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Ali Khan A, Munir M, Miraj F, Imran S, Arif Siddiqi D, Altaf A, Khan AJ, Chandir S. Examining unsafe injection practices associated with auto-disable (AD) syringes: a systematic review. Hum Vaccin Immunother 2021; 17:3247-3258. [PMID: 33989509 PMCID: PMC8381785 DOI: 10.1080/21645515.2021.1911514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Auto-disable (AD) syringes are specifically designed to prevent syringe reuse. However, the notion that specific AD syringe designs may be unsafe due to reuse concerns related to the syringe's activation point has surfaced. We conducted a systematic review for evidence on the association between AD syringe design and syringe reuse, adverse events following immunization (AEFI), or blood borne virus (BBV) transmission. We found no evidence of an association between AD syringe design and unsafe injection practices including syringe reuse, AEFIs, or BBVs. Authors of three records speculated about the possibility of AD syringe reuse through intentionally defeating the disabling mechanism, and one hinted at the possibility of reuse of larger-than-required syringes, but none reported any actual reuse instance. In contrast to AD syringes, standard disposable syringes continue to be reused; therefore, the global health community should expand the use of AD syringes in both immunization and therapeutic context as an essential strategy for curbing BBV transmission.
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Affiliation(s)
| | | | | | | | | | | | | | - Subhash Chandir
- IRD Global, Singapore, Singapore
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Hassan NM, Shalaby SES, Atalla AO, Younis EA. Toward safe environment: injection device disposal among diabetic patients attending tertiary care academic clinic in Middle Delta, Egypt. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:23193-23203. [PMID: 33442798 DOI: 10.1007/s11356-021-12393-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
In Egypt, there are 8.9 million adult diabetics using almost 16 million insulin injection devices daily. Unsafe disposal of these sharps will result in many environmental and public health hazards. This study aimed at evaluating knowledge and practice of diabetic patients toward safe disposal of insulin injection devices. Cross-sectional study and health education sessions were carried out at diabetic outpatient clinic of the Internal Medicine Department, Tanta University Hospitals in Middle Delta, Egypt, during a period of 2 months (November through December 2019). The study enrolled diabetics who were > 12 years age, using insulin therapy for > 1 year, and females that do not have gestational diabetes. By using systematic random sampling, 450 patients were selected from diabetic patients attending the clinic during the period of the study. Patients' knowledge and practice of insulin injection device disposal were assessed and evaluated using predesigned questionnaire. Verbal health education message and printed pamphlet were given to illustrate safe disposal. Out of the selected samples, 429 completed the questionnaires. Out of those participants, 85.5% had poor knowledge and only 13.5% had good practice. A total of 86.5% dispose at household collection bin, 65.3% reuse syringe, and 63.21% throw it at the nearest garbage bin when takes the injection outside home. Binary logistic regression revealed that female sex (adjusted odds ratio [AOR], 2.37; 95% confidence (CI), 1.13-4.94; p = 0.022), rural residence (AOR, 3.05; 95% CI, 1.62-5.72; p = 0.001) and low income (AOR = 2.11; 95% CI, 1.06-4.18; p = 0.033) were the main predicting sociodemographic factors for poor practice. Meanwhile, syringe usage (AOR = 2.81; 95% CI, 1.31-6.03; p = 0.008), twice daily schedule (AOR = 2.82; 95% CI, 1.51-5.26; p = 0.001), patient himself as injection provider (AOR = 2.268; 95% CI, 1.18-4.36; p = 0.014), and unawareness of how to dispose sharps safely (AOR = 7.33; 95% CI, 3.58-14.99; p < 0.001) were the predicting factors of bad practice related to patient and treatment characteristic. Vast majority of studied diabetic patients do not use or dispose insulin injection devices safely. As the problem is nationwide, an integrated nationwide program is needed including a structured health education module for diabetic patients and a system for collection of home insulin sharps from those patients and disposing them safely.
