甘肃省2006年预防接种安全注射现状调查分析

目的：通过对甘肃省2006年预防接种安全注射开展状况进行调查研究，了解在全球疫苗免疫联盟（简称GAVI）项目启动后，甘肃省基层接种点预防接种安全出现的新问题并提出改进策略。方法：采用分层多阶段抽样方法对全省20％的接种点进行安全注射现况调查。结果：调查接种点注射器使用以一次性和自毁型注射器为主，占68．47％；部分农村接种点仍有使用玻璃注射器现象，占3．23％，100％达到“一人一针一管”；使用后的一次性注射器安全处理率达95％以上，但各级仍存在丢弃、掩埋等不安全处理，约为3％～1％。结论：随着一次性注射器及自毁型注射器的推广使用，使用后如何合理回收和处理使用过的一次性注射器是目前安全注射面临的严重挑战，同时，卫生人员安全注射知识的强化和卫生管理的薄弱也是影响甘肃本省预防接种安全注射实施的因素。     

重庆市武隆县医疗机构安全注射现况调查

目的：了解重庆市武隆县医疗机构安全注射现况，为采取干预措施提供依据。方法：用统一设计的调查表对注射服务机构和人员进行调查。结果：52．2％（12／23）的医疗机构玻璃注射器消毒不合格、31．4％（11／35）的医疗机构注射操作不正确、63．6％（21／33）的医疗机构直接丢弃用过的一次性注射器。存在以上至少1种不安全注射行为的医疗机构有77．1％（27／35）。结论：青霉素皮肤过敏试验共用针管的不正确操作、医务工作者销毁注射器被刺伤、一次性注射器卫生质量管理空白是目前主要的不安全因素。培训医务人员的正确注射行为、重视一次性注射器的卫生质量管理和用后的安全处理是提高安全注射水平的重要措施。     

山东、陕西两省部分城乡医疗机构安全注射现状调查

通过对山东、陕西两省部分城乡地区医疗机构预防接种和医疗注射现状的调查，发现两省市级医疗机构预防接种和医疗(肌注)一次性注射器使用率达100％；陕西被调查村级诊所预防接种中存在一次性注射器与玻璃注射器混合使用的情况；仍有些村级诊所使用简单的水煮沸或热水冲洗消毒玻璃注射器的现象；简单焚烧和掩埋使用过的一次性注射器是农村诊所常用方法。建议进一步加强村级卫生人员安全注射意识教育，严格预防接种中医疗注射器使用、消毒、处理的监管措施，确保城乡居民预防接种安全。     

四川省基层接种点安全注射现状调查结果分析

目的 了解四川省基层接种点预防接种安全注射现状以及接种人员和儿童家长对安全注射的认知水平,探讨控制不安全注射行为的策略. 方法用分层多阶段随机抽样方法抽取四川省150个抽样单位,采取现场调查和问卷的形式对150个基层接种点、310名接种人员、305名儿童家长进行调查,数据用Excel软件进行统计分析. 结果目前四川省基层接种点开展预防接种时全部使用一次性或自毁型注射器,比1999年一次性注射器的使用比例(45.60%)大幅度提高.作为医用垃圾统一运走和焚烧后深埋是四川省目前一次性及自毁型注射器使用后处理的主要方式(79.33%).基层接种人员对安全注射知识的认知水平较低,不合格率接近50%,尤以农村地区突出.儿童家长对安全注射的认知水平较好. 结论应采取加强基层接种点注射器使用后的处理回收、强化基层接种人员的安全注射意识和职业道德、加强督导调查以及开展广泛宣传等多项干预措施,提高四川省安全注射水平.     

