Recycling of Injection Equipment in Pakistan

The prevalence of hepatitis C virus (HCV) infection is high in the general population in Pakistan, ranging from 2% to 6%. Reuse of injection equipment in the absence of sterilization is common, particularly in healthcare facilities that serve low-income populations. Studies have identified unsafe injection practices as a major route of transmission of HCV in Pakistan. Changing the behavior of injection providers so that they would use new freshly opened disposable syringes would improve injection safety in Pakistan. However, frequent reports of recycling of injection equipment in the local media question the safety of apparently new syringes. Clinical laboratories are one of the major sources of production of used syringes. To evaluate the resale of used syringes, we followed the course of used syringes from their initial use to their final destination.

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Baseline assessment of therapeutic injection practices in Pakistan in 2020: a cross-sectional study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.0003 ◽

2021 ◽

pp. 16-21

Author(s):

Syed Sharaf Ali Shah ◽

Safdar Pasha ◽

Nikhat Iftikar ◽

Altaf Ahmed Soomro ◽

Nazia Farrukh ◽

...

Keyword(s):

Public Sector ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Injection Equipment ◽

Public And Private ◽

Healthcare Facilities ◽

The Public ◽

Injection Safety

Objective: To assess the magnitude of the problem of injection safety in public and private health facilities in two districts of Sindh and Punjab provinces of Pakistan. Methods: A cross-sectional observational study was conducted between October and December 2020 among public and private health facilities of two districts of Pakistan: Gujarat in Punjab and Larkana in Sindh provinces. A convenient sample size of 60 healthcare facilities (30 from each district) was taken due to time and resource constraint. Six data collection tools were used which included structured observations and interviews with injection prescribers and providers based on WHO Revised Tool C, which were finalised after piloting. Results: Reuse of injection equipment was not observed in any of the 60 health facilities. In exit interviews of 120 patients, it was found that 27 (22.5%) patients reported receiving an injection, while 11 (9.2%) were prescribed intravenous (IV) drips. More injections and drips were prescribed in the private sector (n=15; 25.0%) in comparison with the public sector (n=12; 20.0%). Slightly higher proportion of IV drips were prescribed by the private providers when compared to public sector healthcare providers: 6 (10.0%) vs 5 (8.3%) respectively. Most of the prescribers (n=58; 96.7%) reported that patients who attended public and private health facilities demanded injectable medicines. Used syringes and drips were noted to be visible in open containers and buckets for final disposal in 20 (33.3%) assessed health facilities. Continuou...

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An epidemiological study on knowledge, attitude and practice of injection safety among health care personnel in a tertiary care hospital of Tripura

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183607 ◽

2018 ◽

Vol 5 (9) ◽

pp. 4128

Author(s):

Anjan Datta ◽

Kaushik Nag ◽

Nabarun Karmakar ◽

Tamal Chakraborty

Keyword(s):

Health Care ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Health Care Personnel ◽

Care Hospital ◽

Attitude And Practice ◽

Unsafe Injection ◽

Knowledge Attitude And Practice ◽

Injection Safety ◽

Injection Practices

Background: Injection is considered as one of the key procedures of drug delivery all over the world. Unsafe injection practices are very common in countries like India. This study was aimed to assess knowledge, attitude and practice of injection safety in a tertiary care hospital of Tripura.Methods: A cross-sectional study was conducted among 300 participants including staff nurses, operation theater (OT) assistants and laboratory technicians of Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania; who were primarily involved in routine injection practices related to patient care from January 15th to February 14th 2018. Data was collected using a self-administered questionnaire and analyzed using SPSS version 16.0.Results: Majority (77%) of the participants in this study belonged to 18 to 25 years age group and were females (71.3%); mostly were nurses (88%), followed by OT assistants (6.3%) and laboratory technicians (5.7%) respectively. Good injection safety practices were reported by majority of the participants (67.3%). Higher mean age with knowledge of injection safety, nurses as compared to others and probational work experience than permanent were found to have significant association with safe injection practices of the participants.Conclusions: Even though study findings showed good practice related to injection safety among the health care personnel like similar other studies in this country, still improvement is required to fulfil the gap in knowledge and attitude of the health care providers to keep unsafe injection to the minimum level.