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Affiliation(s)
- Nadira Mansour Hassan
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Safynaz El Saied Shalaby
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa Omar Atalla
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eman Ali Younis
- Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Gaitan Gomez OL, Aristizabal P, Bueno Robles LS. Práctica de inyecciones seguras por parte del personal de la salud: revisión integrativa. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2020. [DOI: 10.11144/javeriana.ie22.pisp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introducción: Las prácticas de inyecciones seguras han recobrado importancia en las últimas dos décadas, como consecuencia de las infecciones asociadas con su aplicación incorrecta. Objetivo: Analizar la evidencia disponible sobre las prácticas de inyecciones seguras ejecutadas por el personal de la salud en su práctica clínica. Método: Revisión integrativa de la literatura, realizada en 12 bases de datos entre 1999 y 2018. Resultados: Se seleccionaron 29 artículos y se identificaron prácticas riesgosas como el reúso de los dispositivos de inyección en el mismo paciente o en otros, fallas en la técnica aséptica, ausencia o no seguimiento del protocolo posexposición, reencapuchado de la aguja y ausencia de inmunización contra el virus de hepatitis B. Conclusiones: Los esfuerzos orientados a la seguridad del paciente deben enfocarse también en acciones concretas dirigidas a la administración de los medicamentos.
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Abstract
PURPOSE OF REVIEW Humanitarian medical organizations focus on vulnerable patients with increased risk for healthcare-associated infections (HAIs) and are obligated to minimize them in inpatient departments (IPDs). However, in doing so humanitarian groups face considerable obstacles. This report will focus on approaches to reducing common HAIs that the authors have found to be helpful in humanitarian settings. RECENT FINDINGS HAIs are common in humanitarian contexts but there are few interventions or guidelines adapted for use in poor and conflict-affected settings to improve prevention and guide surveillance. Based on existing recommendations and studies, it appears prudent that all humanitarian IPDs introduce a basic infection prevention infrastructure, assure high adherence to hand hygiene with wide accessibility to alcohol-based hand rub, and develop pragmatic surveillance based on clinically evident nosocomial infection. Although microbiology remains out of reach for most humanitarian hospitals, rapid tests offer the possibility of improving the diagnosis of HAIs in humanitarian hospitals in the decade ahead. SUMMARY There is a dearth of new studies that can direct efforts to prevent HAIs in IPDs in poor and conflict-affected areas and there is a need for practical, field-adapted guidelines from professional societies, and international bodies to guide infection prevention efforts in humanitarian environments.
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Janjua NZ, Butt ZA, Mahmood B, Altaf A. Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress. World J Gastroenterol 2016; 22:5837-5852. [PMID: 27433097 PMCID: PMC4932219 DOI: 10.3748/wjg.v22.i25.5837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/05/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To summarize the available information about injection use and its determinants in the South Asian region.
METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords “injection”“unsafe injection” and “immunization injection” and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use.
RESULTS: Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior.
CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.
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Basazn Mekuria A, Melaku Gebresillassie B, Asfaw Erku D, Taye Haile K, Melese Birru E. Knowledge and Self-Reported Practice of Insulin Injection Device Disposal among Diabetes Patients in Gondar Town, Ethiopia: A Cross-Sectional Study. J Diabetes Res 2016; 2016:1897517. [PMID: 27738637 PMCID: PMC5055957 DOI: 10.1155/2016/1897517] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/28/2016] [Indexed: 12/13/2022] Open
Abstract
Background. Incorrect sharp disposal practices may expose the public to needle-stick injuries. The present study aimed at assessing the knowledge and practice of diabetic patients towards insulin injection device disposal in Gondar town, Ethiopia. Methods. A cross-sectional study was employed on insulin requiring diabetes patients who visited the diabetes clinic at Gondar University Referral Hospital (GURH) from February 1 to March 28, 2016. Frequencies, percentages, and ANOVA (analysis of variance) and Student's t-test were used to analyze variables. Results. About half of the participants (49.5%) had poor knowledge towards safe insulin injection waste disposal. More than two-thirds (80.7%) of respondents had poor practice and 64.3% of respondents did not put insulin needle and lancets into the household garbage. 31% of respondents threw sharps on street when they travel outside. Respondents living in urban areas had a higher mean of knowledge and practice score than those who live in rural area. Conclusions. This study revealed that knowledge and practice of diabetic patients were low towards safe insulin injection waste disposal in study area. Healthcare providers should also be aware of safe disposing system and counsel patients on appropriate disposal of used syringes.
