Skip to main content
NCBI home page
Bulletin of the World Health Organization logoLink to Bulletin of the World Health Organization
. 1995;73(4):531–540.

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

B Aylward 1, J Lloyd 1, M Zaffran 1, R McNair-Scott 1, P Evans 1
PMCID: PMC2486791  PMID: 7554027

Abstract

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.

Full text

PDF
531

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aylward B., Kane M., McNair-Scott R., Hu D. J., Hu D. H. Model-based estimates of the risk of human immunodeficiency virus and hepatitis B virus transmission through unsafe injections. Int J Epidemiol. 1995 Apr;24(2):446–452. doi: 10.1093/ije/24.2.446. [DOI] [PubMed] [Google Scholar]
  2. Canter J., Mackey K., Good L. S., Roberto R. R., Chin J., Bond W. W., Alter M. J., Horan J. M. An outbreak of hepatitis B associated with jet injections in a weight reduction clinic. Arch Intern Med. 1990 Sep;150(9):1923–1927. [PubMed] [Google Scholar]
  3. Hahn R. A., Onorato I. M., Jones T. S., Dougherty J. Prevalence of HIV infection among intravenous drug users in the United States. JAMA. 1989 May 12;261(18):2677–2684. [PubMed] [Google Scholar]
  4. Heymann D. L., Piot P. The laboratory, epidemiology, nosocomial infection and HIV. AIDS. 1994 May;8(5):705–706. doi: 10.1097/00002030-199405000-00021. [DOI] [PubMed] [Google Scholar]
  5. Hu D. J., Kane M. A., Heymann D. L. Transmission of HIV, hepatitis B virus, and other bloodborne pathogens in health care settings: a review of risk factors and guidelines for prevention. World Health Organization. Bull World Health Organ. 1991;69(5):623–630. [PMC free article] [PubMed] [Google Scholar]
  6. Mann J. M., Francis H., Davachi F., Baudoux P., Quinn T. C., Nzilambi N., Bosenge N., Colebunders R. L., Piot P., Kabote N. Risk factors for human immunodeficiency virus seropositivity among children 1-24 months old in Kinshasa, Zaire. Lancet. 1986 Sep 20;2(8508):654–657. doi: 10.1016/s0140-6736(86)90167-4. [DOI] [PubMed] [Google Scholar]
  7. Marmor M., Hartsock P. Self-destructing (non-reusable) syringes. Lancet. 1991 Aug 17;338(8764):438–439. doi: 10.1016/0140-6736(91)91054-x. [DOI] [PubMed] [Google Scholar]
  8. Phadke M. A., Joshi B. N., Warerkar U. V., Diwan M. P., Panse G. A., Sokhey J., Bhate S. M. Toxic shock syndrome: an unforeseen complication following measles vaccination. Indian Pediatr. 1991 Jun;28(6):663–665. [PubMed] [Google Scholar]
  9. Reeler A. V. Injections: a fatal attraction? Soc Sci Med. 1990;31(10):1119–1125. doi: 10.1016/0277-9536(90)90233-i. [DOI] [PubMed] [Google Scholar]
  10. Samuels M. E., Koop C. E., Hartsock P. I. Single-use syringes. N Engl J Med. 1991 Apr 4;324(14):996–997. doi: 10.1056/NEJM199104043241415. [DOI] [PubMed] [Google Scholar]
  11. Soeters R., Aus C. Hazards of injectable therapy. Trop Doct. 1989 Jul;19(3):124–126. doi: 10.1177/004947558901900310. [DOI] [PubMed] [Google Scholar]
  12. Steinglass R., Boyd D., Grabowsky M., Laghari A. G., Khan M. A., Qavi A., Evans P. Safety, effectiveness and ease of use of a non-reusable syringe in a developing country immunization programme. Bull World Health Organ. 1995;73(1):57–63. [PMC free article] [PubMed] [Google Scholar]
  13. Vincent-Ballereau F., Lafaix C., Haroche G. Incidence of intramuscular injections in rural dispensaries in developing countries. Trans R Soc Trop Med Hyg. 1989 Jan-Feb;83(1):106–106. doi: 10.1016/0035-9203(89)90727-x. [DOI] [PubMed] [Google Scholar]
  14. WARREN J., ZIHERL F. A., KISH A. W., ZIHERL L. A. Large-scale administration of vaccines by means of an automatic jet injection syringe. J Am Med Assoc. 1955 Feb 19;157(8):633–637. doi: 10.1001/jama.1955.02950250007003. [DOI] [PubMed] [Google Scholar]
  15. Wyatt H. V. The popularity of injections in the Third World: origins and consequences for poliomyelitis. Soc Sci Med. 1984;19(9):911–915. doi: 10.1016/0277-9536(84)90320-4. [DOI] [PubMed] [Google Scholar]
  16. Zachoval R., Deinhardt F., Gürtler L., Eisenburg J., Korger G. Risk of virus transmission by jet injection. Lancet. 1988 Jan 23;1(8578):189–189. doi: 10.1016/s0140-6736(88)92770-5. [DOI] [PubMed] [Google Scholar]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization

RESOURCES