Last month, 21 people in UP’s Unnao district contracted HIV after they were administered injections using a single syringe, all in the name of cheaper treatment. This, however, is not an isolated incident and is unlikely to be the last if we don’t change how we do things.
For quite a few years now, there have been horrifying incidents of people dying or being infected with reused injections.
In 2015, 59 children were injected with antibiotics using the same syringe at a government hospital in Hyderabad. In 2012, Haryana reported an outbreak of hepatitis C and 70% of the 1,605 cases were linked to reused syringes. A similar incident was reported from Gujarat in 2009, which resulted in 89 deaths.
Widespread Unsafe Injection Practice in India?
Over 16 billion injections are administered annually of which India accounts for a third, making it one of the most common means of administering medication. However, only 37% of these procedures are deemed safe.
In all other cases, reuse, misuse and unsafe disposal of injections expose patients, healthcare workers and the community to serious and at times, fatal infections.
The data speaks for itself – unsafe injection practices contribute to the spread of 46% cases of Hepatitis B, 38% of Hepatitis C and 12% of HIV infections in India.
Unsafe injection practices leave no one behind.
Healthcare workers face the risk of contracting blood-borne infections through Needle Stick Injuries (NSI).
A study based in a Nagpur hospital revealed that among 450 nurses, 341 NSIs were reported with an estimated incidence rate of 2.39 NSIs per person per year. Hypodermic needles used for injecting drugs and inappropriate handling of sharp wastes were found to be the major causes of these injuries.
Dangers of Irrational Overuse of Injections
Further, the irrational overuse of injections multiplies the effects of unsafe injection practices. It is disconcerting to know that patients are known to prefer injections over oral medications.
Physicians as a result, prescribe injections to meet patient expectations rather than rely on clinical judgement.
The question we need to ask ourselves is how do we stop these statistics from going unchecked and beyond control?
In 2015, WHO published policy guidelines to promote the use of safety engineered syringes. The use of needle-stick injury protection syringes, especially in curative services, and the management of sharp waste are the primary focus of the recommendations.
The guidelines also highlight the need for rational use of injections to minimise unsafe practices. Today, these technologies are available in India, however universal adoption is a challenge.
Increasing Awareness on Unsafe Injection Practices
In April 2005, the Government introduced auto-disabled syringes under the Universal Immunization Program (UIP) in all states but the impact was limited as 95% of injections are administered for therapeutic reasons.
In 2009, the government mandated the use of auto-disabled syringes in all central government hospitals.
On 28 July 2016, World Hepatitis Day, the government also committed to transitioning to Re-Use Prevention (RUP) syringes in a three year transition period.
A welcome step, but one that has to be accompanied by safe disposal practices.
The ‘downstream’ reuse through repackaging and resale of injection devices is common practice in India.
In July 1998, India was one of the first countries to adopt biomedical waste management and handling rules, under the Environment Protection Act, 1986. However, even after two decades, the implementation remains weak.
Health facilities continue to dispose injection devices in open pits or in cardboard boxes instead of using puncture-free and liquid-proof sharp containers.
Last year, the Punjab government announced an injection safety program. Supported by WHO, the state launched an action plan committed to introducing RUP in their health system, sensitising the public and healthcare providers on injection safety, and improving healthcare management practices.
More states must adopt such measures if India is to achieve an a safe environment with regard to injection practice.
We don’t have to stoke a fear of injections but evoke a recognition that prevention is key.
The use of standard disposable syringes has to give way to auto-disabled, RUPs and safety syringes so as to prevent reuse and NSIs. And we can no longer afford to neglect safe disposal practices anymore.
A simple health procedure for prevention and therapy shouldn’t have to result in additional complications, increased risks, and even death.
(Anjali Nayyar is the Executive Vice President for Global Health Strategies (GHS) and has more than 18 years of experience in global health issues. Her expertise lies in developing integrated advocacy and communications strategies aimed at impacting health policy and practice.)
(The views expressed above are of the author’s alone and The Quint neither endorses nor is responsible for them.)
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