Strengthening health care waste management systems to ensure safe injections
The World Health Organization (WHO) estimates that 16 billion injections are given in developing and transitional countries each year, and at least 50 percent of injections in developing countries are estimated to be “unsafe.” In some countries, the rate may be as high as 70 percent. A safe injection is one that does not harm the patient, the health worker, or the community.
In a resource-poor setting, staff may not have proper training in administering safe injections, or the facility may not have adequate supplies of clean needles and syringes or a proper disposal system for infectious medical waste. Each of these factors contributes to the estimated 23.5 million new HIV, hepatitis B, and hepatitis C infections transmitted every year through unsafe injections.
For more than 20 years, PATH has pioneered the development and introduction of innovative health care technologies for injection safety—including autodisable syringes, needle removers, and special containers for disposing of used needles and other medical waste. These technologies must not only be affordable, they must also be appropriate to the environment in which they will be used.
PATH also works to improve health care waste management systems through health worker training, supply procurement, and health care systems strengthening in order to reinforce the web of critical resources that ensure a safe injection each time.
PATH’s efforts are in line with a three-part strategy developed by WHO for promoting safe injections:
1. Changing behavior of health care workers and patients.
To ensure a safe injection each time, injection providers and medical waste handlers must understand and implement best practices for injection safety. These include discarding or properly sterilizing all injection equipment and safely disposing of needles and syringes. Because injection devices and waste disposal methods vary, injection providers may not be up to date on the best practices for injection safety, and countries may lack the resources necessary to conduct regular trainings. To meet these training needs, PATH has developed safe injection training materials that are intended for use and adaptation by programs in resource-poor settings.
2. Ensuring availability of equipment and supplies.
PATH is accelerating development of technologies appropriate for use in resource-poor settings through public-private partnerships. PATH provides expertise in design and adaptation, testing and field trials, and introduction and implementation of devices and techniques that improve injection safety by helping prevent needle reuse and encourage safe disposal of health care waste.
As part of the Making Medical Injections Safer (MMIS) project, PATH assists partner countries’ ministries of health in choosing and procuring safe injection supplies to guarantee that countries get the best price on high-quality products. Once a country’s needs are identified, our procurement team identifies suppliers, initiates competitive bidding, and arranges for rapid shipment of an array of products. Ready access to safer, more reliable supplies will spur developing-country health systems to adopt safe injection supplies as the norm.
3. Managing waste safely and appropriately.
Injection safety includes the safe management of health care waste and requires appropriate equipment and training at the health facility level and the capacity to manage systems at the regional and national levels. Without appropriate policies and adequate resource allocation, health facilities are unable to access the supplies, training, and infrastructure needed to ensure safe injections and safe disposal of health care waste. PATH works with countries on policy development, planning, and advocacy at the national level to begin identifying the infrastructure development needed for functioning health care waste management systems.
PATH collaborates on these issues with partners such as WHO and John Snow, Inc., as well as ministries of health and private-sector collaborators. PATH’s work in the area of health care waste management is supported by the USAID-funded HealthTech Program, the Bill & Melinda Gates Foundation, the PEPFAR-funded Making Medical Injections Safer Project, and others.