河南省农村部分地区不安全注射的现况调查

目的了解河南省农村部分地区安全注射现状，以及卫生服务人员对安全注射的认知、存在的安全隐患等问题，以便为采取干预措施提供依据。方法采用分层多阶段随机抽样法。对河南省3城市所辖3个县13个乡（镇）卫生院，128个村卫生所的239名医护人员进行调查，采取当面问卷调查和现场观察相结合的方法对其注射器材的使用和管理以及安全注射的认知等内容进行调查。结果在一次性注射器处理中，64．94％的注射器进行了焚烧，重复使用和丢弃分别占1．95％和11．69％。在认知方面，有24．70％的乡村医护人员不清楚不安全注射可造成血源性疾病及其危害性；认为使用同一针管只更换针头不会有问题的占6．30％，接种人数多或缺少注射器时，认为可以只换针头方式注射的占14．60％；有27．62％的乡村医护人员不清楚安全注射的定义。在过去半年里曾被用过的注射器刺伤的乡村医护人员占15．06％。结论在河南省农村基层卫生工作中，不同程度地存在着不安全注射问题，乡村医生安全注射知识水平及规范化注射意识，特别是对不安全注射引起传染病及危害性后果的认识亟待进一步提高。     

广西部分农村安全注射实践及认知水平调查

目的 了解广西农村地区安全注射实践操作、乡村医生和农村群众对安全注射的认知水平和安全注射实践行为。方法采用WHO推荐的《安全注射-消毒与实践操作调查表》并补充了部分内容，对广西5个县的24个村卫生室、36名乡村医生和42名就诊病人进行了调查。结果 村卫生所日均门诊为10人次，门诊病人人均注射率为0，64次，临床治疗使用玻璃注射器的占50％，预防接种使用一次性注射器的占640k，，采用一人一针一管的占79％，采用多人一管的占21％；玻璃注射器灭菌采用水洗加浸泡的村卫生所占9％，煮沸的占9％．用高压消毒锅的占82％；一次性注射器用后处理：焚烧的占50％，扔进垃圾的占42％；，埋入地下的占4％，给私人收购的占4％；69％的乡村医生受过安全注射知识培训，其余31％通过其他途径了解安全注射知识；95％的农村病人无安全注射概念，85％的病人认为打针比吃药更有效。结论乡村医生和农村群众对安全注射的认知较低、受经济利益驱动是造成注射频率高、多人一管、不正确处理已使用过的一次性注射器、不严格消毒等不安全注射的主要原因。提示加大对群众安全注射知识的宣传、进一步推广一次性注射器的使用、制定和规范一次性注射器材的采购与回收处理程序、加强对乡村医生培训督导应是今后我区农村安全注射管理与实施的工作重点。     

120位居民接受注射安全性调查的结果与分析

通过对随机抽取的南阳市１２０位居民近期内接受注射安全性的调查,分析后认为：安全注射在部分医疗卫生单位（尤其是村级卫生所）存在问题较为严重;预防接种与其他治疗注射安全性差别不大;专职护理人员操作的安全性要高于其他兼职医务人员;使用一次性注射器的安全注射比例大于使用玻璃注射患者;不安全注射发生异常反应的概率极大。     

甘肃省部分县预防接种点注射器使用干预研究

目的：了解甘肃省全省预防接种注射器使用、处理情况，评价自毁型注射器（AD）在全省预防接种中的效果、影响，为卫生行政部门进行预防接种安全注射管理提供依据。方法：在全省按照典型抽样方法抽取3个县，设立对照组和干预组，采取问卷调查、现场观察等措施，并进行统计学分析评价。结果：干预前，对照乡和干预乡在预防接种工作中都使用一次性注射器，部分使用AD注射器，使用后仍有一定比例的接种人员采取掩埋、随意丢弃的方式进行处理；在干预后，干预组村医在注射器材使用后100％都能对使用后一次性注射器进行安全处理，并认为使用AD注射器可以促进安全注射工作，而对照乡人仍有部分村医不能正确处理使用后的注射器；干预乡的儿童监护人有152人（90．77％）选择使用AD注射器进行预防接种，明显高于对照组。结论：各接种点在配发足量的一次性白毁型注射器，以及对村医进行经常性、短期的强化培训，可以明显提高村医使用安全注射器以及正确处理注射器，达到安全注射的要求。     

