Safe injection practice among health-care workers in Gharbiya Governorate, Egypt
We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.
Injections are among the most frequently used medical procedures, with an estimated 12 billion injections administered each year worldwide.
Injections have been used effectively for many years in preventive and curative healthcare.
Unsafe injection practices throughout the world result in millions of infections, which may lead to serious disease and death. Scientists estimate that unsafe injections may cause about 8–16 million hepatitis B virus infections, 2.3–4.7 million hepatitis C virus infections, and 80 000–160 000 HIV infections each year worldwide.
The estimated risk of infection from bloodborne pathogens following a single needle stick from an infected source-patient is 30% for hepatitis B, 3% for hepatitis C and 0.3% for HIV. The probability of the source of the blood being HBsAg positive (hepatitis B surface antigen) is 1–3 per 1000 in the general population and 5%–15% in high-risk groups. The Centers for Disease Control and Prevention have estimated that there are 12 000 health-care workers infected with hepatitis B virus. They have also estimated that of 61 929 adults employed in health-care settings, 3182 had AIDS.
In Cairo University Hospital, Egypt the overall carrier rate for hepatitis B virus among health-care workers is about 28%. Approximately 13% of the Egyptian population is infected with hepatitis C virus, leading to a high burden of chronic liver disease, cirrhosis and liver cancer, as well as mortality resulting from these diseases. The proportion of new cases of hepatitis C that were attributable to unsafe injections exceeded 40% in 1996. This may have been related to the use of improperly sterilized needles that were used to treat schistosomiasis. As a consequence of these unsafe injections, a large reservoir of chronic infection was established that still drives hepatitis C transmission in Egypt today.
Although most injections given in the world are done following safe clinical practices, poor injection practices continue to transmit viral hepatitis and other infections on a large scale in many countries. Appropriate measures can and must be taken to avoid this route of transmission of disease. This study was conducted from 2003 to 2004 to assess safe injection practice among health-care workers in an Egyptian governorate, and to identify the obstacles to and requirements for applying safe injection practices.