Medical injections and HIV

Medical injections and HIV

The Safe Injection Global Network defines a safe injection to be:

"Safe for the patient, the health worker and the environment"⁷²

Medical injections are injections received as treatment, or for the prevention of ill-health (for example immunisation).

Once a person receives an injection a small amount of their blood can remain on the needle or syringe. If the person was infected with HIV and the same needle or syringe is used on another person, without correct sterilization there is a risk they may become infected with HIV. HIV infected blood on needles, syringes and other medical equipment can survive for up to two hours outside of the body⁷³ and it has been found that syringes containing HIV infected blood can still transmit HIV, even after being rinsed, for up to 4 weeks.⁷⁴ Studies have illustrated the parallel between the re-use of equipment and infection with blood borne viruses.^{75 76}

The reuse of unsterilized needles and syringes can be prevented by using AD syringes.

Receiving injections in healthcare settings is very safe in developed countries. Health workers in these countries have easy access to new equipment and have undertaken training in safe practice. However, access to training, new equipment and resources to sterilize equipment is often lacking in developing countries and generally it is in these countries where the transmission of HIV infection, in healthcare settings, occurs.⁷⁷ Gross re-use of medical equipment, including syringes, was reported in three of Kazakhstan's Hospitals in 2007.⁷⁸ Furthermore, in Romania, more than 10,000 new babies and young children were infected with HIV from contaminated injections and unscreened blood transfusions between 1987 and 1991.⁷⁹

Health systems must be strengthened to provide healthcare workers with training and resources if injections are to be made safer.^{80 81} Similarly, patients must be made aware that medical equipment should be new or sterilised before use.

Only estimates of the probability of becoming infected with HIV through an unsafe medical injection are available and whereas WHO estimates it to be 1.2 percent, other estimates vary from 0.1 percent and 6.9 percent.⁸² Some have identified medical injections in sub-Saharan Africa as a major cause of new HIV infections and claim 20-40% of infections are from medical injections.^{83 84 85 86 87 88} However, WHO estimates for sub-Saharan Africa are far more conservative at 2.5 percent.^{89 90} They uphold that although HIV transmission in healthcare settings, notably medical injections, is an area of concern, most infections are sexually transmitted.⁹¹

Controversy aside it is evident that unsafe procedures when administering medical injections have serious repercussions for the spread of HIV and despite the risks, un-sterilized needles and syringes continue to be re-used. As WHO figures show, across the world up to 39 percent of injections are administered with equipment that has previously been used and un-sterilized.⁹²

The Safe Injection Global Network (SIGN)⁹³ and the Presidents Emergency Plan For AIDS Relief (PEPFAR) are examples of governments and organisations working to promote safe injection and healthcare practices to eliminate the risks to patients and healthcare workers.⁹⁴ 'Making Medical Injections Safer' (MMIS)⁹⁵, funded by PEPFAR, works in 11 countries alongside host governments to promote the safe use and disposal of unsafe injections through initiatives such as the training and education of healthcare providers.⁹⁶ For example an MMIS project in Tanzania during December 2006 resulted in the training of more than 8,000 healthcare workers in safe injection practices.⁹⁷

Technology such as single dose, pre-filled Auto-Disable (AD) injection devices (used for vaccinations) and AD syringes⁹⁸, which have a one-way valve making the syringe useless after one use, have the potential to make injections in developing countries safer.^{99 100 101} Currently, AD syringes are used mainly for immunisation programmes where the potential for the reuse of injection equipment is high. A 2003 joint statement from WHO, UNICEF and UNFPA stated that AD syringes should be used for immunisations, particularly during immunising campaigns.¹⁰² However, vaccinations only account for 10 percent of injections whereas 90 percent are for curative (or treatment) purposes