Safe and newer injection technologies

The different technologies available in safe injection practices can be categorised as: (1) Auto disable syringes for immunisation. (2) Prefilled devices. (3) Reuse prevention syringes for curative injections. (4) New safety devices which include safe blood draw and NSI prevention devices. Auto disable syringes are preferred over normal disposable syringes because of its safety and can be used with minimal amount of training. These syringes improved vaccination coverage rates and are being currently introduced in country EPI. Uniject prefill injection device ensures safety by various ways. There are also reuse prevention syringes for curative injections. The new safety devices have also been discussed in a nutshell.     

Injection safety and Indian Academy of Pediatrics

A major proportion of injections administered in India are unsafe. Unsafety is due to (1) steps that are associated with increased risk of spread of blood borne viruses and (2) errors related to technique of injection and faulty habits. Recommendations of Indian Academy of Pediatrics revolve round the following points: Equipment related, safe injection practices, best injection techniques, rational injection practices, prevention of needle stick injuries and reducing disease transmission recommendation for HIV-PEP (postexposure prophylaxis), HBV-PEP, disposal of syringes and sharps. The points have been discussed elaborately.     

Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology,education and engineering

OBJECTIVE: To describe the frequency, cause and potential cost of prevention of hollow-bore dirty needlestick injury (NSI) sustained by healthcare workers. DESIGN AND PARTICIPANTS: Ten-year prospective surveillance study, 1990-1999, with triennial anonymous questionnaire surveys of nursing staff. SETTING: 800-bed university tertiary referral hospital in Brisbane, Australia. MAIN OUTCOME MEASURES: Rates and circumstances of NSI in medical, nursing and non-clinical staff; knowledge of NSI consequences in nurses; and minimum costs of safety devices. RESULTS: Between 1990 and 1999, there was a significant increase (P < 0.001) in the trend of the reported rate of NSI. Of the 1836 "dirty" NSIs reported, most were sustained in nursing (66.2%) and medical (16.8%) staff, with 62.7% sustained before disposal. Hollow-bore injuries from hypodermic needles (83.3%) and winged butterfly needles (9.8%) were over-represented. Knowledge among nursing staff of some of the risks and outcomes of NSI improved over the decade. A trend (chi(2 )= 9.89; df = 9; P = 0.0016) with increasing rate of reported injuries in this group was detected. The estimated cost of consumables only, associated with the introduction of self-retracting safety syringes with concomitant elimination of butterfly needles, where practicable, would be about $365 000 per year. CONCLUSION: More than one NSI occurs for every two days of hospital operation. Introduction of self-retracting safety syringes and elimination of butterfly needles should reduce the current hollow-bore NSI by more than 70% and almost halve the total incidence of NSI.     

平凉市基层预防接种安全注射干预措施效果评价

目的探讨综合干预措施对促进基层预防接种安全的效果,为制定预防接种安全注射评价体系提供依据。方法采用典型抽样的方法,抽取平凉市2个经济欠发达的县,每个县随机抽取2个乡（分为对照组与干预组）;对干预组实施干预,一年后对2组进行问卷调查,数据采用χ^2检验,P〈0.05为差异有统计学意义。结果干预后干预组村医在＂接种前告知和询问＂、＂接种后观察＂、＂注射器使用后正确处理＂及＂安全注射相关知识知晓＂四项正确率均显著提高,分别由干预前的45.71%,54.29%,82.86%,54.29%提高至97.14%,100.00%,100.00%和94.29%,而对照组提高不明显,干预后干预组与对照组比较差异有统计学意义（P〈0.05）;干预后儿童家长对＂不安全注射会传染疾病＂、＂打疫苗时要求一次性注射器＂、＂乙肝的传播途径＂、＂疫苗预防的病种＂等知识知晓率显著提高,与对照组比较,差异有统计学意义（P〈0.05）。结论对村医开展经常化培训、广泛宣传以及经常性督导检查是促进预防接种安全注射的有效措施。     

