Chapter 9: Injection Safety & Health Care Waste Management

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Chapter Goals

To ensure site-level staff are able to:

  • Use safe injection practices to prevent the spread of pathogens (especially bloodborne pathogens) to clients or providers
  • Properly manage waste generated by VMMC services to protect health care workers, the community, and the environment.

What Users Need to Know

Injection Safety

Appropriate single use and disposal of both needles and syringes is an important topic because it touches upon not only waste management but also client and provider safety. Bacteria from skin and other surfaces and bloodborne pathogens may contaminate both needle (on contact and during aspiration) and syringe (during aspiration). Therefore, providers must never access an anesthetic vial with either a needle or a syringe that has been used on a client, including for the purpose of drawing up more anesthetic for the same client. Providers may be tempted to change the needle but reuse the same syringe; however, this does not remove the risk of transmission, as blood may have entered the syringe. Instead, if a client needs additional anesthetic during a procedure, a new needle and a new syringe should be used to draw the anesthetic and reinject.

Key safe injection practices to prevent transmission of infections to clients or providers include:

  • Never access any medication vial with a previously used syringe or needle (“double dipping”). If a client needs additional anesthetic during a procedure, use a new needle and syringe to draw the anesthetic and reinject. This carries a very small increased cost, and the risks of reuse are much more significant.
  • The best practice is to ensure anesthetic vials are not reused between clients (they should be disposed of during cleanup after the VMMC procedure.) If a provider draws anesthetic for a client from a used vial, it is impossible to know whether the vial was contaminated by a prior provider who incorrectly “double-dipped” into it.
  • If it is not possible to prevent anesthetic vial reuse, the only line of defense against blood-borne pathogen transmission is to ensure no provider ever double dips into a vial. Even if this is done, bacterial infection transmission is still possible, because every time a vial is accessed even with an unused needle, there is a risk of bacterial contamination.
  • Never administer medications from the same syringe to more than one patient, even if the needle is changed.
  • Never use two hands to recap used needles or use fingers to pick up a suture needle exposed to blood.
  • Always dispose of used sharp instruments in sharps containers immediately after use.
  • Always use aseptic technique when preparing and administering injections. This includes cleaning the vial septum properly before entering the vial to reduce the risk of bacterial contamination.
  • Always ensure the sharps container is within arm’s reach and not filled beyond two-thirds full before starting the procedure.

An open-access, 60-minute VMMC provider training module on injection safety is available online at Injection Safety Training Module for VMMC Providers.

Health Care Waste Management

To avoid serious public health and legal consequences, as well as substantial environmental impact, it is essential to develop safe and reliable methods for handling and treating health care waste. Proper waste management spans a number of stages from generation through disposal, thus service providers must have clear standard operating procedures on the segregation, packaging, handling, storage, transport, treatment, and disposal of waste [See SCMS VMMC Health Care Waste Management Toolkit]. Each site should have a health care waste management (HCWM) plan based on local norms and standards. Resources are available to assist site managers in developing their plan. Specifically prepared for VMMC service locations, the SCMS VMMC Health Care Waste Management Toolkit describes the steps of HCWM from collection to proper disposal employing user-friendly, highly illustrated standard operating procedures. The toolkit guides users in developing their own country-specific guideline document, such as the Health Care Waste Management for VMMC Services: A Quick Guide, and provides examples of the standard operating procedures and waste management plans described above. Additional links on HCWM include the World Health Organization’s (WHO) Safe Management of Wastes from Health-Care Activities and the United States Agency for International Development’s (USAID) USAID Sector Environmental Guidelines Healthcare Waste.

Tools, Instruments, and Guidance Documents

  1. Environmental Health Management Toolkit for VMMC Services
  2. Safe Management of Wastes from Health-Care Activities
  3. Health Care Waste Management for VMMC Services, A Quick Guide
  4. USAID Sector Environmental Guidelines Healthcare Waste
  5. CDC Frequently Asked Questions (FAQs) Regarding Safe Practices for Medical Injections
  6. WHO Safe Injection Global Network (SIGN)
  7. Management of Solid Health Care Waste at Primary Health Care Centers: A Decision-Making Guide
  8. Injection Safety Training Module for VMMC Providers

To read more about the frequently referenced information, additional information, and to read related case studies download the chapter PDF.

Download Chapter 9 (PDF, 4 MB)