HIV Prevention Knowledge Base
Biomedical Interventions: Injection Safety
Rational Injection Use in Uganda: An In-Depth Analysis of Outpatient Prescription Records in Five Districts
This report on the impact of a Making Medical Injections Safer project compares the use of injections before and after an intervention to train health workers in rational injection use and to promote community-level behavior change. The study analyzes injection prescriptions by facility and patient characteristics. In four of the five districts studied, there was a significant reduction in the irrational use of injections, but the prevalence remains high, at approximately double the target of 15 percent. The authors recommend continued efforts to reinforce the promotion of non-injectable treatments.
The Association between Medical Injections and Prevalent HIV Infection: Evidence From a National Sero-Survey in Uganda
Using data from a nationally representative, population-based behavioral survey, this study found that a quarter of the male respondents and a third of the female respondents had received at least three medical injections within the previous 12 months. HIV prevalence was significantly higher among those who had received five or more medical injections versus those who had received none, even after adjusting for a wide range of confounding factors. The authors acknowledge that their data was subject to some measurement constraints and possible selection bias but still conclude that their findings support the need for programs to encourage the rational use of injections.
Prevention of HIV Transmission in Health Care Settings
This technical brief puts injection safety in the wider context of HIV transmission prevention in health care settings, as one of a range of primary prevention mechanisms that also includes blood safety, surgical care, waste disposal, and occupational health. It provides a summary of the global burden of HIV associated with medical injections, a checklist of operational considerations when developing HIV interventions for health care settings, and details of specific activities that can be implemented to promote safe injections. There is also a list of key World Health Organization resources on HIV in the health care setting.
Caring for Healthcare Workers: A Global Perspective
This editorial describes some of the major developments in the last two decades’ in reduction of occupational injuries due to contact with needles, other sharp devices, and blood. In the United States and other industrialized countries, the advent of antiretroviral drugs has enabled more effective post-exposure prophylaxis and dramatically reduced the number of inpatients living with HIV. There has also been a trend away from using needles wherever possible, substituting needles with a range of devices designed to protect the user from sharps injuries, a practice that needs to be extended beyond the industrialized world, the author writes. The article urges greater protection against injection-related injuries for health care workers worldwide.
Aide-Memoire: Standard Precautions in Health Care
This document emphasizes the key role that standard precautions play in the prevention of infection in health care settings. It summarizes the elements of the most basic level of infection control measures in health care—an infection control policy, hand hygiene, personal protective equipment, cough etiquette, environmental cleanliness, waste disposal, and prevention of sharps injuries. There is a checklist and a one-page summary of the key elements of standard precautions, with particular emphasis on hand and respiratory hygiene techniques. It is useful for developing strategies and interventions in infection prevention and control, including injection safety, in health care settings.
This fact sheet describes the extent of injection misuse and overuse in health care settings, fuelled by misguided demand from patients and irrational use by doctors. It explains how reuse of unsterilized needles and syringes, as well as inadequate disposal and black market resale of injecting equipment, all put lives at risk. There is also a summary of the burden of injection-related disease, notably HIV and hepatitis B and C. It highlights changing the behavior of patients and health care workers, ensuring adequate supplies of safe injection equipment, and proper waste management as key components of HIV prevention programs targeting injection safety.
Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection: National Case Surveillance Data During 20 Years of the HIV Epidemic in the United States
National case surveillance data on occupationally acquired HIV infections shows that there is a fourfold higher incidence of such infections among female health care workers than their male counterparts. Nurses account for over two-fifths of all occupationally acquired cases of HIV. Hollow-bore needles used in phlebotomy caused almost all of the percutaneous exposures detected by surveillance. Safe use and disposal of needles, adoption of needleless procedures, and safety-engineered devices should be promoted as key components of a range of protective measures, the authors write. Employers are urged to continually monitor preventive measures and educate their employees about ways to reduce the risk of exposure to HIV.
Unsafe Injections in the Developing World and Transmission of Bloodborne Pathogens: A Review
This review brings together evidence from published studies and unpublished World Health Organization reports to show that the vast majority of injections in developing countries are therapeutic, most are unnecessary, and up to half are unsafe. Whereas the risk of needle-stick injuries in the general population has been almost eliminated in developed countries, it remains a significant threat to patients in developing countries. In some of the studies reviewed, unsafe injections were linked to blood-borne infections. Although injections account for a small proportion of HIV infections relative to sexual- and drug use–related transmission, they expose populations that would not have otherwise been at risk.