一次性输液器组成材料的可提取物研究

针对5个不同厂家的一次性输液器进行提取试验,采用顶空GC-MS对其中易挥发性物质进行分析,采用GC-MS对其中挥发和半挥发性物质进行分析,电离方式EI,质量扫描范围m/z 30~650。采用香兰素作为内标物监控整个处理过程,并分别比较液-液萃取法和固相萃取法两种提取方法的差异。提取试验分别选择HCl,NaOH,吐温80,乙醇-水溶液作为提取溶剂,比较一次性输液器组成材料中可提取物的种类差异。结果表明,所建立的分析测试方法可靠,能够准确、灵敏地检测出输液器中所含的挥发性成分,获得材料中可提取物的信息,从而达到对一次性输液器安全性考察的目的。     

Atypical mycobcterial injection abscess

Other than suppurative organisms, atypical mycobacteria are also known to cause injection abscesses following vaccinations, injections, tattooing and even after implants. Though the usage of disposable needles is practised universally, sporadic cases do occur. The disease entity should be considered, while dealing with injection abscesses, to institute specific therapy. Acid-fast bacilli should be looked for in the pus and mycobacterial culture of the material from injection abscesses should be done for a definitive diagnosis.     

HOW SAFE IS YOUR HOSPITAL - DOCTOR?

The use of disposable syringes, needles and other ‘disposable’ items has gained wide popularity in hospital practice. The supposed advantages are ensuring sterility and preventing the spread of infection from patient to patient. However are these aims really being met? In the present state of awareness and disposal procedures being followed we are not achieving aims and it may even be more prudent to go back to the glass syringes with proper autoclaving facilities. Alternatively there is the need to improve the disposal facilities in hospitals for the disposable articles.KEY WORDS: Disposable equipment, Syringes, Infection controlUse of needles and syringes has revolutionized the medical practice. It is amazing that syringe was used for the first time by Alexander Fleming in 1910 to administer Salvarasan nicknamed ‘606’ for the treatment of syphilis. We have come a long way since. Today we cannot imagine a modern hospital without syringes and needles. Every medical practitioner frequently uses needles and syringes either for drug administration or to obtain a specimen of blood, fluid or tissue for diagnostic tests.In not so distant past, glass syringes were the norm - the user being responsible for its proper sterilization and maintenance. Some practitioners still use them, though, these are now near extinct species. The plastic age, with the advent of plastic syringes, shifted the onus of sterilization from the user to the manufacturer. Doctors were more than happy to cast off the responsibility of sterilizing the syringes and needles and grabbed the plastic syringes. The genie of “disposable” articles was thus unbottled. The catalog of so called disposables now includes syringes, needles, catheters, cannulae, gloves, intravenous drip sets, blood taking sets, the tiles and tubes used in labs, specimen collection containers, and others. These “disposable” plastic articles have some distinct advantages :

• a)These are easy to store, nonbreakable, have long shelf life and are ready to use. It is common practice among doctors and nurses to carry such ready-to-use articles in their pockets.
• b)The needles accompanying these syringes are very sharp, easy to use and the jab is less painful to the patient. The reusable conventional all - metal hypodermic needles get blunted due to repeated use, and the jabs are distinctly painful.
• c)The cumbersome process of washing and sterilizing the glass syringes is eliminated.
• d)The plastic ware are the “in” thing, are extensively used in Western world, therefore, appear fashionable and glamorous to both, the patients and the medics.

These are some of the obvious reasons why plastic ware have become not only acceptable but almost a necessity in modern medical practice. The manufacturers promote and propagate their use with obvious eyes on the profit margins.But it all appears too good to be true and benign. Every leisure, every perk is counterbalanced by undeclared responsibility. Often we forget or disregard, sometimes unknowingly but mostly consciously, these coexisting additional responsibilities and the restraints.The privilege of use of plasticware thrusts upon us some such responsibilities. These are :

• a)Proper and safe disposal.
• b)Destruction of the “disposable” to prevent recycling.

