Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal

BMC International Health and Human Rights

P Ravi Shankar⁴  Bhuvan KC¹  Devendra S Rathore³  Sudesh Gyawali² 

[1] Department of Pharmacy, Novel Academy, Pokhara Sub-metropolitan city, Kaski, Nepal;PhD research Scholar, School of Pharmacy, Suresh Gyan Vihar University, Jaipur, India & Assistant Professor, Department of Pharmacology, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal;Department of Pharmacy, Rajasthan Pharmacy College, Jaipur, India;Department of Pharmacology, KIST Medical College, Lalitpur, Nepal

关键词: Sharp waste;    Safe injection practice;    Safety;    Nepal;    Needle stick injury;    Health care workers;    Baglung;   

Others  :  855362
DOI  :  10.1186/1472-698X-13-3

 received in 2012-08-19, accepted in 2012-12-27,  发布年份 2013

【 摘 要 】

Background

Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety.

Methodology

A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18^th May to 16^th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats.

Results

The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management.

Conclusions

Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.

【 授权许可】

   
2013 Gyawali et al; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Hutin YJF, Hauri AM, Armstrong GL: Abstract use of injections in health care settings worldwide, 2000: literature review and regional estimates. BMJ 2003, 327:1075-1078.
• [2]Drucker E, Alcabes PG, Marx PA: The injection century: massive unsterile injections and the emergence of human pathogens. Lancet 2001, 358:1989-1992.
• [3]Reid S: Preliminary results of the WHO GBD from unsafe injections [abstract]. Geneva: World Health Organization; 2010. http://who.int/injection_safety/sign/en/ webcite. In Report on Annual Meeting of the Safe Injection Global Network, 9-11 November 2010, Dubai, United Arab Emirates (Accessed 18 Dec. 2011)
• [4]Riaz H, Kamal SW, Riaz T, Aziz S, Rajper J, Noorulain W: Methods of disposal of used syringes by hepatitis B and C patients at an urban and rural setting. J Pakistan Med Asso 2012. http://jpma.org.pk/full_article_text.php?article_id=3241 webcite
• [5]Jagger J: Caring for health care workers: a global perspective. Infect Control Hosp Epedemiol 2007, 28:1-4.
• [6]Khurram M, Ijaz K, Bushra TH, Khan YN, Bhushra H, Hussain W: Needle stick injuries: a survey of doctors working at tertiary care hospitals of Rawalpindi. J Pakistan Med Asso 2011, 61:63-65.
• [7]Kermode M: Healthcare workers safety is a pre-requisite for injection safety in developing countries. Int J Infec Diseases 2004, 8:325-7.
• [8]World Health Organization (WHO): Injection safety fact sheets (April 2002). http://who.int/injection_safety/toolbox/en/InjectionFactSheet2002.pdf webcite (accessed 18 Dec. 2011)
• [9]World Health Organization (WHO): Question & Answers, Safety of injections. http://who.int/injection_safety/about/resources/en/QuestionAndAnswersInjectionSafety.pdf webcite (accessed 18 Dec. 2011)
• [10]Lloyd JS, Milstien JB: Auto-disablesyringes for immunization: issues in technology transfer. Bull World Health Organ 1999, 77(12):1001-7.
• [11]Bhattarai MD: Proper HIV/AIDS care not possible without basic safety in health set-up. Bull World Health Organ 2002, 80:333.
• [12]Bhattarai MD, Wittet S: Perception About Injections And Private Sector Injection Practices In Central Nepal.General Welfare Pratisthan And Gates Children's Vaccine Programme At PATH. 2000. http://path.org/vaccineresources/files/Nepal-Inject-Practices-RA.pdf webcite (accessed 14 Aug. 2012)
• [13]Nakarmi M, Thakuri S, Stringer R: Injection safety in Nepal [abstract]. Geneva: World Health Organization; 2010. http://who.int/injection_safety/sign/en/ webcite. In Report on Annual Meeting of the Safe Injection Global Network, 9-11 November 2010, Dubai, United Arab Emirates http://who.int/injection_safety/toolbox/sign2010_meeting.pdf webcite] (accessed 18 Dec. 2012).
• [14]District Development Committee Baglung (Home page). http://ddcbaglung.gov.np/page.php] (accessed 2 Aug. 2012) Available in Nepali Language
• [15]World Health Organization (WHO): Pilot-testing the WHO tools to assess and evaluate injection practices; A summary of 10 assessments coordinated by WHO in seven countries (2000-2001). (WHO/BCT/03.10). WHO; 2003. http://www.who.int/injection_safety/toolbox/PilotTestingReportFinal.pdf webcite
• [16]Reeler AV: Anthropological perspectives on injections: a review. Bull World Health Organ 2000, 78(1):135-43.
• [17]Chowdhury AKA, Roy T, Faroque ABM, Bachar SC, Asaduzzaman M, Nasrin N, Akter N, Gazi HR, Kabir AKL, Parvin M, Anderson C: A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Publ Health 2011, 11:779. BioMed Central Full Text
• [18]Ministry of Health and Population, Nepal, Department of Drug Administration: Final Draft: National List of Essential Medicine. Fourth revision edition. 2009. http://www.unfpa.org/sowmy/resources/docs/library/R085_MOHNEPAL_2009_EssentialDrugs_Medicines.pdf webcite] (accessed 2 Aug. 2012)
• [19]Mantel C, Khamassi S, Baradel K, Nasri H, Mohsni E, Duclos P: Improved safety after targeted interventions in the Syrian Arab republic. Trop Med Int Health 2007, 12:422-30.
• [20]The Himalayan Times (Nepali Daily): Hospital waste posing health hazard. The Himalayan times (National daily) 2012. http://www.thehimalayantimes.com/fullNews.php?headline=hospital+waste+posing+health+hazard+&NewsID=318633 webcite
• [21]World Health Organization (WHO): Revised injection assessment tool (tool C- revised). Geneva: Geneva, Switzerland; 2008. http://www.who.int/injection_safety/Injection_safety_final-web.pdf webcite
• [22]Zafar A, Habib F, Hadwani R, Ejaz M, Khowaja K, Khowaja R, Irfan S: Impact of infection control activities on the rate of needle stick injuries at a tertiary hospital of Pakistan over a period of six years: an observational study. BMC Infect Dis 2009, 9:78. BioMed Central Full Text
• [23]Ghimire P, Dhungyel BB, Tiwari BR: Hepatitis B and malaria among Nepalese blood donors. Scientific World 2007, 5:81-84.
• [24]Miller MA, Pisani E: The cost of unsafe injection. Bull World Health Organ 1999, 77(10):808-11.
• [25]Bhattarai MD, Adhikari P, Bhattarai MD, Kane A, Uprety T, Wittet S: Rapid assessment of perceptions, knowledge and practices related to immunization injection safety in Nepal. General Welfare Pratisthan and Gates Children's vaccine Programme at PATHhttp://path.org/vaccineresources/files/Immunization_Injection%20Safety_in_Nepal.pdf webcite] (accessed 16 Aug. 2012)
• [26]Kerlinger FN: Foundations of Behavioral Research. 2nd edition. Delhi-110007 (INDIA): Surjeet Publications; 2011.