This chapter assimilates the best practices for delivering injections in health-care and related facilities. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). The chapter outlines recommended practices, skin preparation, preparation and administration of injections, and related health procedures. Show
Best injection practices described are aimed at protecting patients, health workers and the community. 2.1. General safety practicesThis section describes the following practices that are recommended to ensure the safety of injections and related practices:
2.1.1. Hand hygieneHand hygiene is a general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis (25). It is the best and easiest way to prevent the spread of microorganisms. Hand hygiene should be carried out as indicated below, either with soap and running water (if hands are visibly soiled) or with alcohol rub (if hands appear clean). Practical guidance on hand hygienePerform hand hygiene BEFORE:
Perform hand hygiene AFTER:
You may need to perform hand hygiene between injections, depending on the setting and whether there was contact with soil, blood or body fluids. Avoid giving injections if your skin integrity is compromised by local infection or other skin conditions (e.g. weeping dermatitis, skin lesions or cuts), and cover any small cuts. Indications and precautions for hand hygiene are shown in Table 2.1. Table 2.1Indications and precautions for hand hygiene. 2.1.2. GlovesHealth workers should wear non-sterile, well-fitting latex or latex-free gloves when coming into contact with blood or blood products (26). Indications for glove use in injection practice are shown in Table 2.2. Table 2.2Indications for glove use in injection practice. 2.1.3. Other single-use personal protective equipmentMasks, eye protection and other protective clothing ARE NOT indicated for the injection procedures covered by this document unless exposure to blood splashes is expected. Practical guidance on single-use personal protective equipmentWhen using single-use personal protective equipment, dispose of the equipment immediately after use. 2.1.4. Skin preparation and disinfectionTable 2.3 shows the skin preparation protocols for different types of injection. Table 2.3Skin preparation for different types of injection. Practical guidance on skin preparation and disinfectionTo disinfect skin, use the following steps (27–29):
DO NOT pre-soak cotton wool in a container – these become highly contaminated with hand and environmental bacteria. DO NOT use alcohol skin disinfection for administration of vaccinations. 2.1.5. Summary of best practiceThe steps outlined above are summarized in Table 2.4, below. Table 2.4Infection prevention and control practices. 2.2. Injection devices and medications2.2.1. Injection devicesHealth-care settings should ensure that an adequate supply of single-use devices is available, to allow providers to use a new device for each procedure. Practical guidance on use of injection devicesWhen using a sterile single-use device (i.e. a syringe and hypodermic needle that is not separated or manipulated unless necessary (7):
2.2.2. MedicationTypes of medication containers and recommendations on their use are given in Table 2.5. Table 2.5Recommendations on medication containers. Practical guidance on giving medications
2.2.3. Preparing injectionsInjections should be prepared in a designated clean area where contamination by blood and body fluids is unlikely (1, 7). Practical guidance on preparing injectionsThree steps must be followed when preparing injections.
Procedure for septum vialsWipe the access diaphragm (septum) with 70% alcohol (isopropyl alcohol or ethanol) on a swab or cotton-wool ball before piercing the vial, and allow to air dry before inserting a device into the bottle.
Labelling
2.2.4. Administering injectionsAn aseptic technique should be followed for all injections. Practical guidance on administering injectionsGeneral
Reconstitution
Needleless system
Delay in administration
Important points
2.3. Prevention of sharps injuries to health workersUse of best practices can help to prevent sharps injuries to health workers (31–33). Further information on this topic can be found in Chapter 4. Practical guidance on prevention of sharps injuriesTo avoid sharps injuries:
2.4. Waste managementUse of sealed, puncture and leak-proof sharps containers helps to prevent access to used devices (24, 34). Practical guidance on waste managementTo ensure that waste is dealt with safely:
Which are the parts of syringes and needles?Disposable syringe with needle, with parts labelled: plunger, barrel, needle adaptor, needle hub, needle bevel, needle shaft.. A typical plastic medical syringe, fitted with a detachable stainless steel needle.. What are the sterile parts of a syringe?So, that leaves just the outer barrel, the finger flange, and the thumb tip of the plunger.
Which parts of the syringe and needle must be kept sterile when preparing and administering an injection select all that apply?The needle is made up of the hub, shaft, and bevel. The bevel is the tip of the needle that is slanted to create a slit into the skin. The hub fits onto the tip of the syringe. All three parts must remain sterile at all times.
How do you maintain sterility of a needle?According to the Centers for Disease Control and Prevention (CDC) , moist heat is the most effective way to sterilize needles. That's because of its ability to kill microorganisms. In a medical setting, autoclave machines may be used to sterilize needles or other medical equipment by pressurizing saturated steam.
|