Unsafe injections, fatal infections
Avoiding unnecessary therapeutic injections will be the first step to check blood-borne infections from contaminated injection devices
SAFE THAN SORRY: Using auto-disable syringes will go a long way in reducing infections. — Photo: K.V. Srinivasan
ABOUT 40 per cent of the 16 billion injections given in the year 2000 in the developing countries alone had used unsterilised injection devices leading to the spread of blood-borne virus infections — 41 per cent hepatitis C infections, 30 per cent hepatitis B infections and 5 per cent HIV infections. These figures come from one of the most authentic sources — the World Health Organisation.
The paper published in the British Medical Journal (September 2005) points out that the reuse of unsterilised injection devises in the South East Asian region was as high as 75 per cent. And the risk of HIV infection through contaminated injection devices in South Asia, according to the WHO, may be as high as 9 per cent.
The results of the study undertaken by the Indian Clinical Epidemiology Network and AIIMS, Delhi and supported by the Union Ministry of Health and Family Welfare and the WHO point out that 63 per cent of injections in India are unsafe. Of this, nearly one third carry a risk of transmitting blood-borne viruses.
Unsafe injections are those that use faulty techniques for administering injections and expose the recipient to avoidable risk of infections.
This highlights the compelling need to include safe injection practices in addition to safe sex to keep HIV and hepatitis infections at bay. “It’s so easy to fix and so inexpensive to do,” Mr. Yvan J.F. Hutin the lead author of the paper published in the British Medical Journal was quoted as saying in the New Scientist (November 2003).
Though the global incidence of HIV through contaminated injection devices may be 5 per cent, and 9 per cent in the case of South Asia, the figure quoted for Africa hovers around 2.5 per cent. The low figures quoted for Africa has been hotly debated and contested though.
The study undertaken in India, which was also supported by the WHO, clearly points out a much higher possibility of HIV infection (compared with Africa and possibly in line with the South Asian figures) from contaminated needles and syringes.
While many reasons have been ascribed for the low figures being quoted for the African region, one of the reasons is the fear of the focus being shifted from safe sex to contaminated needles and the repercussions thereof. That is no reason why the high figures cited in the Indian study should lead to any dilution of already existing prevention strategies.
On the other hand, the findings should enable us in India to arm ourselves for better protection from all possible sources of infection. And central to this is the role of the patient and the doctor in avoiding unnecessary injections. The quick relief provided by injections is the most often cited reason for patients insisting for them even when they are totally unnecessary. Doctors, on their part, are only too willing to oblige, knowing the psychological relief that injections provide but unwittingly expose patients to potential risks.
The majority of therapeutic injections in developing countries are unnecessary, according to the WHO.
“… for AIDS, unsafe sex is by far the biggest risk. Injection safety is not the driver of the HIV epidemic. There is no good data to support it,” Dr. Hutin the lead author of the paper published in the British Medical Journal was quoted as saying in the New Scientist (November 2003).
Dr. Schmid shares Dr. Hutin’s views. “We do think the focus should remain on safe sex,” Dr. George Schmid, a senior HIV researcher with WHO in Geneva, was quoted as saying in the New Scientist (February, 2004).
That the WHO, UNICEF and UNFPA had recommended that all countries use only auto-disable syringes in immunisation programmes starting from 2003 and the advice that all countries use single use injection devices for therapeutic purposes underlines the importance attached to preventing the spread of infections through contaminated injection devices.
Though belated, the Union Ministry of Health and Family Welfare has made the use of auto-disable syringes mandatory for immunisation programmes. This simple measure will go a long way in making sure the chances of HIV or other blood-borne infections are eliminated in the child immunisation programmes.
However, the mandate includes only government health facilities. Making it mandatory for all private immunisation centres to use only auto-disable syringes will go a long way in reducing infections.
The use of combination vaccine for immunisation programmes will further help in not only reducing the expenses but also go a long way in reducing the risk of unsafe injections.
The doctors and patients’ onus does not end by ensuring the use of sterilized injection devices. Making sure that syringes and needles are destroyed to prevent possible misuse should also be high on the priority list, lest the used syringes and needles are either reused on someone else or is sold to rag pickers, who in turn form a part of the chain that enable the entry of contaminated syringes and needles into the market.
Avoiding the use of glass syringes even when they sport disposables needles, insisting on disposable syringes and needles and if possible using auto-disable syringes will go a long way in curbing the spread of blood-borne infections. It may be borne in mind that the study found that glass syringes are 12 times more capable of causing infections.
The main reason is the inadequate sterilization and gross ignorance on the correct ways of sterilising glass syringes. “Written guidelines for sterilisation were available at only 10 per cent of all health facilities across the country. It was disturbing to note that more than half (56 per cent) of the prescribers reported an incorrect sterilisation process,” the report stated.