1. The WHO injection safety assessment tool: first results SIGN Meeting 2001 New Delhi, India

2. Rationale for Assessments zAssessments identify local problems to design effective, efficient interventions zData provide baseline information, & suggest indicators for monitoring zData open the door to dialogue èOverall, it shall help countries designing and implementing a safe injection policy

3. Standard assessment of injection practices Objectives z To determine if the country meets necessary requirements for staff competence, equipment, supplies, and waste disposal z To assess if the injections are administered according to recommended best practices z To estimate the proportion of healthcare facilities where injection practices are safe

4. Methods zStandardized and representative method to allow for: yMeasuring and documenting progress yComparison across countries zSimple/structured and flexible y2-3 weeks zCan be adjusted to country needs (for instance focus on immunization and/or therapeutic injections) Standard assessment of injection practices

5. Methods (contd.) zCross sectional observational study yObservation of supplies yObservation of injections yInterview of healthcare workers zTwo stage cluster sampling y8 districts selected y10 health care centres in each district èRepresentative of the country Standard assessment of injection practices

6. The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. Safe injection assessments June 2000-August 2001 Nepal, Kyrgyzstan, Egypt, Morocco, Oman, Syria, Paraguay, Honduras, Burkina Faso, Niger, Ethiopia, Chad, Zimbabwe and Gambia

7. First results: use of injection material (based 9 available reports) z3 countries are not using sterilizable injection material any more zIn 6 countries, between 6 and 84% of observed injections are done with sterilizable material (countries in transition) z1 country is using AD-syringes for all observed immunizations zOnly 2 countries practice the bundling of vaccines, injection equipment and safety boxes for the immunization activities

8. Risk for the recipient (Use of sterile equipment for injections) y100% use of sterile equipment for all observed injections in only one country (using disposable equipment) yIn 6 countries using sterilizable equipment: xNon documented sterilisation regularly with TST spot xUse of sterile equipment between 55 and 88% xSpare parts and a 2 day supply were not available in a majority of the health facilities yCountries using AD or disposable syringes have between 85 to 100% of health facilities using sterile equipment

9. Risk for the health care worker zUse of safety-boxes observed in 60% of health facilities (0-89%) zSharps found in open containers in 80% of health facilities (34-95%) zUsed syringes recapped in 54% of health facilities (16-71%) zAt least 1 needle-stick injury in the last 12 months for 61% of health care workers (22- 76%)

10. Risk for the community zNo sharps found in the surroundings of health facility in 50% of cases (27-77%) zWaste disposal, open burning or dumping unsupervised in 39% of health facilities (18-64%) zHealth care waste policy in only 5% of the health facilities (0-9%)

11. Conclusions zThe risks for the recipient are high in countries using sterilizable equipment zThe safety of the health care worker and the community is a problem in all observed countries zLimitations in comparing across countries - the tool is designed to help individual countries to develop and implement a safe injection policy zNext step: very important to follow-up these assessments, country by country...