Ensuring Safe Injection
Objectives
At the end of the module, participants are expected to:
1. Describe the principles and guidelines to be observed for
immunization safety
2. Know important ways and practices to ensure safe injections
3. Know how to prevent needle-stick injuries
4. Familiarize with steps on how to dispose of used syringes and
needles
Topic outline
• Components of vaccine safety and quality
• Guidelines on safe injections and proper disposal of vaccine
wastes
• AEFI and how to establish and maintain a monitoring and
reporting system for such events
Activities
1. Short lecture: Importance of vaccine safety (5 min)
2. Activity 4.1: Quiz on injection safety (30 min)
3. Activity 4.2: Demonstration of needle handling (30 min)
4. Activity 4.3: Safety Box Assembly and Use (15 min)
5. Short lecture: Procedures for disposing of sharps waste and
injection equipment (10 min)
6. Self-review: Responsible persons for Waste Management
Immunization Safety
Importance:
● Reduces the risk of disease transmission by injection
● Reduces the risk of preventable adverse reactions and the impact
of real vaccine reactions through proper case management
● Ensures the effectiveness of the immunization
Immunization Safety
Safe
Vaccine Immunization
Injections and
Safety and Safety
Waste
Quality Surveillance
Disposal
Vaccine Safety and Quality
1. Safe cold chain practices
- Vaccines must be kept at the correct temperature from manufacture
to use:
To ensure potency and effectiveness
To prevent higher rates of local reactions
2. Reconstitution and proper use of diluent
2.1 Safe use of diluents
2.2 Safe use of opened multi-dose vials of the vaccine in
subsequent immunization sessions
2.3 Check if vaccines are safe to use
Vaccine Safety and Quality
2.3 Check if vaccines are safe to use
Check the vaccine and diluent labels
Check the expiry dates
Check the VVM
Check for exposure to sub-zero temp. of freeze-sensitive vaccines
(PENTA, Td, Hep B) and perform Shake Test accordingly.
For each vaccine used, health workers must know the following:
o Age of client at which each dose should be given
o Number of doses required and min. interval between doses
o Correct dosage
Safe Injections
Injection Safety
- Safe handling of all injection equipment
- Routine monitoring of the availability and use of safe injection
equipment
- Correct disposal of contaminated injection equipment
Safe Handling of Injections and Syringes
TRUE OR FALSE
1. While conducting the immunization session, the Safety Box must
be easily reachable to the vaccinator.
2. The vaccinator can place all used syringes on a tray during the
session. After the session, she can discard everything in a pit.
Safe Handling of Injections and Syringes
TRUE OR FALSE
3. Use a new sterile AD syringe and needle for every injection.
4. You may prepare up to five pre-filled syringes during the session to
save time, especially when there are many patients waiting for
vaccination.
Safe Handling of Injections and Syringes
TRUE OR FALSE
5. For multi-dose vials, leave a sterile needle in the rubber stopper of
the vial. This aspiration needle will help you aspirate liquid from the
vial.
6. Before injection, wipe the injection site with clean water.
Safe Handling of Injections and Syringes
TRUE OR FALSE
7. Always recap needles before placing them in the Safety Box.
8. Do not carry used syringes and needles around the immunization
area or work site.
Safe Handling of Injections and Syringes
TRUE OR FALSE
9. Close and dispose of the safety box securely when it is three-
fourths (3/4) full.
10. When there are no available Safety Boxes, carefully remove
needles and syringes from a filled box or container and transfer them
to a plastic bag. Then dispose of them in a pit as recommended in the
Philippine Clean Air Act of 1999.
Safe Handling of Injections and Syringes
Synthesis for Activity 1
ANSWERS
Check your own paper.
Safe Handling of Injections and Syringes
1. While conducting the immunization session, the Safety Box must
be easily reachable to the vaccinator. TRUE
2. The vaccinator can place all used syringes on a tray during the
session. After the session, she can discard everything in a pit. FALSE
Safe Handling of Injections and Syringes
3. Use a new sterile AD syringe and needle for every injection. TRUE
4. You may prepare up to five pre-filled syringes during the session to
save time, especially when there are patients ready for vaccination.
FALSE
Safe Handling of Injections and Syringes
5. For multi-dose vials, leave a sterile needle in the rubber stopper of
the vial. This aspiration needle will help you aspirate liquid from the
vial. FALSE
6. Before injection, clean the injection site with water. TRUE
Safe Handling of Injections and Syringes
7. Always recap needles before placing them on the Safety Box.
FALSE
8. Do not carry used syringes and needles around the immunization
area or work site. TRUE
Safe Handling of Injections and Syringes
9. Close and dispose of the safety box securely when it is three-
fourths (3/4) full. TRUE
10. When there are no available Safety Boxes, carefully remove
needles and syringes from a filled box or containers and transfer them
to a plastic bag. Use gloves. Then dispose of them in a pit as
recommended in the Philippine Clean Air Act of 1999. FALSE
Safe Handling of Injections and Syringes
Activity 4.2: Demonstration of needle handling
Objectives:
1. Familiarize handling of syringes including areas safe and unsafe
to touch.
2. Practice use of AD syringes
Time allotment: 30 minutes
Materials/Resources needed:
1. Regular syringe with needles
2. AD syringes
3. Vaccines or vial with water to practice aspiration
4. Best to have volunteers for the actual demonstration
Safe Handling of Injections and Syringes
Activity 4.2: Demonstration of needle handling
Instructions:
1. Show samples of regular and AD syringes
2. Demonstrate areas safe and unsafe to touch
3. Demonstrate how to aspirate liquid from vials
4. Allow participants to practice the use of syringes
5. Dispose syringes properly
Syringes
Parts of syringes
Parts of Syringes that can be touched
Parts of syringes that should not be touched
Safe Injection Practices
1. Inspect the packaging very carefully.
2. