Immunization resources

Injection safety

Information on the epidemic of unsafe medical injections worldwide and efforts to improve injection safety. Our featured resources give you quick access to the most essential and up-to-date information on safe injection practices and lessons learned.

Featured resources

Designing safe syringe disposal systems for immunization services (2003)
PATH
This 30-page manual for program managers helps guide decision-making related to safe syringe disposal at the district level. A range of disposal methods and issues are covered, including practical advice on incineration (with details on two small scale incinerators), burning in oil drums and pits, safety box burial, and transport of filled safety boxes.

Giving safe injections (2001)
PATH
This 112-page manual is a training curriculum for health care workers who provide injections. It includes information on the health impact of unsafe injections, selecting safe and effective vaccines, reconsituting vaccines safely, reading Vaccine Vial Monitors (VVMs), preventing needlestick injuries, and using a variety of auto-disable syringes.

Managing sharps waste in Andhra Pradesh (2007)
PATH, Government of Andhra Pradesh (India), US Agency for International Development
A report on the introduction and scale up of a practical system for sharps waste management focused on reducing the number of injections given, needle removal, syringe disinfection, and collection of syringe plastic for recycling.

Practical, local solutions for safely managing contaminated syringes and other medical waste (2004)
Wittet S, et al. PATH
PATH partnered with Nepali nongovernmental organization General Welfare Pratistan and seven communities in Central Nepal on the Safe Injection Promotion Initiative, aimed at generating local solutions to waste management, among other injection safety issues.  This 23-page report describes the variety of solutions generated by the communities, along with some of the challenges they face.

The Safe Injection Global Network (SIGN) Alliance
Coordinated through World Health Organization (WHO), SIGN is a voluntary coalition of stakeholders aiming to achieve safe and appropriate use of injections throughout the world.

Unsafe injections, fatal infections (2000)
Reeler A, Simonsen L. PATH
The authors provide an overview of medical and social science wisdom on the extent of unsafe injections and the complex reasons why many injections are given in an unsafe manner.

Using Uniject™ to increase the safety and effectiveness of hepatitis B immunization (2002)
Nelson C, Widjaya A, Wittet S. PATH
This paper describes use of an innovative injection device to immunize Indonesian newborns as soon after birth as possible. Results were positive: more infants were protected against hepatitis B earlier in life, health workers and parents liked the device, and use of Uniject was cost-effective.

General resources

Anthropological perspectives on injections: A review (2000)
Reeler A. Bulletin of the World Health Organization. 78(1): 135-143.
This article discusses the popularity of injections, as well as the widespread practice of injections provided by both formal and informal health care providers. The authors also suggest interventions for curbing unsafe and unnecessary injections.

Best infection control practices for interdermal, subcutaneous, and intramuscular needle injections (2003)
Hutin Y, et al. Bulletin of the World Health Organization. 81(7): 491-500.
Evidence-based guidelines for making injections safer. Abstracts are available in Spanish, French, and Arabic.

Global Advisory Committee on Vaccine Safety
WHO
The Global Advisory Committee on Vaccine Safety was established at WHO in 1999 "to respond promptly, efficiently, and with scientific rigour to vaccine safety issues of global importance." The site contains Q&As, policy statements, and links to studies on a wide variety of issues like thiomersal, smallpox vaccination, and evidence (or lack of evidence) of links between specific vaccines and health problems.

Guidelines for national strategies for the safe and appropriate use of injections (2000)
SIGN Alliance
This two-page document summarizes key elements to assist in the development of a national strategy for ensuring safe and appropriate use of injections.

Healthcare waste management
WHO
This website is designed to promote the safe management of health care waste through news, publications, general information, and services for professionals in health care waste management.

Immunization safety review: Vaccinations and sudden unexpected death in infancy (2003)
Board on Health Promotion and Disease Prevention, US Institute of Medicine
Read this report free on the web or order the book from this site. The authors reviewed epidemiologic evidence on Sudden Unexpected Death in Infancy (SUDI) and neonatal death. Based on their review, investigators found that evidence did not support a causal relationship between diphtheria, tetanus, and whole-cell pertussis (DTwP) vaccine and sudden infant death. They also concluded that evidence is inadequate to accept or reject a causal relationship between other vaccines and SUDI.

Injection safety fact sheet (2002)
WHO
This document summarizes issues and concerns associated with unsafe injection practices.

Injection safety & technology
WHO
Resources available on this website include scientific articles, technical tools, policy statements, and more.

