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Landscape for safe injection, phlebotomy, and waste management equipment. Standards, specifications, and products.
Boston, Massachusetts, JSI, MMIS, 2010 Jan.  p.This document provides guidelines for implementing a procurement policy for safe injection and brings together issues that countries should consider when developing and implementing the procurement aspect of a national injection safety policy. The document points out issues to consider in transitioning from policy to implementation, regulatory factors, public-sector considerations, and the need to sensitize private-sector manufacturers. It also includes a landscape of manufacturers of safe injection equipment.
Uncovering high rates of unsafe injection equipment reuse in rural Cameroon: Validation of a survey instrument that probes for specific misconceptions.
Harm Reduction Journal. 2011 Feb 7; 8(4):1-9.Background: Unsafe reuse of injection equipment in hospitals is an on-going threat to patient safety in many parts of Africa. The extent of this problem is difficult to measure. Standard WHO injection safety assessment protocols used in the 2003 national injection safety assessment in Cameroon are problematic because health workers often behave differently under the observation of visitors. The main objective of this study is to assess the extent of unsafe injection equipment reuse and potential for blood-borne virus transmission in Cameroon. This can be done by probing for misconceptions about injection safety that explain reuse without sterilization. These misconceptions concern useless precautions against cross-contamination, i.e. "indirect reuse" of injection equipment. To investigate whether a shortage of supply explains unsafe reuse, we compared our survey data against records of purchases. Methods: All health workers at public hospitals in two health districts in the Northwest Province of Cameroon were interviewed about their own injection practices. Injection equipment supply purchase records documented for January to December 2009 were compared with self-reported rates of syringe reuse. The number of HIV, HBV and HCV infections that result from unsafe medical injections in these health districts is estimated from the frequency of unsafe reuse, the number of injections performed, the probability that reused injection equipment had just been used on an infected patient, the size of the susceptible population, and the transmission efficiency of each virus in an injection. Results: Injection equipment reuse occurs commonly in the Northwest Province of Cameroon, practiced by 44% of health workers at public hospitals. Self-reported rates of syringe reuse only partly explained by records on injection equipment supplied to these hospitals, showing a shortage of syringes where syringes are reused. Injection safety interventions could prevent an estimated 14-336 HIV infections, 248-661 HBV infections and 7-114 HCV infections each year in these health districts. Conclusions: Injection safety assessments that probe for indirect reuse may be more effective than observational assessments. The auto-disable syringe may be an appropriate solution to injection safety problems in some hospitals in Cameroon. Advocacy for injection safety interventions should be a public health priority.
International Journal of STD and AIDS. 2009 May; 20(5):295-9.A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12-17%, and up to 34-47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.
Procuring Single-Use Injection Equipment and Safety Boxes: A Practical Guide for Pharmacists, Physicians, Procurement Staff and Programme Managers
Geneva, Switzerland, World Health Organization [WHO], 2003 May 5. (WHO/BCT/03.04)The objective of this guide is to accompany pharmacists, physicians, procurement staff and programme managers through the process of procuring single-use injection equipment and safety boxes of assured quality, on a national or international market, at reasonable prices. International organizations have established standardized procurement procedures for medicines and medical devices. This guide describes how these procedures can be used to ensure the procurement of injection equipment and safety boxes. Institutions procuring injection equipment need to develop a list of manufacturers that are prequalified on the basis of certain criteria which include international quality standards. This guide provides steps and tools for procurement, including a pre-qualification procedure of injection equipment for purchase. Developing a monitoring system for supplier performance will improve and safeguard the quality of injection equipment selected and prevent or eliminate unreliable suppliers.