The ideal way of disposal and destruction of these plastic ware involves following steps :

• a)All these articles after use must be dipped in suitable disinfectant solution for few hours to reduce the load of pathogens.
• b)These must then be shredded or incinerated to destroy the item completely to prevent recycling.

The ideal is defined as conjectural, therefore, unachievable - rightly so. Specially in our circumstances, safe disposal is almost unheard-of. Neither the paramedics are educated and motivated adequately nor are the wherewithal for such safe disposal available.Let us peep in one of the busy wards of our hospitals and see what really transpires. For the sake of simplicity let us take the case of syringes and needles. On an average, every patient in these wards needs two jabs a day - either to take the specimen or to administer a drug. It means about 100 jabs in a 50 bedded ward - and that many syringes and needles per day, which the ward never ever gets. But our staff is not deterred by such obstacles, the resident doctors and nurses have to be perpetually on syringe hunt - begging, borrowing AND (not or) lifting them from wherever they can - including consultants'' lockers or colleagues'' pockets. But there is never enough for everyone due to the prohibitive cost and enormous number of these syringes required.Ingenuity comes in handy in such circumstances. Following are some of the commonly resorted ways. Each patient is allotted a syringe - to be used repeatedly for few days before discarding. Or the patients are “pooled” around a syringe and needle, same needle and syringe being used on a group of them. Sometimes syringes are considered “superfluous” while collecting blood samples - or in dire circumstances the “flush” technique is followed. It is simple - just flush the used syringe with saline - and hopefully out go all those “bad” bugs, the syringe is ready for the next in line. Just pray that it is not you!! That much for the principles of asepsis and sterilisation. Some patients - the elite educated ones come with their own syringes and needles as a respite - though not often.After the poor syringe and needle have done their tour of duty through the ward or Out Patient Department (OPD), they go to their resting place - not an antiseptic container but usually a cardboard “khokha”. Such a “khokha” gallantly displays its scars and the blood of the victims on its walls. The “khokha” is also the resort of used bandages, dressings, gauze pieces, cotton swabs, used gloves, broken glass pieces of phials, empty vials and waste papers. The venerable Class IV employee, with his bare hands scoops up the contents for their onward journey to - incinerator? Well you missed it again. It is the garbage dump near the incinerator. It is obvious because the road to incinerator is paved with bramble, broken glass bottles, sharply cut tins etc and in any case - who remembers seeing any embers or smoke in the incinerator? The garbage dump is much easily approachable and magnanimous. In some places these used syringes and needles are returned to the medical store - the all encompassing accounting procedure must be followed before issuing the fresh indent! Despite this small detour, what ever the route may be, the ultimate destination is the garbage dump.We all believe in rebirth. From the soil unto soil - and from the soil again. In come our rag pickers. They too have their own specializations and hierarchy - some go only for papers, others for polythenes while the ones in higher echelons go only for hard plastic moulded wares - the syringes, the catheters and the like. These are value added items and fetch better returns than other items. But it is hard work - rummaging through these heaps braving the sun and competing the stray dogs, one manages a bagful of these goodies in a day. So what if in the course of such treasure hunt one gets few jabs from unsheathed needles or cuts due to sharp glass pieces? A severe cut is usually dressed with gauze and bandage readily available in the same dump! All that talk about HIV, hepatitis viruses and other germs getting through these pricks and cuts is only figment of someone''s imagination. The thought of contracting these diseases is a luxury the rag picker can ill afford. The effort is worth it, as a bagful of syringes and needles fetch handsome Rs 5–10 per kilo - enough for a meal to pull him through the night.A number of companies dealing with disposable plastic wares have sprung up in last few years. These are very kind in accepting all these syringes and needles from poor rag pickers. They contribute to the ever increasing industrial “production” by repacking and marketing these items. Since their inputs are minimal, they successfully bag most of the contracts on the basis of lowest quotation. And there comes the old syringe wrapped in stylish labels - “DISPOSABLE HYPODERMIC SYRINGE, STERILE, NONTOXIC, PYROGEN FREE” “Destroy after single use” is normally in the tiniest print and not readable. After all, how many of us can recount the birth and lives our souls have gone through? Why bother about a lowly syringe and needle?     