甘肃省不同经济状况地区预防接种安全注射现状调查

为了解甘肃省不同经济状况地区预防接种安全注射现状,1999年7月结合世界银行贷款疾病预防(卫生Ⅶ)项目计划免疫子项目接种率及影响因素调查,抽取部分接种点进行相关调查.结果显示调查接种点中达到"一人一针一管”的占53.1%,单纯使用一次性注射器的占16.9%;农村大部分接种点使用玻璃注射器或同时使用玻璃注射器及一次性注射器;灭菌方式由以往煮沸为主变为以高压蒸汽为主;接种人员安全注射知识较缺乏、接种点缺乏足够的注射器材是造成不安全注射的主要原因.今后应重视和加强预防接种安全注射工作,采取培训、宣传、督导检查、配备补充注射器材等综合措施,确保预防接种中达到安全注射.     

湖南省162个基层预防接种点安全注射状况调查分析

为了解湖南省基层预防接种安全注射状况，促进安全注射，采取分层多阶段随机抽样方法，对162个基层预防接种点安全注射现状进行了调查。接种点以一次性注射器和玻璃注射器为主，安全注射率为46．30％，村级和使用玻璃注射器的接种点安全注射率相对较低。只有35．18％的基层预防接种人员能够正确认识不安全注射的危害。对如何提高基层预防接种点安全注射水平提出了建议。     

Injection practices among nurses--Vâlcea, Romania, 1998

In the early 1990s, human immunodeficiency virus (HIV) infection associated with possible reuse of syringes and needles was reported among children in Romanian orphanages. These findings led health-care workers to use new disposable syringes and needles for administering injections. Bythe late 1990s, reports suggested that new disposable syringes and needles had become standard for all injections. However, surveillance data collected by the Romanian Ministry of Health (MoH) during 1997-1998 indicated that acute hepatitis B virus (HBV) infection was associated with receiving injections among children aged <5 years. In Romania, injection frequently is used to administer medication, and nurses administer most injections. To identify the practices that might have resulted in injection-associated HBV transmission, selected clinic and hospital nurses were surveyed. This report summarizes the findings of the survey, which indicated that although nurses used new disposable syringes and needles, other inadequate infection-control practices might explain injection-associated HBV transmission. Results of the survey were used by the Romanian Coalition to Prevent Nosocomial Infections to prepare standards for injection safety to protect patients and health-care workers from HBV infection.     

Risk of transmission of hepatitis B virus through childhood immunization in northwestern China

Transmission of bloodborne pathogens by means of unsafe injection practices is a significant public health problem in developing countries. Although the overall proportion for immunization is low among injections, unsafe immunization practices affect mostly infants, a population with an increased likelihood of becoming hepatitis B virus carriers. This study estimated the prevalence of unsafe injection among vaccinators working at the peripheral level in northwestern China and the risk of HBV infections among infant vaccinees, and analyzed factors contributing to the most prevalent unsafe practice: the reuse of a non-sterilized reusable syringe among infants. A knowledge-attitude-practice survey was conducted in which 180 peripheral vaccinators selected by multi-stage cluster sampling in each of four provinces and one autonomous region completed a self-administered questionnaire. The lack of observational data for assessing the validity of the self-reported practices made the study prone to systematic respondent bias that may have skewed the results towards underestimation of unsafe practices. The minimum estimate of the percentage of peripheral vaccinators reusing a syringe and/or needle without sterilization between infants was 7.2-55.0%, whereas the percentage of those disposing of used disposable syringes and needles inappropriately was 8.9-23.3% by province. According to a model-based estimate, the annual number of HBV infections among 100,000 fully immunized children due to unsafe immunization injection was at least 135-3120. An insufficient supply of syringes and the attitude to justify reuse were significantly associated with the unsafe reuse of a reusable syringe in most part of the area studied. Introduction of auto-disable syringes may contribute to curb the unsafe practices, but the development of safe collection and disposal procedures for used syringes and needles is prerequisite. Sufficient supply of equipment as well as training, supervision, and monitoring targeting specifically on the risk behaviors and concerned attitudes are essential for behavior changes among the vaccinators.     

