An assessment of injection safety in public health facilities in Nairobi
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.