[e-drug] Prefinal draft injection best practices document

[Kirsten Myhr <myhr@online.no>]

E-drug: Prefinal draft injection best practices document
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[If E-druggers want to comment on the draft, please contact the SIGN 
secretariat, see address below. Copied from SIGN.]

Yvan Hutin, WHO/SIGN, has kindly posted the penultimate pre-publication
version of the Safe Injection best practices document for your 
consideration.

Get the PDF file at: ftp://acithn.uq.edu.au/signfiles/
doubleclick on the file: BestPracticesNearFinalDraft2001.PDF

Please find attached the pre-final version of the best practices document.
It has been updated according the comments and suggestions received from
various SIGN participants. We are now in the process of writing a document
that links the literature review that was done to the recommendations that
we made so that the whole thing can be submitted to a peer-review journal.
Thus, this version is only pre-final as it could still be modified through
the journal-specific peer review process.

We hope that these best practices will be useful to SIGN participants
worldwide.

Best regards,

Dr Yvan Hutin
Medical Officer
Safe Injection Global Network (SIGN)
Blood Safety and Clinical Technology (BCT)
World Health Organization
20, Avenue Appia, Rm. M 22
CH- 1211 Geneva 27
Switzerland

Tel: +41 (22) 791 34 31 (direct)
Fax: +41 (22) 791 48 36
E-mail: hutiny@who.int
________________________________________________

Best Infection Control Practices for Skin-Piercing Intradermal,
Subcutaneous, and Intramuscular Needle Injections
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

Eliminating unnecessary injections is the highest priority towards
preventing injection-associated infections. When injections are medically
indicated they should be administered safely. These best practices are
measures that have been determined through scientific evidence or expert
consensus to most effectively protect patients, providers, and communities.

1. USE STERILE INJECTION EQUIPMENT
* Use a sterile syringe and needle for each injection and to
reconstitute each unit of medication.

* Ideally, use new, quality-controlled disposable syringe and needle.
Inspect packaging for breaches in barrier integrity. Discard a needle or
syringe if the package has been punctured, torn, or damaged by exposure to
moisture.

* If disposable syringes and needles are unavailable, use equipment
designed for steam sterilization. Sterilize equipment according to WHO
recommendations and document the quality of the sterilization process using
Time, Steam, Temperature (TST) spot indicators. (1)

2. PREVENT CONTAMINATION OF INJECTION EQUIPMENT AND MEDICATION
* Prepare each injection in a clean designated area where blood or
body fluid contamination is unlikely. (2)

* Use single-dose vials rather than multi-dose vials. (2) If multi-dose
vials must be used, always pierce the septum with a sterile needle. (1)1
Avoid leaving a needle in place in the stopper of the vial. (2)

* Select pop-open ampoules rather than ampoules that require use of a
metal file to open. If using an ampoule that requires a metal file to open,
protect fingers with a clean barrier (e.g., small gauze pad) when opening
the ampoule. (2)

* Inspect for and discard medications with visible contamination or
breaches of integrity (e.g., cracks, leaks). Follow product-specific
recommendations for use, storage, and handling. (3)

* Discard a needle that has touched any non sterile surface. (3)

3. PREVENT NEEDLESTICK INJURIES TO THE PROVIDER
* Anticipate and take measures to prevent sudden patient movement
during and after injection. (2)

* Avoid recapping and other hand manipulations of needles. If
recapping is necessary, use a single-handed scoop technique. (1)

* Collect used syringes and needles at the point of use in a sharps
container that is puncture- and leak-proof and that can be sealed before
completely full. (2)

4. PREVENT ACCESS TO USED NEEDLES
* Close and seal sharps containers for transport to a secure area in
preparation for disposal. After closing and sealing sharps containers, do
not open, empty, re-use, or sell them. (2)

* Manage sharps waste in an efficient, safe, and environment-friendly
way to protect people from voluntary and accidental exposure to used
injection equipment. (2)

5. OTHER PRACTICE ISSUES
1. Engineered technology:
* Whenever possible, use devices designed to prevent needlestick
injury that have been shown to be effective for patients and providers.
* Auto-disable (AD) syringes are increasingly available to prevent re-
use of injection equipment in selected settings, including immunization
services.

2. Provider's hand hygiene and skin integrity.
Perform hand hygiene (i.e., wash or disinfect hands) prior to preparing
injection material and giving injections.  The need for hand hygiene 
between
each injection will vary based on the setting and whether there was contact
with soil, blood or body fluids. Avoid giving injections if skin integrity
is compromised by local infection or other skin condition (e.g., weeping
dermatitis, skin lesions, cuts). Cover any small cuts.

3. Gloves.
Gloves are not needed for injections. Disposable gloves may be indicated if
excessive bleeding is anticipated.

4. Swabbing of vial tops or ampoules.

Swabbing of vial tops or ampoules with an antiseptic or disinfectant is
unnecessary.  If swabbing with an antiseptic is selected for use, use clean
disposable swab and maintain appropriate contact time. Do not use cotton
balls stored wet.

5. Skin preparation prior to injection.

Wash skin that is visibly dirty. Swabbing of the clean skin prior to giving
an injection is unnecessary. If swabbing with an antiseptic is selected for
use, use clean disposable swab and maintain appropriate contact time. Do 
not
use cotton balls stored wet.
___________________________________________________________________________

Footnotes:
1. Strongly recommended and strongly supported by well-designed 
experimental
or epidemiological studies.

2. Strongly recommended on the basis of strong theoretical rationale and
suggestive, descriptive evidence.

3. Recommended on the basis of expert consensus and theoretical rationale.
___________________________________________________________________________

Comments and suggestions should be directed to the:

Secretariat of the Safe Injection Global Network (SIGN),
World Health Organization,
Department of Blood Safety and Clinical Technology,
Avenue Appia 20,
Geneva 27, Switzerland 1211.
Fax +41 22 791 4836. E-mail: sign@who.ch

Visit the SIGN website at: http://www.injectionsafety.org
SIGN files are available on the web at:  ftp://acithn.uq.edu.au/signfiles/
SIGNpost archives: ftp://acithn.uq.edu.au/signfiles/SIGNpostArchives
Join SIGN at: http://www.injectionsafety.org/html/joining.html
To subscribe or un-subscribe send an email to:  sign@who.int


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