Contact. 2006 Aug; (182):4-5.Saving lives is the paramount goal of all HIV programmes. Successful HIV prevention programmes utilize all approaches known to be effective, not implementing one or a few select actions in isolation. These include promoting sexual abstinence, fidelity among married couple and the use of condoms for those who are not in a position to abstain or be faithful. It also includes ensuring that injecting drug users have access to clean needles and syringes as well as programmes supporting them to stop drug use. The strategies also include assurance that HIV-positive pregnant women receive treatment to prevent HIV transmission to the child. These strategies (See insert) were endorsed by the UNAIDS board last year and provide the framework for re-energizing HIV prevention globally. (excerpt)
Peddro. 2001 Dec; 4.The world has been responding to HIV/AIDS for twenty years, and some universal lessons have been learned during that period. One is that effective AIDS responses have to start with the world as it is, not as we would like it to be. A second lesson is that blaming or castigating people at risk of HIV infection simply adds to the stigma, drives risky behaviour underground and fails to stop the spread of the epidemic. And a third lesson is that no matter how well-hidden it may be, HIV transmission via injecting drug use has been at least partly responsible for the epidemic nearly everywhere. Up to now, 114 countries have reported the occurrence of HIV infection among their drug injecting communities. Injecting drug use is either the main mode of transmission of HIV infection or one of the main modes in many countries in Asia, Latin America, Europe, and North America. Even in the epidemic in sub-Saharan Africa, although the great bulk of HIV transmission is attributable to sex, injecting drug use is also a source of risk. Since sharing injecting equipment causes a great deal of contamination, this practice can be responsible for the unpredictable mushrooming of the epidemic. But the spread of HIV as the result of injecting drug use is never confined to the injecting drug users alone: injecting drug users also have sexual partners, and may also be mothers needing to protect their infants from HIV, and in many places the sex trade and drug abuse are closely associated. HIV transmission via injecting drug use therefore has the potential to kick-start much wider epidemics, such as that which occurred at the end of the 1980s in Thailand. (excerpt)
Lancet. 2006 Sep 23; 368(9541):1064-1065.Viviana Simon and colleagues provide a valuable update on the epidemiology and prevention of HIV/AIDS. However, they do not mention that iatrogenic routes still contribute to HIV spread in developing countries. Data from WHO's Global Database on Blood Safety indicate that, in 2001--02, more than 6 million blood units were not screened for major bloodborne infections, including HIV. Most of these unscreened donations are collected in poor regions of the world, where HIV infection is more frequent and the basic requirements for a modern transfusion system (ie, the collection of a locally sufficient blood supply from non-remunerated donors, within a formal organisational and legislative framework) remain unmet Transfusions in developing countries are mainly given to young women and children. (excerpt)
Best infection control practices for skin-piercing, intradermal, subcutaneous, and intramuscular needle injections.
Geneva, Switzerland, WHO, Department of Blood Safety and Clinical Technology, SIGN, 2001 Nov.  p. (WHO/BCT/DCT/01.02)Best Infection Control Practices for Skin-Piercing Intradermal, Subcutaneous, and Intramuscular Needle Injections. Use sterile injection equipment; Use sterile injection equipment; Prevent needlestick injuries to the provider; Prevent access to used needles; Prevent access to used needles. (excerpt)
[Unpublished] 1990. , 18 p. (GPA/GCA(3)/90.11)The member of the Global Commission on AIDS (GCA) convened on March 22-23, 1990 to explore the issue of drug use and HIV infection, review prevention activities, and identify critical issues for AIDS prevention and control in the early 1990s. This document provides a full account of each session including the names of the presenters, the information shared, and the discussions that followed. In the session about drug use and HIV infection, the problem was identified as being "truly global" because the sharing of injection equipment occurs everywhere. Some of the reasons cited for sharing equipment are initiation into intravenous drug use, social bonding, and practicality. Rapid spread of HIV has been seen in New York City, several Italian cities, Edinburgh, and Bangkok. Characteristically, it has taken only 3-5 years after the introduction of HIV for about 50% of injecting drug users (IDU) to be infected. Several studies have demonstrated that behavior change can lower the risk of transmission and infection rates. Amsterdam, Innsbruck, Seattle, and Stockholm had all achieved stabilization of their prevalence of HIV among IDUs at levels between 10-30%. It was emphasized that the means for behavior change must be provided for education to have an impact. The discussion of prevention activities featured the use of education, information, and communication (IEC) programs to execute mass campaigns, focus interventions, and provide monitoring and evaluation. Specific prevention activities discussed were condom usage, outreach to persons with sexually transmitted diseases, and blood safety. There were separate presentations on the status of blood transfusion programs and vaccine development. 10 issues were identified by the GCA that warrant priority attention in the early 1990s. These critical issues are research, complacency and abatement of a sense of urgency, preservation and protection of human rights and legal issues, equity of access, human sexuality, women and AIDS, AIDS as a disease affecting families, HIV/AIDS and drug use, economic and social implications of HIV/AIDS, and the collation and improvement of data.