Antibodies to the human immunodeficiency virus in needles and syringes used by intravenous drug abusers

The sharing of needles and syringes by intravenous drug abusers has been recognized as a critical factor in the transmission of the human immunodeficiency virus (HIV). In an attempt to reduce the sharing of needles and syringes among intravenous drug abusers, a pilot sterile needle-and-syringe exchange programme was established in an inner city neighbourhood in Sydney. The contents of exchanged syringes were screened for antibody to HIV by the enzyme-linked immunosorbent assay (ELISA); reactive and borderline samples were tested further by the Western Blot method. Of a sample of 300 needles-and-syringes that were exchanged, three (1%) needles-and-syringes were confirmed as containing antibody-seropositive blood by both ELISA and Western Blot methods and thus as being potentially infectious. As only 70% of known positive-control syringes were detected in this study, the proportion of potentially infectious needles-and-syringes that was found may have underestimated the proportion of infectious injection equipment that was returned. These findings highlight the importance of the removal of used needles and syringes from circulation in addition to the supply of sterile equipment. This method of monitoring exchanged needles-and-syringes is suggested as a means to evaluate measures that are designed to reduce the transmission of HIV among intravenous drug abusers. The rapid implementation of sterile needle-and-syringe exchange programmes is imperative to stem the spread of HIV infection.     

开塞露不同肛注方法在骨科便秘患者中的效果比较

目的:比较开塞露两种不同肛注方法在骨科便秘患者中的通便效果。方法:将160例骨科住院便秘患者随机平均分为试验组和对照组,分别采用使用一次性注射器连接吸痰管肛注开塞露和传统方法肛注开塞露,观察通便效果。结果:试验组与对照组患者不同通便有效率分别为97.5%与71.3%,组间比较差异有统计学意义(χ2=20.9,P<0.01)。结论:采用一次性注射器连接吸痰管肛注开塞露的通便效果优于传统开塞露肛注法。     

Injection technique

Injection means the administration of a substance into the skin, subcutaneous tissue, muscle tissue or vein. So far the information is available, it is found that a major proportion of injections administered in India are unsafe. Technique of injection and faulty habits are the reasons of unsafe injections. Intravenous, intramuscular, subcutaneous are most frequently used parenteral routes. Different needle positions while administering injections, preferred site, size and-length of the needle are all discussed while safe injection practices are taken into consideration.     

Lawful, non-burn options for injection waste disposal

The Government of India has decided to introduce auto disable syringes in the entire country for immunisation which means a lot of immunisation injection waste gets generated in the process. There is a need for managing immunisation waste to avoid occupational risk, risk to the public and also the indirect risks via the environment. Treatment technology options for safe management waste at different locations is elaborated in this article.     

HIV risk behaviour among injecting drug users in Perth: the Australian National AIDS and Injecting Drug Use Study.

