الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Safe injection is one that does not cause harm to the recipient, the provider or the community where it is performed. Whether these injections are for vaccination, therapeutic injections or for diagnostic testing, the people and the community involved must not be exposed to risks of unsafe injection.
Unsafe practices are major route of transmission for BBVs including hepatitis B virus, hepatitis C virus, HIV infections and other complications such as abscesses, septicemia, malaria , viral hemorrhagic fevers and anaphylactic shock. So it constitutes a major public health problem especially since injections are the most common health care procedure practiced worldwide.
Unsafe practices as identified by the WHO are namely overuse; reuse of disposable needles and syringes; poor waste disposal practices; shortages of injection devices and lack of awareness of risks. In general the doctors and nurses in developing countries , where the prevalence of BBVs infections is high and the infection control standards are often poor, are frequently exposed to the blood of others in the course of their work most commonly as a consequence of needle stick injuries.
The specific objectives of this study were to assess the awareness of health care providers in the health units of Alexandria regarding injection safety guidelines, determine the adequacy of the logistics for safe injection and to estimate the magnitude of unsafe injection practices among the studied health care units.
To accomplish these aims a cross-sectional observational study was carried out in 16 representatives of Alexandria PHC units from all districts across the governorate during three- months period. These units were randomly taken from a master list of licensed units obtained from the Regional Information Centre. Data were collected using a modified version of the Injection Safety Assessment Tool (Tool-C Revised), developed by the WHO.
The results of this study were portrayed in four sections:
Section I: Observation of PHC units
• Injection waste disposal: Few number of units had loose sharps inside or on the ground outside the unit (18.7%). All units use safety boxes and in sufficient amounts. The proper storage of full containers away from the public in a separate room was noted in 87.5% of the units.. However, 12.5% of units had an overflowing sharps container in the vaccination room and 25% of units did not have an infectious waste container.
• Sinks with water and soap for hand washing were available in 81.2% and alcohol-based hand rubs in only 6.2% of the units. Posters promoting proper hand wash were found in 87.5% of the units while no unit had posters regarding injection safety. Evidences of needles left in diaphragm of multidose vials or attempts to sterilize equipment were not found in any unit of the 16 under study.
Section II: Observation of injection practices
Practices before administering injections include:
• A visibly clean table, where injections are prepared, was only seen in 50% of the units while dirty tables or where (food stuff) were placed on the same table as the injection equipment was observed in the other 50%. Only 37.5% of providers wash their hands before preparing injections, additionally, alcohol-based hand rubs were never used. The skin of children was cleaned by only 12.5% of providers.
• Techniques followed for using multidose vials: Cleaning the rubber cap with antiseptics were not done in any unit under the study. Needles were removed from the rubber cap after the withdrawal of each dose in all the units studied. Moreover, the needles and syringes used for each injection were taken from a sterile and unopened packet in all the units too.
• Clients who brought their syringes represented 12.5% of the observed units.
Practices after administering injections include:
• Sharp disposal immediately after the injections into puncture proof sharps disposal containers was done in all the observed units. In addition, needles were always thrown with their syringes and were never recapped in all units.
• Syringes supplies were adequate in all units according to the records present in the units. Sharps containers were observed to be abundant in some and scarce in other units. Gloves were never used in any of the injections observed.
Section III: Interview of Provider
• All 82 providers in the 16 units (100%) claimed they do not use any sterilizable injection equipment. Special manuals for waste management and injection safety program were not available in all the units visited (except one unit). Stock out of sharp containers was rare while no stock out of syringes was reported.
• Clients bringing their own equipment for injections was reported by 12 % of providers who gave several explanations (only one of them is related to injection safety).
• 78% of the interviewed providers had one or more NSI during vaccination procedures. 77% were unaware of the reporting system of needle stick injury.
• 66% of providers declared they had injection safety training ( some as on the job training). Full Hepatitis B vaccination was reported by 78% of providers and knowledge regarding diseases transmitted through unsafe injections was present in 85%. Only 73% of providers knew the type of final waste disposal used by the unit.
Section IV: Interview of supervisors
• Results agreed with those obtained from observations and interview of providers concerning reused equipment, injection safety manuals and stock outs of both syringes and sharps containers. Meanwhile, Post-exposure prophylaxis following NSIs was totally neglected in all the units and was left for providers to perform simple inadequate measures.
• All supervisors reported having workers designated for handling wastes and provided with heavy gloves for their protection. Only 2 received proper training.
from the present study we concluded that the noncompliance to injection safety practices was frequent in the PHC units including hand hygiene; clean place for preparation of vaccines and use of gloves. Meanwhile, other hazardous practices were absent including reuse of needles; sterilization of needles and recapping of needles before disposal. Many units had adequate sharp disposal system including the presence of puncture resistant containers in all units; their sufficient amounts and overflowing containers were rare. As regards health care providers, incomplete coverage with Hepatitis B vaccine; high frequency of NSIs and the lack of injection safety training were the main problems reported.
Based on these findings, the suggested recommendations to improve injection safety in Alexandria PHC units included regular training and information dissemination on best practices; support of the healthcare workers through complete coverage with Hepatitis B immunization and provision of injection safety manuals and protective equipment such as gloves.