BULLETIN OF THE WORLD HEALTH ORGANIZATION.. 1999; 77(12):996-1000.This article reviews a WHO approach aimed to achieve injection safety that encompasses all elements from patients' expectations and doctors' prescribing habits to waste disposal. Additionally, the paper describes its implications for two injection technologies: sterilizable and disposable. It argues that focusing on any single technology diverts attention from the more fundamental need for health services to develop their own comprehensive strategies for safe injections. National health authorities will only be able to ensure that injections are administered safely if they take an approach that encompasses the whole system and choose injection that fit their circumstances. When national authorities seek to identify the strategy most suited to their needs, they must take account of all three elements: behavior, management, and finance.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1998; 76(1):99-100.More than half of the injections administered in many developing countries are unsterile, resulting in millions of cases of viral hepatitis B and C and increased transmission of HIV infection. Since both hepatitis B and C and HIV viruses have a long incubation period and take a long time to kill, the association with an injection is seldom made. To combat this problem, the World Health Organization (WHO) has distributed millions of sterilizable needles and syringes and steam sterilizers around the world. WHO's Expanded Program on Immunization (EPI) has stimulated the development of the one-time "autodestruct" syringe and seeks to make this the standard injection device in all countries. The EPI has called upon all donors, international agencies, and health departments to bundle a supply of autodestruct syringes and boxes for their disposal after use with all vaccines supplied for emergency purposes. Education to change attitudes of the public and health providers remains a vital component of the campaign to reduce the risk of inappropriate and unsterile injections.
How to estimate incremental resource requirements and costs of alternative TT immunization strategies: a manual for health and program managers. Revised version.
Arlington, Virginia, John Snow, Inc. [JSI], Resources for Child Health Project [REACH], 1989 Jun. , 22 p. (USAID Contract No. DPE-5927-C-00-5068-00)The REACH Project originally prepared this manual for health and program managers for WHO workshops in Africa on the control of neonatal tetanus. The manual provides rapid methods for determining incremental resource requirements and costs of tetanus toxoid (TT) immunization programs. Its design allows for flexibility. It categorizes costs into variable costs such as vaccines, syringes, and needles and fixed costs such as training, personnel, supervision, and transportation. The manual provides a worksheet for calculating the variable costs for programs which requires the managers to consider the target population (pregnant women or women of childbearing age) and coverage objective (TT2 or TT5). Further it presents a formula for determining costs of additional personnel (a variable cost): personnel costs=number of workers x proportion of time for TT vaccination for each worker x annual gross earnings of each workers. It also has guidelines for determining fixed costs such as cold chain equipment costs. Transportation costs consists mostly of fuel costs but also includes the costs of vehicles to move vaccines, supplies, and personnel. Training costs include production of training materials, travel, per diem, and proportion of annual salaries of trainers and trainees for training time. The manual also has worksheets for determining supervision and monitoring costs. Further it has a worksheet to calculate additional media costs for TT immunization including radio. TV, and posters. Once managers have determined the costs of various components of TT immunization programs, they can sum the costs up and determine the cost effectiveness of TT immunization strategies on another worksheet. The manual concludes with a formula to assist managers determine whether changing from 1 strategy to another would save them more money and be more cost effective.