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A study on assessment of safe injection practices among internees in government general hospital, Kakinada, Andhra Pradesh, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20174852 ◽

2017 ◽

Vol 4 (11) ◽

pp. 4321

Author(s):

Sujatha Peethala ◽

Sridevi Garapati

Keyword(s):

General Hospital ◽

Andhra Pradesh ◽

Healthcare Providers ◽

Cross Sectional Study ◽

Cross Sectional ◽

Safe Disposal ◽

Safe Injection ◽

Unsafe Injection ◽

Injection Safety ◽

Injection Practices

Background: Injections are commonly used in healthcare settings for the prevention, diagnosis, and treatment of various illnesses. Unsafe injection practices put patients and healthcare providers at risk of infectious and non-infectious adverse events. Safe injection practices are part of standard precautions and are aimed at maintaining basic levels of patient safety and provider protections. Objectives of this study were to assess the knowledge and observe safety practices while giving the injections.Methods: A cross-sectional study conducted among 200 internees in Government General Hospital, Kakinada, Andhra Pradesh in the months of January and February 2010. Data was obtained by semi- structured questionnaire; analyzed by using SPSS software version16.0 at p<0.05 significance level.Results: In the present study, knowledge of internees was enquired into and practices were also observed in various aspects of injection safety. Knowledge on washing hands before giving injection was 64% but when it comes to practice, it was only 29%; knowledge on use of hub-cutter after giving injection was found to be 48% but in practice hub-cutter use was observed to be very less (5.5%); knowledge on safe disposal of used syringes was 42% but only 9.0% were practicing safe disposal. Similarly knowledge on use of color coded bags according to guidelines was 40.5% and in practice it was observed to be 14%.Conclusions: In the present study knowledge and practices on injection safety was found to be poor; dissemination of IEC, behavior change campaigns and continuing education on universal precautions and proper disposal of injection related waste was recommended.

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Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010–2017)

International Health ◽

10.1093/inthealth/ihz113 ◽

2019 ◽

Vol 12 (5) ◽

pp. 388-394

Author(s):

Emmanuel O Adewuyi ◽

Asa Auta

Keyword(s):

Health Surveys ◽

Meta Analysis ◽

Healthcare Services ◽

Demographic And Health Surveys ◽

Injection Equipment ◽

Middle Income ◽

Middle Income Countries ◽

Unsafe Injection ◽

Injection Practices ◽

Low And Middle Income

Abstract Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. Results The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3–35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. Conclusions Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.

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A study on knowledge regarding different aspects of injection safety among injection providers at different levels of health care

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20171794 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1737

Author(s):

Uroosa Farooq Allaqband ◽

Anjum B. Fazili ◽

Rohul Jabeen Shah ◽

Ab. Majid Ganai ◽

Walied K. Balwan ◽

...

Keyword(s):

Statistical Significance ◽

Healthcare Providers ◽

P Value ◽

Cross Sectional ◽

Healthcare Facilities ◽

Definition Of ◽

Unsafe Injection ◽

Exposure Prophylaxis ◽

Age Range ◽

Injection Safety

Background: Estimates suggest that at least 50% of the world’s injections administered each year are unsafe, particularly in developing countries. Unsafe injection practices put patients and healthcare providers at risk of infectious and non-infectious adverse events, sound knowledge of healthcare providers is vital to break the chain of blood borne diseases transmission caused by unsafe injection practices.Methods: Cross sectional observational questionnaire based study was carried out amongst 152 injection providers of 40 healthcare facilities of two districts of Kashmir valley (one rural and one urban) selected purposively. Results are summarised and presented in the form of tables and chi (x2) test was used for test of association with statistical significance set at p-value of less than 0.05.Results: In this study out of 152 injection providers, majority (81.57%) were in the age range of 21-40 years and 74.3% were females. 43.4% of the participants were FMPHWs, 30.9% were nurses and 13.8% pharmacists. Overall 65.8% and 67.1% of injection providers had correct knowledge regarding WHO definition of safe injection and infections transmitted by unsafe injections respectively. Majority (90.8%) were aware about the biomedical waste management rules.Conclusions: We conclude that over all the knowledge of different aspects of injection safety was good among the participants except the poor knowledge ofpost exposure prophylaxis and disposal of injection related waste despite the use of color coded bags at the sites of waste generation.