Perceptions about injections and private-sector injection practices in Central Nepal (2000)
Bhattarai M, Wittet S. General Welfare Pratisthan, PATH
This eye-opening report documents provider injection practices and attitudes toward medical injections among providers and the general public. In spite of widespread use of disposible syringes and seemingly high awareness of the dangers of cross-infection, many unsafe and unnecessary injections were observed daily in the study area. Improper disposal of contaminated medical waste, including needles and syringes, is also a serious problem.

Safe health care waste management (2000)
WHO
A two-page aide-memoire focusing on national strategies for safe handling and disposal of medical waste.

Safety of injections—facts and figures (2004)
 WHO

Safety of injections—questions and answers (2004)
WHO

Strategies for safe injections (1999)
Battersby A, et al. Bulletin of the World Health Organization. 77(12): 996-1000.
A discussion of the implications of using sterilizable versus disposible injection equipment. Abstract also available in French.

SIGN moderated listserv
 SIGN Alliance
The Safe Injection Global Network has initiated a moderated discussion listserv to assist in achieving safe medical injections. To contribute material and join the discussion, email sign@acithn.uq.edu.au.

Policy statements and reports

Behavior change: Reducing the number of injections given to patients in Indonesia (abstract only; 1996)
Hadiyono J, Suryawati S, Danu S, Santoso B, Santoso S. Social Science and Medicine. 42(8): 1177-1183.
This paper details the use of a technique called "interactional group discussion" to reduce injections in public health facilities.

The cure that kills (2008)
 Practical Patient Care
This paper examines the health risks posed by unsafe injections in Africa and outlines some of the programs that are helping reduce these risks.

Disposal and destruction of syringes and needles in Vietnam and the Philippines (1998)
 WHO
The paper reports on a field trial of disposal and destruction methods (including autocombustion incinerators) in the two countries.

Improved injection practices after the introduction of treatment and sterility guidelines in Tanzania.
Vos J, et al. Tropical Medicine and International Health. 3(4):291-296.
Following a training program at health centers, observations included increased health worker knowledge and improved sterilization practices, along with reductions in the provision of unnecessary injections.

Progress in improving the safety of injections in the EPI Western Pacific region (1998)
WHO
Includes a "Guide for developing a national plan of action for injection safety" and a "Checklist for EPI supervisors—sterilization and injection practices."

Rapid assessment of perceptions, knowledge, and practices related to immunization injection safety in Nepal (2001)
General Welfare Pratisthan and PATH
This eye-opening report gives an in-depth look at immunization practices and concerns among immunization providers and managers in Nepal. The report shows that despite adequate training and supply of vaccines, availability of proper disposal training, as well as other materials like needles, syringes, and fuel, continue to impact vaccine safety.

Safety of immunization injections in Africa: Not simply a problem of logistics (2000)
M. Dicko et al., Bulletin of the World Health Organization, 78(2): 163-169.
Report of an evaluation of a "logistic approach" on immunization injection safety. The investigators found that unsafe injection practices were generally due to a failure to integrate nursing practices and public awareness with injection safety issues, as well as an absence of influence from EPI managers on health care service delivery. (File also includes abstracts in Spanish and French.)

Safety of injections—WHO-UNICEF-UNFPA joint statement on the use of auto-disable syringes in immunization services
WHO, UNICEF, UNFPA
This policy statement outlines recommended approaches to immunization safety through the use of auto-disable syringes and proper sharps disposal.

Manuals and curricula

Best infection control practices for skin-piercing intradermal, subcutaneous, and intramuscular needle injections (2001)
SIGN, WHO, and the International Council of Nurses
This leaflet outlines the best practices for safe injections, with pictograms to aid in training.

Infection prevention: An online course (2004)
EngenderHealth
Designed to help health care providers, supervisors of health care facilities, and medical/nursing students strengthen their ability to protect themselves, their clients, and members of the surrounding community from infections. Topics covered include disease transmission, handwashing, gloving, aseptic technique, surgical scrub and surgical attire, use and disposal of needles and other sharps, instrument processing (including decontamination, cleaning, sterilization and high-level disinfection, and storage), housekeeping, and waste disposal.

Proper handling and disposal of AD syringes and safety boxes (2002)
PATH
Part of PATH's "Training Resource Series," this unique training module was specially designed to be easy to adapt for specific national programs. In addition to key technical content it includes quizzes, role plays, and creative ideas for trainers.

Sample injection safety leaflets for health care providers (2001)
Mongolia Ministy of Health
Two safe injection leaflets were prepared by the Ministry of Health in Mongolia in collaboration with SIGN. One provides a guide to giving safe injections. The other provides guidelines for preventing needlestick injuries.