[Unpublished] 1987 Nov. , 19 p.Immunizations often involve injecting a needle into the skin and, if health personnel do not take appropriate precautions, they can transmit pathogens such as hepatitis B and HIV. The most difficult form of microbe to destroy is bacteria encased in spores, e.g. Clostridium tetani. The most common method in developing countries to disinfect immunization equipment is to boil them nonstop for 20 minutes. Based on some studies, key researchers believe that exposure to 100 degrees Celsius water for several minutes can actually destroy or inactivate essentially all vegetative bacteria, viruses, protozoa, yeasts, and molds. Yet there is no agreement on the amount of time and temperature needed to inactivate the hepatitis B virus since some evidence indicates that it is highly resistant to heat (60 minutes needed) whereas other evidence indicates it is not very resistant (2 minutes). Many researchers believe HIV can be inactivated at 80 degrees Celsius. Health workers must clean immunization equipment before boiling since organic materials and oils on the equipment prevent heat penetration and protect microbes. Further they should submerge all equipment at the same time and make sure that the water is at full boil continuously for the entire specified time. Indeed health workers in developing countries should adhere to the procedure listed in the WHO/EPI/UNICEF pamphlet entitled How to Boil Needles and Syringes Properly. Steam is by far the best method to sterilize immunization equipment, however. WHO/EPI is trying to introduce portable special pressure cookers which can attain a temperature of 121 degrees Celcius to act as autoclaves for needles and syringes. WHO/EPI and UNICEF are exploring disposable syringes as another means of preventing disease transmission. Researchers are also working on developing vaccines that do not require injection such as the oral polio vaccine.
[Unpublished] 1987 Jun.  p.The World Health Organization (WHO) has made estimates of ORS units available, per 100 diarrhea cases in children under 5. They estimate over 1/2 of these children have ORS available and 10% use it. Availability and use is greater in Asia and less in Africa especially Central and West Africa. Total requests for ORS increased from 220 million in 1984 to 356 million in 1985. In 1985, UN furnished 25% and local production is over 60%. Tables presented here show the supply of ORS for each country, for each year from 1981 to 1985, access rates and use rates. A UN organization also supplies disposable and sterilizable syringes, 6,000,000 in 1984 increasing to 46,000,000 in 1985, and to over 61,000,000 in 1986. African countries use over 1/2 of the syringes and the Americas use about 1.5th. Tabular data shows the number of syringes supplied to each country in 1984 through 1986.
JOHNS HOPKINS MAGAZINE. 1989 Feb; 41(1):10-1.The reuse of unsterilized syringes is spreading AIDS, hepatitis B and the African Ebola-Marburg virus. In the US 25% of the AIDS cases are related to intravenous drug abuse. In developing countries syringe reuse is related to poor health care delivery systems. In these countries syringes are used over 5 times before sterilization; in some countries the syringes are distributed by people who sell injections of vitamins and antibiotics. In 1986 Halsey challenged the medical community to design a syringe that would not transmit these diseases, and shortly thereafter a separate challenge was issued by the World Health Organization. The requirements of this syringe are its self destruction after use, little requiring retraining of medical personal, and no more than 1 cent to the cost, and be simple to make. These challenges brought 70 various syringe entries and all but 3 were eliminated. The Hopkins syringe is similar to a regular syringe except it has a polymer insert that seals up after one use. When water flows around the polymer insert it swells and closes off the passageway preventing any liquid from flowing in or out of the syringe. Another syringe seals up in 2.5 minutes which allows the health worker time to draw and inject a patient before the syringe destructs. By using hydrogels that are already approved for use in contact lenses and food substances, the safety has been tested. Companies looking at production costs estimate that the polymer insert will add only 1/4 of a cent to the cost of a syringe.
Washington, D.C., National Academy Press, 1988. x, 239 p.The Committee for the Oversight of AIDS Activities presents an update to and review of the progress made since the publication 1 1/2 years ago of Confronting Aids. Chapter 1 discusses the special nature of AIDS (Acquired Immunodeficiency Syndrome) as an incurable fatal infection, striking mainly young adults (particularly homosexuals and intravenous drug users), and clustering in geographic areas, e.g., New York and San Francisco. Chapter 2 states conclusively that HIV (Human Immunodeficiency Virus) causes AIDS and that HIV infection leads inevitably to AIDS, that sexual contact and contaminated needles are the main vehicles of transmission, and that the future composition of AIDS patients (62,000 in the US) will be among poor, urban minorities. Chapter 3 discusses the utility of mathematical models in predicting the future course of the epidemic. Chapter 4 discusses the negative impact of discrimination, the importance of education (especially of intravenous drug users), and the need for improved diagnostic tests. It maintains that screening should generally be confidential and voluntary, and mandatory only in the case of blood, tissue, and organ donors. It also suggests that sterile needles be made available to drug addicts. Chapter 5 stresses the special care needs of drug users, children, and the neurologically impaired; discusses the needs and responsibilities of health care providers; and suggests ways of distributing the financial burden of AIDS among private and government facilities. Chapter 6 discusses the nomenclature and reproductive strategy of the virus and the needs for basic research, facilities and funding to develop new drugs and possibly vaccines. Chapter 7 discusses the global nature of the epidemic, the responsibilities of the World Health Organization (WHO) Global Program on AIDS, the need for the US to pay for its share of the WHO program, and the special responsibility that the US should assume in view of its resources in scientific personnel and facilities. Chapter 8 recommends the establishment of a national commission on AIDS with advisory responsibility for all aspects of AIDS. There are 4 appendices: Appendix A summarizes the 1986 publication Confronting Aids; Appendix B reprints the Centers for Disease Control (CDC) classification scheme for HIV infections; Appendix C is a list of the 60 correspondents who prepared papers for the AIDS Activities Oversight Committee; and Appendix D gives biographical sketches of the Committee members.
