Injection safety: knowledge and practice among ...

Injection safety: knowledge and practice among health workers S. Kolade Ernest Department ot Paediatrics /Child Health University of Ilorinl. Ulliversify of florin Teaching Hospiwl, !lorill, Nigeria

Summary The increase in the spread of human immune-deficiency virus (HIV) infection among our population calls for measures to check its transmission. Health workers are at risk especially those in clinical practice who work with needles and other sharp objects that could aid transmission of the virus. Professionalism is at its lowest at Primary Health Care level and workers responsible for giving imn}unization with injections need clear understanding of principles of safe injection. To appreciate how to formulate a training programme, the knowledge and practice of injection safety among the workers were assessed through the use of a questionnaire. Fifty eight percent thought only children receiving immunization were at risk of a disease, 58.3% know the diseases transmissible by needle stick injury. On reasons for prevalence of unsafe injectiqn practices, 27% suggested inadequate provision, 18.3% poverty, 17.7% ignorance, 17,2% improper disposal, 11.8% lack of surveillance and health supervision for workers and 8% negligence. On syringes and needles disposal, 53.2% suggested burning only, 2.1 % burying and 44.7% both burning and burying. Less than 9% knew that auto-destruct syringes exist while 38.9% were aware of the joint WHO and UNICEF statement on "hundling approach" in vaccine packaging. Only about 50% of respondents had facilities for disposal of needles and syringes in their health centers, 45.6% wear protective clothing during service delivery. On making injection safer 33.7% suggested re-training of health workers, 22% retraining of workers and public re-education, 16.8% suggested planning budgeting and purchasing of auto-destruct syringes, 16.5% social mobilization and advocacy and 11 % suggested the provision of facilities for disposal. It was concluded that awareness on safe injection practices was low a,mong the health workers and that their practices could put them at greater risk of needles stick injury and hence the spread of HIV and other infection among them. Training on safe injection practices is therefore recommended. Key words: Sqfe Injection Practice, Health Workers Training, HIV

Infection. Resume L'accroisement de I'infection et de la propagation de sida (syndrome immuno-defficitaire acquis) (VH!) dans notre societe attire notre attention pour mettre en relief des l11esures pour contr61er la transmission de cette maladie. Les gens charges de la sante ruhlique comrol1ent heoucoup de risques soutout le·medecin generaliste qui travaille avec les aiguilles et tout autre materiels transchan{s:1 travers les quel on pellt avoir "attaque de ce virus. Professionnalisme n'a pas assez du sens au niveau premier du souci sanitaire alors que les gens responsahles pour donner I'illlmunisation avec les piqures ont hesoin de renseignement it I'egard des regles portant sur la piqures inoffensive. On avait rediger un quentionnaire tout en soulignant I'importance d'une formation et la rratique de I'administration d'une piqures inoffensive. 58% avaient'pense que c'est surtout les enfants qui ret,:oivent I'immunisation sont en danger d'une maladie, 58,3% avaient conscients travers des blessures d'une aiguille. A I' egard des des maladies questions relatives it I'incidence de la pratique de !a piqure dangereuse. 27% disaient que c'est a cause de donnees

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inadequates, 18.3 % la pauvrete 17.7 % ignorance, 17,2 % condition malseante. 11.8% negligence des materiels et de personnel et la negligence. Aux questions relatives aux evacuation des seringues et aiguiiles. 53,3 % avaient sugere intlammee seulement, 2,1 % enterrement lOt 44,7% pour I'intlammee et l'enterrement. Moins de Y% ont col1scient qu' il y avait des seringues qui peuvent se detruire d'ul1e l11aniere aU(()lllatique, alors que 38.9% ont cOl1scient de I'exposition con-joint'e entre WHO et UNICEF J. I'egard de "BUNDLING APPROACH" on ce qui concerne I'empaquetage des vaccins. Env irons 50 % ava ient des amenagements installations d' evacuation des aiguilles et des seringues dans leurs h6pitaux, 45,6% portent des hahits de rrotection au cours de leur engagements. Atin d'assurer une securite au cours de I'e·ngagement. 33,7% avaient suggeres la formation continue des medicins generalistes, 22 % la formation continue des ouvriers, conseiller d' orientation professionne!le pour les ouvriers ainsi que pour Ie public, 16,8% avaient suggeres la oudgetisation et la fourniture de l'installation de I'auto-destruction des seringues 16.5% la mobilation sociale et Ie plaidoyer: et 11 % avaient suggeres la fourniture des amenagements rour I' evacuation des ordures. En conclusion, on avan remarque que la prise de conscience sur l'exercice de Ja piqure en offensive est en haisse parmi les ouvriers au sien de la sante ainsi. ils som en danger de ia blessure it travers I'aiguille ce qui peul provoquer I 'attaque de sida et des autres infections. Alors, nous proposons la formation sur I' exercice de la piqure inoffensive. Introduction Injection as a form of drug administration is universaliT practiced and in very many cases unavoidable if effective therapeutic dose of such drugs must be given. However, when the health rroviding system is l10t safety conscious, the process hecomes detrimemal to health. and poses serious and potentially dangerous conse4uences'. Unsafe injection is any form of injection practice that poses any health risk to the recipIent. The practices inciude multiple needle users without adequate sterilization between users and unsatisfactory disposal of needles that may encourage needle stick injury in others. This will encourage transmission of infectious diseases. After the eradication of smailpox, it became erroneously helieved by several that parental route of drug administration was the most efticacious in all cases so most people sought tor injections as a f()l'm of treatment for medical problems 1.2. The use of injection for medical treatment is common in Africa and have heen objectively rroven hy Nwnkolo and Parry2. Vincent-Ballereau lOt al-' reported the study of 4 dispensary in Burkina Faso with a mean rate of use of injection, usually intramuscular, ranging from j 18 ((j 1077 injection per 1000 consultations. Also other studies in multiple sub-saharan African countries have shown that at least 65 % of the general population received injections over a period of 2 to 5 years45. There is even higher injection rate among prostitutes in Africa7• Over 80% of peor1e attending health facilities are given one form of injection or the other and that over 30% of the injections may g be unsafe ·"·IO.lI. Records in a dispensary in Burkina Faso showed 46 consultations per needle and 230 per syringe2• Regretably, the reuse of disposahle needle and syringes was due to inadequate supply and their steril ization often inadequately. From anecwdal experiences, many of the people utilizing 6