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Affiliation(s)
- Abebe Basazn Mekuria
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
- *Abebe Basazn Mekuria:
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Kaleab Taye Haile
- Department of Pharmaceutics, School of Pharmacy, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
| | - Eshetie Melese Birru
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Chechela Street, Lideta Subcity Kebele 16, Gondar, Ethiopia
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Mclaws ML, Ghahramani S, Palenik CJ, Keshtkar V, Askarian M. Assessment of injection practice in primary health care facilities of Shiraz, Iran. Am J Infect Control 2014; 42:300-4. [PMID: 24406260 DOI: 10.1016/j.ajic.2013.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/27/2013] [Accepted: 09/03/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Occupational risk for several bloodborne viruses is attributable to unsafe injection practices. To understand injection frequency and safety, we surveyed injection rates and factors influencing injection prescription in primary health care facilities and associated health clinics in Shiraz, Iran. METHODS We used both quantitative and qualitative approaches to study the frequency and safety of injections delivered in 27 primary health care facilities. We used observations and 3 data collecting tools. Patterns of 600 general practice physicians' (GPs) prescriptions were also reviewed. In-depth interviews to elicit the factors contributing to injection prescriptions were conducted. RESULTS The annual per capita injection rate was 3.12. Corticosteroids were prescribed more frequently than antibiotics (P < .001). Knowledge of participants concerning transmission risks for 3 of the most common bloodborne infections (BBIs) was less than 75%. Factors affecting use of injections by GPs included strong patient preference for injections over oral medications and financial benefit for GPs, especially those in private practice settings. CONCLUSION Frequency of therapeutic injections in the participating facilities in Shiraz was high. Sociocultural factors in the patient community and their beliefs in the effectiveness of injections exerted influence on GP prescribing practices. Programs for appropriate and safe injection practices should target GP and injection providers, as well as patients, informing them about alternative treatments and possible complications of unnecessary and unsafe injections.
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Leonard L, Timmins F. Remembering the importance of preventing blood-borne infections in the critical care setting. Nurs Crit Care 2013; 18:4-7. [PMID: 23289551 DOI: 10.1111/nicc.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lenora Leonard
- Infection Prevention & Control Nurse Specialist, UPMC Beacon Hospital Dublin, Dublin, Ireland
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Gyawali S, Rathore DS, Shankar PR, Kumar KV. Strategies and challenges for safe injection practice in developing countries. J Pharmacol Pharmacother 2013; 4:8-12. [PMID: 23662018 PMCID: PMC3643353 DOI: 10.4103/0976-500x.107634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.
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Affiliation(s)
- Sudesh Gyawali
- Department of Pharmacology, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal ; PhD Scholar, Suresh GyanVihar University, Jaipur, India
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Chowdhury AKA, Roy T, Faroque ABM, Bachar SC, Asaduzzaman M, Nasrin N, Akter N, Gazi HR, Lutful Kabir AK, Parvin M, Anderson C. A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Public Health 2011; 11:779. [PMID: 21985397 PMCID: PMC3198945 DOI: 10.1186/1471-2458-11-779] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 10/10/2011] [Indexed: 12/20/2022] Open
Abstract
Background Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh. Methods The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined. Results As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications. Conclusions As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.
