Best Infection Control Practices for ID, SC, and IM Injections

1. Best Infection Control Practices for ID, SC, and IM Injections Presentation of the Process and Outcome of the SIGN Working Group Meeting Geneva, 19-20 October 2000

2. A safe injection does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in any waste that is dangerous for other people

3. WHO Objectives for Safe and Appropriate Use of Injections • Policy • Quality and safety • Access • Use

4. WHO Objectives for Safe and Appropriate Use of Injections • Policy • Quality and safety • Access • Use: appropriate, rational, and cost effective • Pilot interventions • Injection practices standards • Sharps waste management

5. Injection Safety Standards:Background • No consolidated guidelines available on safe injection practices • The “safe injection” definition does not translate into a list of critical steps • Need to obtain a reference for behaviour change and IEC strategy • Little evidence available • Need to focus on infectious complications

6. A “Best Practices” Document • Best, not “perfect practices” • Not a standard for regulatory purposes • Not prescriptive guidelines • May be adapted • By programmes • By countries • Distil critical issues • Not always practical, feasible, or cost-effective

7. Process for Development of Best Practices for Infection Control • Break down of a “safe injection” into critical steps • Identification of research questions for each step • Literature review • Formulation of a draft best practices document • Discussion of the document (19-20 October 2000) • Revised draft for public comments • Availability of a final document

8. Process for Development of Best Practices for Infection Control • Break down of a “safe injection” into critical steps • Identification of research questions for each step • 55 independent questions identified • Literature review • Formulation of a draft best practices document • Discussion of the document (19-20 October 2000) • Revised draft for public comments • Availability of a final document

9. Process for Development of Best Practices for Infection Control • Break down of a “safe injection” into critical steps • Identification of research questions for each step • Literature review • Approximately 150 articles reviewed • Evidence tended to be problem-focused • Little research on impact of specific interventions • Several areas where no evidence was available • Formulation of a draft best practices document • Discussion of the document (19-20 October 2000) • Revised draft for public comments • Availability of a final document

10. Grading System for the Level of Evidence • Category 1 • Strongly recommended and supported by well-designed analytical studies of observational or intervention nature. • Category 2 • Strongly recommended on the basis of strong theoretical rationale and suggestive, descriptive evidence. • Category 3 • Recommended on the basis of expert consensus and theoretical rationale.

11. Process for Development of Best Practices for Infection Control • Break down of a “safe injection” into critical steps • Identification of research questions for each step • Literature review • Formulation of a draft best practices document • Discussion of the document (19-20 October 2000) • Thoughtful two-day discussion • Consensus on revised draft document reached • Revised draft for public comments • Availability of a final document

12. Composition of the Working Group • Subject matter experts (infection control, HCW protection, waste disposal) • Programme specialists (e.g., immunisation, diabetes, injection drug use) • Behaviour and system specialists • Nursing generalists

13. Process for Development of Best Practices for Infection Control • Break down of a “safe injection” into critical steps • Identification of research questions for each step • Literature review • Formulation of a draft best practices document • Discussion of the document (19-20 October 2000) • Revised draft for public comments • Four scientifically-supported practice areas addressed • Five practice issues discussed where science inconclusive or requires clarification • Availability of a final document

14. Four Scientifically-Supported Practice Areas • Use of sterile injection equipment • Preventing contamination of equipment and medication • Preventing needlesticks • Preventing access to used needles

15. Five Practice Issues Discussed where Science Inconclusive or Requires Clarification • Use of engineered technology • Hand hygiene • Use of gloves for providing injections • Swabbing vials or ampoules • Skin preparation prior to injection

16. Plans for Review • Distribution of draft document at annual SIGN meeting in Cairo, October 2000 • Post draft on SIGNpost (SIGN Internet forum) for comments • Revise by February 2001 • Post final document • Other methods for distribution are under consideration