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Injection salety: kllowle(l,f(e and practice among heallh workers- S. Kolade Emesl

health facilities in Nigeria usually demand for injections. Good doctors are recognized by their frequency of injection prescription. This is even more strongly noticeable among the Fulanis in the northern part of Nigeria. The belief that" injections are oetter" is also unintentionally reinforced by the fact that most vaccines are given by injections. If this trend is maintained, an increase in unsafe il~eciton may be expected in tile next millennium giving rise to increasing occurational hazards of exposure to HIV and other diseases as well as the recipient of such services. The absence of facilities to adequately sterilize equipment after use and the re-use of needles ti)r another individual after soaking them in disinfectants are clearly inappropriate especially when the syringes are made up of plastic materials. Ignorance of the need to prorerly dispose off used material and absence of auto-destruct or autodisabled syringes which prevenr re-use, are militating factors that call for attention. The National Immunization Days (NIDs) in Nigeria, mainly focused on Oral Polio Vaccine (OPV) administration in an attempt to eradicate poliomyelitis. However, in an attempt to increase the coverage of many antigens among our children otht:r antigens were usually included in the immunization campaigns. These added vaccines are usually those Administered by il~ections. After several rounds of NIDS, it was observed and reported that consciousness for injection safety was low among NIDs service providersl2. The National Programme on Immunization Agency (NPIA), WHO and UNICEF plan to emhark on a training and retraining programme on safe injection practices in all the states of the federations in Nigeria. Therefore, an assessment of the knowledge and practices of injection safety among service providers for National Immunizations Days (NIDs) in Jigawa State of Nigeria was done to help determine areas of focus for effective retraining programme on injection safety. The transmission of HIV through needles sticks or injections contaminated with material from an infected individual is well establishedl. However, in an untreatable disease, prevention that will reduce disease risk to zero percent level is desirable. This can only be done by starting at the tirst level of prevention. This level of prevention is by imparting knowledge of prevention into the health workers. The second level of prevention would include provision of protective clothing and autodestruct syringes. While the third leve/ would be post-exposure administration of Zidovudinel415 In order to properly set in motion the desirable ohjective of a zero percent level risk, a cohort of services providers tilr national Immunization Days (NIDs) were assessed to determine their knowledge bases and practices about safe injection. Such knowledge can help to formulate the nature of training' needed at the level of medical practice to reduce risks of unsafe injections.

Methods Health workers with the Primary Health Care department of the Jigawa State Ministry of Health and Health workers from nongovernmental organizations (NGOs) who served as volunteer workers during the National Immunization Days (NIDs) were the respondents. They were identified by the Director of Primary Health Care (PHC) and his assistant. Health workers already have identified place of primary assignment before the NIDs while volunteers workers have identitied service posts. With the use of a questionnaire, information was collected on their present knowledge and practices on injection safety in their primary place of work and NIDs posts. Such intill"lnation included knowledge about risk of needle stick il~ury, diseases likely to be transmitted, individuals at risk, causes of unsafe injection practices, syringes and needles disposal, types of syringes available and WHOIUNICEF 1997 statement on the "bundling approach". Other intilFJllation about their regular practices were collected.

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Such as type of syringes they used. syringe disposal facilities in their posts. use of protective cfothing, officer responsible for syringes/needles disposal, methods of syringes/needles disposal and suggestions on how to make injection practices more safe. Data was entered into IBM compatible microcomputer and the analysis done using Epi Inti) Version 6. Results Sufficient information was obtained from a total of 125 respondents. Ninety-two (73.6%) were males, 17(13.6%) were females ami 16(12.8%) did not indicate their sex. All have been working for hetween 5 and 20 ye:lrs and have been involved in immunization ~Ictivities. Tahle I. AI/had secondary school eliucaiton hefore their professional training. Two (1.6%) were nurses. 33(26'-+ %) were Ctlmmunity health assistant, 38(30.4) were comnllllJiry health extension workers, 1(0.8%) was comlllunity health officer. while 46(36.8%) were voluntary post workers. Five (4%) did not indicate the professions (Table 1).

Table 1 Distribution of study popltlation by sex and profession Number % Sex 9 Male 73.6 2 F~l11al~ 13.6 17 Nor 12.S I (,

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