河南省农村地区一次性注射器处理方式的调查

目的：了解河南省农村地区一次性注射器处理方式的现状，通过现场调查收集并分析相关资料，以便为采取干预措施提供依据。方法：采用分层多阶段随机抽样法，对河南省3城市所辖3个县13个乡（镇）卫生院、128个村卫生所的调查，采取问卷调查和现场观察相结合的方法对其注射器材的处理和管理等内容进行调查。结果：在一次性注射器处理中，64．94％的注射器进行了焚烧；重复使用和丢弃分别占1．95％和11．69％。结论；在河南省农村基层卫生工作中，在一次性注射器的处理上较为混乱，存在较大隐患。进一步加强农村卫生机构注射器的使用、消毒和处理的监督管理力度，仍是今后实施安全注射工作的重点     

Hepatitis B control in China: knowledge and practices among village doctors.

OBJECTIVES. To guide development of a hepatitis B control program in China, we investigated village doctors' sterilization practices, injection use, vaccination levels, and knowledge and counseling skills. METHODS. The head doctor from each village health station in a rural county (n = 260) completed a self-administered questionnaire. RESULTS. Of the respondents, 94.2% reported adequate sterilization of needles; however, inadequate sterilization of syringes and acupuncture needles was common. Injections were found to be frequent and profitable. Of head doctors, 16.2% reported that most infants in their villages are vaccinated against hepatitis B. There was very high knowledge of modes of hepatitis B transmission, but it was not used to formulate advice for a hypothetical carrier. Knowledge of the consequences, prevalence, and use of condoms to prevent sexual transmission was lower. CONCLUSIONS. The sterilization of acupuncture needles, reuse of syringes, and frequent injections are practices that may transmit the hepatitis B virus. Research into issues of vaccine acceptance is needed to expand immunization. A review of treatment practices and better training in counseling for village doctors is suggested.     

Contamination of medicine injection paraphernalia used by registered medical practitioners in south India: an ethnographic study

While considerable attention has been directed at the important role of intravenous drug use in the spread of human immunodeficiency virus (HIV) and hepatitis B, little research to date has been conducted on the role of medicine injections in disease transmission. This is the case despite the fact that (a) the number of medicine injections is several orders of magnitude greater than injections of illegal drugs and (b) the networks of people potentially affected by contaminated medicine injection paraphernalia is far wider. In this article we examine the medicine injecting practices of a random sample of 40 registered medical practitioners (RMP) who have not had formal training in allopathic medicine (do not have MBBS or MD degrees) in Tamil Nadu, India. Attention is drawn to: (a) the lack of vigilance practitioners exercise in maintaining hygienic needles and syringes, (b) their perceptions of what constitutes acceptable hygienic procedure and (c) how patients respond in contexts where they are able to purchase disposable needles and syringes directly from practitioners or from the open market prior to visiting a practitioner. Study results are a cause for alarm and indicate widespread contamination of injection paraphernalia as well as common reuse of disposable needles. The study was confined to RMPs and the researchers strongly suggest that future studies of MBBS trained doctors practising in the public and private sectors be carried out. A structured observation instrument developed to record needle and syringe contamination during the process of injection administration is provided.     