OBJECTIVE: This study was carried out in 1989 to examine behaviour involving risk of human immunodeficiency virus (HIV) infection and to measure the prevalence of HIV antibodies in a sample of injecting drug users (IDUs) in Perth. DESIGN: The study was a cross-sectional survey with a sample of convenience of 196 IDUs drawn from drug treatment (54%) and non-treatment (46%) populations. RESULTS: Sixty-five per cent of the sample were men and 35% women. Subjects were predominantly heterosexual, were in their late twenties, had not completed secondary school, and were on sickness, unemployment or pension benefits. The majority were poly-drug users, but heroin and amphetamines were the only drugs that had been injected by more than 20% of the sample more than once a month. Respondents reported injecting an average of 43.6 (SD 83.6) times a month and using 33.7 (SD 55.4) new needles a month. The majority (70%) had injected within weeks of the interview. Sixty-seven per cent had shared needles within months. Respondents claimed to pass on used needles more frequently than to accept them, and were most likely to share with close friends or lovers when clean needles were unavailable and/or when they were withdrawing. While most respondents cleaned used needles, few used bleach all or most of the time. Most (78%) respondents had been tested for HIV seropositivity at least once. Most had multiple sexual partners and 92.3% had engaged in at least one unsafe sexual practice during the previous six months. Sixty-four per cent had changed some aspect of drug using, and 38% some aspect of sexual behaviour since hearing about the acquired immunodeficiency syndrome (AIDS). HIV seroprevalence for the 179 respondents who were tested was 2.2%, but this figure should not be taken as an estimate of seroprevalence for the Perth IDU population. CONCLUSION: Respondents' behaviour placed them at a high level of risk for HIV infection. Based on reported behaviour, it is recommended that education for IDUs in Perth should emphasise, among other things: not passing on used needles; cleaning used needles and syringes with bleach; planning ahead so that sterile equipment is available; and further risk reduction, particularly the adoption of safer sexual practices.     

洪江区吸毒人群中针具交换项目实施效果评价

目的探讨在注射吸毒人群中开展针具交换的可行性，评价其预防注射吸毒者HIV感染效果。方法通过政策倡导、同伴教育和行为干预及健康教育，在社区开展清洁针具交换。结果开展清洁针具交换活动后发放和销售针具比基线调查时上升了173．91％，注射吸毒人员最近一次共针率从31．86％下降到12、87％，最后一次性行为安全套使用率、吸毒人员艾滋病知识知晓率分别从33．66％和20．79％上升到70．80％和80．7％。结论在吸毒人群中开展健康教育和以同伴教育为主的针具交换活动有助于提高吸毒人员对艾滋病相关知识的认识，改变危险行为．控制艾滋病传播。     

上海市部分医疗机构中的医生有关注射安全实践的预调查

目的:对世界卫生组织全球注射网络(SIGN)提供的快速评估工具在中国环境中进行预试,收集上海市部分医疗机构中的医生们在注射安全的知识、态度和实践方面的定性和半定量信息.方法:采用SIGN提供的标准化调查问卷对医生进行访谈,并采用焦点组访谈的方式收集有注射安全方面的额外信息.结果:在调查样本中,每名医生平均每周医治87.9例患者,并给其中35.2%的患者开出了注射处方.在调查的935份合格处方中,有47.8%的处方包括了至少1次注射.在100名被调查的医生中,只有22%认为自己开出了过多的注射处方.结论:即使在人们对AIDS的认识越来越多的时候,注射在上海的卫生医疗机构中的使用频率仍然很高,调查研究表明,医生在过度应用注射中起了一定的作用.     

Development of insulin delivery systems

Delivery system of insulin is vital for its acceptance and adherence to therapy for achieving the glycemic targets. Enormous developments have occurred in the delivery system of insulin during the last twenty years and each improvement was aimed at two common goals: patients convenience and better glycemic control. Till to date, the various insulin delivery systems are: syringes/vials, injection aids, jet injectors, transmucosal delivery, transdermal delivery, external insulin infusion pump, implantable insulin pumps, insulin pens and insulin inhalers. Syringe/vial is the oldest and conventional method, still widely used and relatively cheaper. Modern plastic syringes are disposable, light weight with microfine needle for patients convenience and comfort. Oral route could be the most acceptable and viable, if the barriers can be overcome and under extensive trial. Insulin pen device is an important milestone in the delivery system of insulin as it is convenient, discrete, painless, attractive, portable with flexible life style and improved quality of life. More than 80% of European diabetic patients are using insulin pen. Future digital pen will have better memory option, blood glucose monitoring system, insulin dose calculator etc. Insulin infusion pump is a good option for the children, busy patients with flexible lifestyle and those who want to avoid multiple daily injections. Pulmonary route of insulin delivery is a promising, effective, non-invasive and acceptable alternative method. Exubera, the world first insulin inhaler was approved by FDA in 28 January 2006. But due to certain limitations, it has been withdrawn from the market in October 2007. The main concern of inhaled insulin are: long term pulmonary safety issues, cost effectiveness and user friendly device. In future, more acceptable and cost effective insulin inhaler will be introduced. Newer avenues are under extensive trial for better future insulin delivery systems.     

