Safe injection Practices

Safe injection practices prevent transmission of infectious diseases from one patient to another, or between a patient and health care personnel(HCP) during preparation and injection of medications. A safe injection 

• Does not harm the recipient (e.g. no abscess formation.)
• Does not expose HCP to any avoidable risks (e.g. needle stick injury)
• Does not harm the community (e.g. unsafe disposal of waste)

What are unsafe injection practices?

Unsafe injection practices are caused by avoidable risky situations and practices including: 

• Lack of awareness of the risks of unsafe injections. 
• Overuse of injections for illnesses for which effective oral medications exist. 
• Needle-stick injuries to health care workers from recapping needles. 
• Lack of clean workspaces. 
• Re-use of syringes because of shortages of syringes. 
• Unsafe sharps collection and waste management.

What are safe injection practices recommendations?

1. Prepare injections using an aseptic technique in a clean area.
2. Disinfect the rubber septum on a medication vial with alcohol before piercing.
3. Do not use needles or syringes for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
4. Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when withdrawing additional doses for the same patient.
5. Use single-dose vials for parenteral medications when possible.
6. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
7. Do not combine the leftover contents of single-use vials for later use.

The following apply if multidose vials are used:

• Dedicate multidose vials to a single patient whenever possible.
• If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area to prevent inadvertent contamination.
• If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use.
• Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a different date.
• Do not use a fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient.

Injections should only be used:

• For serious and life-threatening illness where they are recommended by treatment guidelines. 
• When patients are unable to swallow. 
• When patients vomit profusely. 
• When there is no effective oral medication or the absorption process is significantly altered. 

References:

1. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/safe-injection-practices.html
2. https://www.who.int/occupational_health/activities/1bestprac.pdf
3. https://www.who.int/infection-prevention/tools/injections/IS_HealthCareProviders_Leaflet.pdf
4. https://www.ncdc.gov.in/WriteReadData/l892s/Handbook%20on%20Safe%20Injection%20Practices.pdf
5. https://www.cdc.gov/injectionsafety/ip07_standardprecaution.html
6. https://vikaspedia.in/health/sanitation-and-hygiene/handbook-on-safe-injection-practices/techniques-of-safe-injections
7. https://www.cdc.gov/injectionsafety/PDF/Injection-Safety-Guidelines-P.pdf