A STUDY ON ASSESSMENT OF INJECTION PRACTICES IN VARIOUS HEALTH CARE SETTINGS OF KASHMIR VALLEY.
Authors: Allaqband Uroosa Farooq , Fazili Anjum B , Shah Rohul Jabeen , Balwan Walied K. 
Published: April 2019

Background: Injection is an important drug delivery system especially for severely ill patients, acute emergency conditions and immunizations. But injections can spread disease to patients, healthcare workers, waste handlers and even in common healthy people if not used and disposed in proper way. Every year at least 16 billion injections are administered worldwide and at least half of them are unsafe. Breaks in safe injection practices coupled with overuse of injections may expose the recipients, healthcare workers or the community to several harms including life-threatening infections. Some factors that lead to unsafe injection practices include use of unsterile injection equipment, unsafe collection of sharps and management of injection related waste, reuse of contaminated needles and syringes and improper sterilization (especially of glass syringes).

Material and Methods: A cross sectional observational questionnaire based study was carried out in 40 healthcare facilities of two districts of Kashmir valley (one rural and one urban) selected purposively. The study was conducted amongst 152 injection providers in which 528 injections were observed. The study period was of 1 year from April 16-March 17. A prefabricated validity tested questionnaire was used to gather the requisite information. The questionnaire was divided into two parts. First part consists of questions on three types of observations and the second part consists of questions on four types of interviews.

Results: Out of total 528 injections observed 77.3% were curative (I/V, I/M) rest 22.7% were prophylactic (I/M, S/C, I/D). Majority of the providers resorted to practices which were unsafe and harmful to their being. These included practices like breaking glass ampoules without a protective barrier, nonuse of gloves in 97.3%, re-capping of needles in 68.2%, nonuse of needle destroyer in 85.8% and delay in disposal of used needle and syringes in a sharps container in 97.7% of health providers. Majority of the injection providers adopted practices which were unsafe for the patient/client. These included practices like preparation of injection on unclean surface, table or tray in 95.6%, not washing hands before preparing injection 99.8%, not cleaning hands with alcohol based hand rub in 98.5%, not cleaning the rubber cap of multidose vial in 99.3% and palpating venipuncture site after skin preparation with antiseptic in 80.2%.

Conclusion: As per the practice of providers, less than 1% of the providers washed their hands with soap and water before and 3.9% after the injection. In all the injections syringe and needle used were taken out from a sterile unopened packet. 95.6% of the injections were not prepared on a clean dedicated table or tray. None of the providers used a clean barrier to protect fingers when breaking the top of glass ampoules.  Only 0.7% of providers cleaned the rubber cap of the multi-dose vial with antiseptic and 70.2% of providers removed the needle from rubber cap.  In case of I/V injections, 90.1% of providers secured the patient and the intended puncture site before the procedure and none of them used a new pair of gloves before administering any type of injections.

Keywords: Injections, Health care settings, Healthcare workers.