奉化市预防接种安全注射现状调查

目的 为了解奉化市各预防接种点预防接种安全注射现状，促进预防接种安全注射工作。方法 采用现场调查和问卷调查等形式，对全市18个接种点进行了预防接种安全注射现状调查。结果 100．00％接种点都由奉化市疾病预防控制中心统一配发实行“一人一针一管”，并实行使用后统一上级回收；安全注射率迭96．00％以上；安全知识培训率迭96．86％；安全注射知识正确回答率为63．45％-88．28％。其中市级为85．92％-98．59％，镇（乡）级为36．49％。79．73％。结论 加强预防接种人员尤其是基层接种人员安全注射知识基本内容的培训，提高他们的安全注射意识。在知识、态度厦行为上都达到安全注射非常必要。     

门诊治疗淋巴结结核的疗效观察及护理干预

目的:探讨在局部治疗联合全身化疗方案治疗脓肿型、溃疡型淋巴结结核疗效同时,运用相应的护理措施,注重治疗过程的重要护理环节,确保医疗效果.方法:收集门诊治疗的脓肿型、溃疡型淋巴结结核83例;建立淋巴结结核门诊病人治疗档案及依从性调查表、健康教育执行登记表,并对患者进行系统的健康教育;全身化疗方案:2HRZ/7HR;局部治疗方案:清创+换药+药物封闭+缝合;观察治疗时间与疗效.结果:治疗1个月治愈36例(43.37%),2个月治愈61例(73.49%),3个月治愈83例(100%).结论:应用局部治疗联合全身化疗治疗脓肿型、溃疡型淋巴结结核能缩短治疗时间;建立淋巴结结核门诊病人档案及依从性调查,加强健康教育,提高病人的医嘱依从性是保证疗效的关键.     

门诊糖尿病人胰岛素笔用针头使用安全调查及分析

目的了解糖尿病患者胰岛素笔注射针头使用情况并进行分析,找出患者操作的误区,防止笔用针头重复使用对病人造成伤害.方法采用自行设计的胰岛素笔注射相关信息调查评价表对206例接受胰岛素笔注射的门诊病人进行评估,其中腹部注射区域皮肤状况由糖尿病专科护士进行评估,并对结果进行相关因素分析。结果胰岛素针头重复使用情况普遍,重复使用一次性胰岛素笔用针头主要与经济、年龄、文化程度、观念、风险教育有关,49.51%的患者腹部注射区域存在异常。结论糖尿病患者重复使用胰岛素注射针头现象严重,糖尿病教育需进一步加强,护理人员在指导胰岛素注射时,应针对病人的特点、学历、经济状况等因素进行教育干预,提高病人对重复使用危害性的认识,减少注射造成的损害。     

预防接种安全注射现状和影响因素分析

安全注射问题已经成为21世纪全球公共卫生领域关注的焦点问题之一。预防接种安全注射影响因素主要与一次性注射器的使用率、注射器材使用后处理及预防接种人民对安全注射的认识有关。应采取加强接种人员培训,普及使用自毁型注射器,加强注射器材安全处理等措施,以进一步提高预防接种注射安全。