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Affiliation(s)
- A K Azad Chowdhury
- 1Department of Clinical Pharmacy & Pharmacology, University of Dhaka, Bangladesh
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Dong L, Wang D, Gao J, Yan H. Doctor's injection prescribing and its correlates in village health clinics across 10 Provinces of Western China. J Public Health (Oxf) 2011; 33:565-70. [PMID: 21345884 DOI: 10.1093/pubmed/fdr019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Unsafe use and overuse of injection play an important role in transmission of very serious blood-borne infections. No studies have been conducted to investigate the levels and determinants of injection utilization in rural Western China. METHODS A total of 20 125 prescriptions were collected from 680 village clinics across 10 provinces of Western China. A generalized estimating equation logistic regression model was employed to examine the determinants of injection utilization. RESULTS The proportion of prescriptions with injection was 22.93%. Village doctors who had full-time medical education prescribed less injections than those without full-time education (OR = 0.65; 95% CI: 0.52, 0.80). The injection proportion was higher among children less than 3 years old in comparison with adults aged 18-44 years (OR = 1.72; 95% CI: 1.43, 2.08). The number of drugs in a prescription was also a significant predictor of injection (OR = 1.91; 95% CI: 1.77, 2.06). CONCLUSIONS Injection prescribing proportion in rural Western China was higher than that in India and lower than that in Cambodia. Injection prescribing was associated with the education of village doctor, patient age and diagnoses of diseases. The findings have important policy implications for recommendations on injection utilization in China.
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Affiliation(s)
- Lifang Dong
- Department of AIDS Control and Prevention, Shaanxi Center for Disease Control and Prevention, Xi'an, Shaanxi 710054, P.R. China
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Reducing use of injections through interactional group discussions: A randomized controlled trial. Indian Pediatr 2010; 47:409-14. [DOI: 10.1007/s13312-010-0076-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 04/24/2009] [Indexed: 10/19/2022]
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Lee R. Occupational transmission of bloodborne diseases to healthcare workers in developing countries: meeting the challenges. J Hosp Infect 2009; 72:285-91. [DOI: 10.1016/j.jhin.2009.03.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 03/23/2009] [Indexed: 12/31/2022]
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Sukriti, Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, Kumar M, Kaanan AT, Sarin SK. Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India. J Gastroenterol Hepatol 2008; 23:1710-5. [PMID: 18761556 DOI: 10.1111/j.1440-1746.2008.05483.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. METHODS A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects. RESULTS Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg-positive, and 24.7% of 700 HCWs screened had past exposure (IgG-anti-HBc-positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti-HBs titers > 10 IU/mL. CONCLUSIONS Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.
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Affiliation(s)
- Sukriti
- Department of Gastroenterology, G.B. Pant hospital, New Dehli, India
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Rao PH. Report: Hospital waste management--awareness and practices: a study of three states in India. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2008; 26:297-303. [PMID: 18649579 DOI: 10.1177/0734242x08088693] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The study was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. Hospitals/nursing homes and private medical practitioners in urban as well as rural areas and those from the private as well as the government sector were covered. Information on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with respect to segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. Awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to Common Waste facilities is still limited. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities.
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Affiliation(s)
- P Hanumantha Rao
- Center for Human Development, Administrative Staff College of India, Bella Vista, Khairatabad, Hyderabad, India.
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Mantel C, Khamassi S, Baradei K, Nasri H, Mohsni E, Duclos P. Improved injection safety after targeted interventions in the Syrian Arab Republic. Trop Med Int Health 2007; 12:422-30. [PMID: 17313514 DOI: 10.1111/j.1365-3156.2006.01802.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Concerns about unsafe injection practices and possible infections with blood-borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the 'Focus Project', which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow-up survey was carried out in February 2004, 2 years after initiation of the project. METHODS Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004. RESULTS Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non-negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle-stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle-stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001). CONCLUSIONS The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well-structured immunization programme to the more diverse curative health services.