卫生保健工作者安全注射的知识、态度和实践的快速评诂

目的　收集卫生机构卫生保健工作者中关于注射的知识、态度和实践方面的定性和半定量信息 ,估计各种注射者实施的对患者、提供者和社区无害的注射的百分比。方法　采用SIGN提供的标准化工具对卫生保健工作者进行访谈。采用直接观察法 ,标准化问卷和焦点组访谈在处方者、注射者和处理医疗废弃物的后勤人员中收集定性和半定量信息。结果　每个处方者平均每周要接待 87 9名患者 ,其中 35 2 %会开出注射处方。在调查的 935份有效处方中 ,4 7 8%至少包括 1次注射。访问的 10 0名护士中 ,平均每人每周要实施 90 9次注射 ,其中 12 1%的注射是用于免疫的。在这 10 0名护士中 ,有 75 %报告在过去 1年中受到过尖锐物刺伤。每名护士平均每天要给 32名患者分配药物 ,其中 73 4 %的患者会接受注射。结论　即使在目前对AIDS的认识不断提高的情况下 ,注射在上海的使用程度仍然很高 ;一些因素提示卫生保健者对过度使用注射起到了一些作用 ;虽然在上海已经建立了一套有效的注射提供、管理、监督和废弃物处理体系 ,但是在注射者和医疗废弃物处理人员中仍时常发生尖锐物刺伤 ;一次性注射器和针头已经完全被医疗人员和患者所接受     

Reducing the risk of unsafe injections in immunization programmes: financial and operational implications of various injection technologies.

The unsafe use and disposal of injection equipment continues to put patients, health care workers, and the general community at risk of infections such as hepatitis B virus and human immunodeficiency virus. Although the potential for unsafe injection practices varies substantially with the type of equipment that is used, technology alone cannot totally eliminate the risk. A knowledge of the cost, practicality and, most importantly, the potential for misuse, is critical for selecting the most appropriate injection equipment for each immunization setting. Four types of injection equipment are currently available for administering vaccines: sterilizable needles and syringes; standard disposable needles and syringes; autodestruct needles and syringes; and jet injectors. In general, the cost per injection is lowest with sterilizable equipment and highest with autodestruct. However, only autodestruct syringes virtually eliminate the risk of unsafe injection practices. Owing to differences in cost and programme factors, in some settings it may be appropriate to use a combination of equipment. For example, autodestruct syringes may be used in areas where it is difficult to ensure adequate supervision, while in medium-sized, fixed-site clinics with safe injection practices, sterilizable equipment will be the most cost-effective.     

Injection practices in southern part of India

The World Health Organization defines 'a safe injection' as one that does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in any waste that is dangerous to the community. Irrational and unsafe injection practices are rife in developing countries. The objective of the present study was to assess the injection practices in the state of Tamilnadu, India, using the Rapid assessment and response guide of the Safe Injection Global Network of the World Health Organization. Thirty-nine prescribers, 62 providers, and 175 members of the general public were interviewed. The areas were chosen out of convenience while at the same time adhering to the guidelines. The study was carried out between April and June 2001. The per capita injection rate was 2.4 per year. The ratio of therapeutic to immunization injections was 6.5:1, and the proportion of injections given with a disposable syringe and needle was 35.4%. Knowledge about diseases transmitted by unsafe injections, for example involving human immunodeficiency virus and hepatitis B virus, was greater among all the study groups. The annual incidence of needlestick injuries among providers was 23.6, which is extremely high. It is concluded that there are deficiencies in practice such as an excessive, unwarranted usage of injections, a sizeable prevalence of unsafe injection practices, the short supply of injection equipment leading to a high incidence of needlestick injuries, a low proportion of hepatitis B virus immunization among providers, and a lack of adequate sharps containers and disposal facilities in this part of India. It is suggested that immediate and long-term remedial measures, such as the education of prescribers to reduce the number of injections to a bare minimum, an adequate supply of injection equipment, provider protection with immunization for hepatitis B virus, the provision of adequate sharps containers with safe disposal facilities and, not least, community education, be undertaken to avoid the future epidemic of transmissible diseases.