SOUTH. 1987 Apr; (78):109-12.The prevalence of acquired immunodeficiency syndrome (AIDS) in East African countries is the topic of this news article. With the exception of Uganda, most countries' data are considered underreported. Highest estimates are 1 to 3 million cases in Africa; official counts reported to the World Health Organization (WHO) total 2561 cases. In Kenya, 250 cases and 400 infected prostitutes have been confirmed. Nigeria does not admit to any cases, officially. Uganda's officials estimate that 5-10% of urban adults are carriers. Testing is too expensive there, even of blood donors, as costs would bankrupt the health budget. USAID has contributed condoms, however. Infants born of or breast fed by infected mothers are at risk: many of babies have AIDS in Uganda, Zambia, Zaire and Rwanda. On the other hand, Rwanda has instituted a well-coordinated AIDS education campaign with the help of the Norwegian Red Cross, and Uganda, the first country to publicized AIDS, may be selected for the WHO AIDS center.
In: Infant and child survival technologies, annual technical update No. 1 by Technologies for Primary Health Care Projects [PRITECH]. Arlington, Virginia, Management Sciences for Health, PRITECH Project, 1984 Sep. 34-5.During the past few years, 1 of the more exciting developments in vaccine production is the great improvement in the thermal stability of vaccines. Such improvements in vaccine stability, in combination with a carefully monitored distribution system (cold chain), have the potential for greatly increasing the coverage of an immunization program. The Expanded Programme on Immunization of the World Health Organization (WHO/EPI) has played a major role in aiding the development, adaptation, and field testing of equipment designed to meet the conditions encountered in the distribution of vaccines through the cold chain. An important innovation is the development of solar powered refrigerators for vaccine storage and ice making. In addition, WHO/EPI has attempted to identify the best methods for packing vaccine carriers and cold boxes. Since the rate of decline of vaccine potency is affected both by temperature and by age, it is important to know what temperature each vial of vaccine has been exposed to. Temperature monitoring devices that have been devised are discussed. Vaccination equipment (i.e., needles, syringes, and methods for sterilizing them) is essential to an immunization program. Alternatives to the syringe or needle for vaccine administration include the jel-injector and aerosol administration. Less expensive, more durable syringes are also being developed.
Guide to equipment selection for M/F sterilization procedures. Guide du materiel utilise pour les procedures de sterilisation des hommes et des femmes.
Population Reports. Series M: Special Topics. 1977 Sep; (1): p.This is a guide to aid in selecting and maintaining the proper equipment used in the following sterilization procedures: 1) minilaparotomy, 2) laparoscopy, 3) conventional laparotomy, 4) colpotomy, 5) culdoscopy, and 6) vasectomy. Prototype, experimental, or infrequently used instruments are not discussed. Colpotomy, minilaparotomy, and conventional vasectomy are low-technology procedures requiring relatively simple, locally produced instruments, e.g., retractors, forceps, and scalpels. High-technology equipment consists of specialized items, e.g., laparoscopes and culdoscopes. These are produced in a limited number of technically advanced countries. Equipment donor agencies are discussed. The following factors must be considered in selecting equipment: 1) suitability for the intended procedures, 2) quality of the instrument, 3) ease of repair, and 4) initial cost. Each type of equipment is pictured, diagrammed, described, and charted against others of its kind. Maintenance and repair guidelines are provided.