purposes and syringes with needle-stick preventionfeatures (e.g., safety syringes) for general purposes. WHO is strengthening its collaboration with national regulatory authorities to ensure the quality and safety of injection devices through: (1) the enforcement of national regulations based upon international standards for injection devices3 and (2) reliance on internationally accepted certifying bodies that provide the ISO certification and carry out the auditing function.8
The safe collection and disposal of used sharps (e.g., needles, syringes with fixed needles) is an integral part of the life cycle of injection devices. The collection of sharps waste in safety containers (e.g., safety boxes) at the point of use and their safe and environmentally-responsible disposal protect health care workers and the general public from needle-stick injuries. Interventions to reduce injection overuse reduce waste thereby facilitating its management. Management choices and technology options will depend on many considerations, including workers’ safety, sustainability and acceptability. Low-cost, effective waste treatment options are available.
UNFPA, UNICEF and WHO have reaffirmed the current policy stating that by the end of the year 2003, all countries should be using only auto-disable syringes in immunization services. Auto-disable syringes and safety boxes should be supplied in adequate quantities with all consignments of vaccines.9