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Affiliation(s)
- Carsten Mantel
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Germany.
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Tahir M, Sharma SK, Smith-Rohrberg D. Unsafe medical injections and HIV transmission in India. THE LANCET. INFECTIOUS DISEASES 2007; 7:178-9. [PMID: 17317597 DOI: 10.1016/s1473-3099(07)70034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Mantel C, Khamassi S, Baradei K, Nasri H, Mohsni E, Duclos P. Improved injection safety after targeted interventions in the Syrian Arab Republic. Trop Med Int Health 2007. [DOI: 10.1111/j.1365-3156.2007.01802.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tarakeshwar N, Krishnan AK, Johnson S, Solomon S, Sikkema K, Merson M. Living with HIV infection: perceptions of patients with access to care at a non-governmental organization in Chennai, India. CULTURE, HEALTH & SEXUALITY 2006; 8:407-21. [PMID: 16923645 DOI: 10.1080/13691050600859609] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Through interviews, we examined explanatory frameworks of living with HIV infection among 50 HIV-positive individuals (23 women, 27 men) receiving care at a non-governmental organization in Chennai, India. Results were analysed according to three sets of issues, all of which were found to differ by gender: causal beliefs about HIV, impact of HIV, and care/treatment of HIV. HIV-positive participants attributed their infection to biological, moral and social causes, and the physical, financial and relationship dimensions of their lives were impacted upon by the infection. Furthermore, HIV-related stigma evoked fears about isolation and discrimination. Regarding care/treatment, men were most usually first initiated into the healthcare system while women often entered as a consequence of their partner's condition. Non-adherence to medication was reported by 32% of the participants due to financial constraints or side-effects. Although all participants were hopeful about a cure for HIV, women were less positive than men about treatment. Results highlight the importance of a gender-sensitive approach to HIV care, nuanced to accommodate an individual's gender, marital status and social background.
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Kermode M, Singh LB, Raju RK, Alam S, Cox H, Crofts N. Injections for health-related reasons amongst injecting drug users in New Delhi and Imphal, India. Public Health 2006; 120:634-40. [PMID: 16753193 DOI: 10.1016/j.puhe.2006.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 10/04/2005] [Accepted: 01/31/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In many parts of the world where unsafe injection practices in health settings are common, the prevalence of blood-borne viruses (BBVs) is high amongst injecting drug users (IDUs). If IDUs in these settings are receiving injections for health-related reasons, the possibility of amplification of BBV transmission via medical injections exists. The aim of this study is to describe the nature and extent of injections received for health-related reasons amongst IDUs in two Indian cities, New Delhi and Imphal. METHODS A cross-sectional survey of 200 IDUs was conducted in late 2004. Trained peer outreach workers asked participants about health problems experienced, consultations with healthcare providers and health-related injections received in the preceding 4 weeks. RESULTS Most participants (99.5%) were male, the average age was 29 years, and the average time since first injection of illicit drugs was 6 years. A total of 133 injections were received for health-related reasons during the preceding 4 weeks by 15% of the participants. The average number of injections was 8.6/participant/year. CONCLUSION Injections for health-related reasons were commonplace amongst these IDUs. Therefore, amplification of BBV transmission within communities due to unsafe injections is possible and warrants further investigation.
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Affiliation(s)
- M Kermode
- Australian International Health Institute, School of Population Health, University of Melbourne, Level 5/207 Bouverie Street, Melbourne, Vic. 3010, Australia.
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Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control 2005; 33:34-41. [PMID: 15685133 DOI: 10.1016/j.ajic.2004.07.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue. OBJECTIVE To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India. METHODS A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period. RESULTS A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions. CONCLUSION The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.
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Affiliation(s)
- Michelle Kermode
- School of Population Health, University of Melbourne, Melbourne, Victoria, Australia.
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