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Faculty Opinions recommendation of Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007-2008.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4943956.4876055 ◽

2010 ◽

Author(s):

Nicolas Bruder

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Las Vegas ◽

Virus Infections ◽

Unsafe Injection ◽

Injection Practices

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Examining unsafe injection practices associated with auto-disable (AD) syringes: a systematic review

Human Vaccines & Immunotherapeutics ◽

10.1080/21645515.2021.1911514 ◽

2021 ◽

pp. 1-12

Author(s):

Anokhi Ali Khan ◽

Mehr Munir ◽

Fatima Miraj ◽

Shayan Imran ◽

Danya Arif Siddiqi ◽

...

Keyword(s):

Systematic Review ◽

Unsafe Injection ◽

Injection Practices

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Inactivation of Candida auris and Candida albicans by Ultraviolet-C

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.868 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s292-s292

Author(s):

William Rutala ◽

Hajime Kanamori ◽

Maria Gergen ◽

Emily Sickbert-Bennett ◽

David Jay Weber

Keyword(s):

Infection Prevention ◽

Antifungal Drugs ◽

Candida Auris ◽

Healthcare Facilities ◽

Environmental Surfaces ◽

Route Of Transmission ◽

Indirect Exposure ◽

Ultraviolet C ◽

Severe Infections ◽

Uv C

Background:Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it has caused severe infections with frequent mortality in over a dozen countries. C. auris can survive on healthcare environmental surfaces for at least 7 days, and it causes outbreaks in healthcare facilities. C. auris has an environmental route of transmission. Thus, infection prevention strategies, such as surface disinfection and room decontamination technologies (eg, ultraviolet [UV-C] light), will be essential to controlling transmission. Unfortunately, data are limited regarding the activity of UV-C to inactivate this pathogen. In this study, a UV-C device was evaluated for its antimicrobial activity against C. auris and C. albicans. Methods: We tested the antifungal activity of a single UV-C device using the vegetative bacteria cycle, which delivers a reflected dose of 12,000 µW/cm2. This testing was performed using Formica sheets (7.6 × 7.6 cm; 3 × 3 inches). The carriers were inoculated with C. auris or C. albicans and placed horizontal on the surface or vertical (ie, perpendicular) to the vertical UV-C lamp and at a distance from 1. 2 m (~4 ft) to 2.4 m (~8 ft). Results: Direct UV-C, with or without FCS (log10 reduction 4.57 and 4.45, respectively), exhibited a higher log10 reduction than indirect UV-C for C. auris (log10 reduction 2.41 and 1.96, respectively), which was statistically significant (Fig. 1 and Table 1). For C. albicans, although direct UV-C had a higher log10 reduction (log10 reduction with and without FCS, 5.26 and 5.07, respectively) compared to indirect exposure (log10 reduction with and without FCS, 3.96 and 3.56, respectively), this difference was not statistically significant. The vertical UV had statistically higher log10 reductions than horizontal UV against C. auris and C. albicans with FCS and without FCS. For example, for C. auris with FCS the log10 reduction for vertical surfaces was 4.92 (95% CI 3.79, 6.04) and for horizontal surfaces the log10 reduction was 2.87 (95% CI, 2.36–3.38). Conclusions:C. auris can be inactivated on environmental surfaces by UV-C as long as factors that affect inactivation are optimized (eg, exposure time). These data and other published UV-C data should be used in developing cycle parameters that prevent contaminated surfaces from being a source of acquisition by staff or patients of this globally emerging pathogen.Funding: NoneDisclosures: None

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Effects of health decentralization, financing and governance in Mexico

Revista de Saúde Pública ◽

10.1590/s0034-89102006000100023 ◽

2006 ◽

Vol 40 (1) ◽

pp. 152-160 ◽

Cited By ~ 9

Author(s):

Armando Arredondo ◽

Emanuel Orozco

Keyword(s):

Community Participation ◽

Low Income ◽

Service Providers ◽

Health Financing ◽

Cross Sectional Study ◽

Negative Effects ◽

Cross Sectional ◽

Final Destination ◽

Use Of Resources ◽

Health Service Providers

OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

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