Editorial: Making injections perfectly safe
Published in The Hindu on September 24, 2005
The recent disclosure that nearly a third of all injections administered in India carry the risk of transmitting blood-borne viruses, including hepatitis and HIV, is alarming. Along with faulty techniques, this rendered 63 per cent of injections unsafe. According to the World Health Organisation, of the 16 billion injections given worldwide in 2000, close to 40 per cent were found to transmit blood-borne viruses through the use of contaminated needles, with HIV accounting for five per cent globally and nine per cent in South Asia. That the incidence of unsafe injections is highest at immunisation centres followed by government health facilities, and that the major cause is the use of inadequately sterilised glass syringes that carry a 71 per cent risk of transmitting viruses point to a systemic failure in risk prevention. With a dismal record of sterilisation, the common practice of repeatedly using the same glass syringe with disposable needles has been a cause for great concern. One of the recommended correctives is the use of disposable syringes with fixed needles. Multi-dose vials, commonly used at government health centres by default, necessitate puncturing the vial’s rubber stopper several times when syringes with fixed needles are used. Repeated puncturing can leave traces of rubber in the drug, which in turn can lead to complications when injected into the blood. Use of auto-disable syringes with removable needles may address this issue to some extent. The immediate focus should however be on replacement of glass syringes by the commonly-used disposable syringes and needles, or auto-disable syringes.
A total shift from glass to disposable syringes is feasible: their use is already high in both urban and rural areas. But a major problem here is the rampant reuse of disposable syringes, either in-house or through sale to rag pickers. Putting in place a mechanism to destroy needles and syringes after single use and educating people to go for a fresh syringe and needle each time should be given high priority. With immunisation accounting for 17 per cent of all injections administered and with 74 per cent of such injections found unsafe, the move by the Union Health Ministry to introduce auto-disable syringes for this segment in government health facilities will cut the risk of infection to an extent. The Government should make their use mandatory for immunisation programmes in private health facilities also. The role of combination vaccines in immunisation programmes becomes particularly important as they will reduce infection risk and also expense. For curative purposes, the use of auto-disable syringes can be a viable alternative, particularly in urban private health facilities. More basically, an effective way of cutting the rate of unsafe injections is to avoid the needless ones that patients apparently expect (or demand) and many doctors offer, with little professional scruple.
