| dc.description.abstract | Introduction and Background: Injections given In formal and informal health care
settings are probably the most common percutaneous procedures worldwide. Unsafe
injections are suspected to occur routinely in developing countries. World Health
Organization estimates that at least 30% of the 12 billion injections administered each year
are unsafe hence posing serious health risks to recipients, health workers and the public.
These unsafe practices are associated with substantial morbidity and mortality, particularly
hepatitis Band C and Human Immunodeficiency Virus (HIV). With the global increase in
health use of injections for vaccination and therapeutic services, measures to reduce risks
need to be put in place.
Objective: To determine injection safety practices in public health facilities in Nairobi.
Study design: This was a descriptive cross-sectional study conducted between November
2005 and February 2006 using a combination of quantitative and qualitative
methodologies. Public health facilities within Ministry of Health or Nairobi City Council
were randomly selected for the study.
Methodology: A total of 68 health facilities belonging to Nairobi City Council and
Ministry of Health were randomly selected for the study. Data collection procedures
included observation of available injection equipment and observation of injection
administration practices. Injection providers and health cleaners who were randomly
selected for the study were also interviewed for history of exposure to accidental prick
injuries, vaccination status, knowledge and the kind of protective gear they were provided
with. Through focus group discussions with scavenging boys and private garbage
collectors and observations of selected dumping sites, information regarding presence of
inappropriately disposed injection related waste in the common dump sites was collected.
This was augmented by a visit to the dumpsites.
Findings: All the facilities included in the study were using disposable syringes and auto
disable syringes for therapeutic injections and immunization injections respectively. About 17.6 percent of the facilities lacked safety boxes in stock, 12.3 percent lacked safety boxes
in the injection rooms, and 8.8 percent had expired syringes. Only one facility lacked
syringes and needles. The most common method of sharp disposal was burning in a pit or in an enclosure which was being used by 38 percent of the facilities. Of all the facilities
included in the study, 32 percent of the facilities were transporting the sharps for offsite
treatment, 16.2 percent were burning sharps on an open ground while 1.5 percent reported
throwing the sharps in a pit latrine. Only 11.8 percent of the facilities had an incinerator.
Inappropriate disposal of sharps was evident in 58 percent of the health facilities. About
16 percent of the injection providers and 15.2 percent of health cleaners reported
accidental prick injury in the year preceding the study. Of those who had needle stick
injuries, only 2 out of 11 health workers and 2 out of 9 health facility cleaners went for
HIV prophylaxis. Most of the scavenging boys and private garbage collectors recounted
being pricked several times by used needles that were found disposed in common dumping sites.
Conclusion:
The study found that most of the health facilities were adequately supplied with necessary
injection equipment; all the health facilities were using sterile equipment for injections. It
was also found that facilities offering therapeutic injections were more likely to lack safety
boxes compared to facilities offering immunization injections. Health care workers were
found to be at risk of blood borne infections resulting from unsafe injections.
Inappropriate disposal of injection related waste from health facilities and consequently
putting the community at risk of contracting blood borne infections was also noted to be
widespread. These findings are an awakening call to the health authorities of the dire need
of integrating modern intervention that have been proven to be effective across programs
rather than implementing vertical programs such as immunization programmes
Recommendation:
Ministry of Health and NCC should put measures in place to ensure that there is
continuous availability of sterile injection equipment including safety boxes in each health
care facility including those not offering immunization. The occupational safety of health
care workers should be adequately addressed to minimize the risk of blood borne
infection. This is through appropriate training to increase the knowledge and practice of
safe disposal; provision of post-exposure prophylaxis against HIV/AIDS, and vaccination
against hepatitis B. Mechanisms to appropriately dispose off 'sharps' (i.e. needles and
syringes) should be put in place so as to minimize the risk of accidental needle-stick
injuries. This should include setting up a waste management system for the safe disposal
of sharps and especially promoting strict compliance with waste segregation at the source.
Facilities for safe handling and disposal of injection related waste should therefore be
improved or created where they do not exist. | en |
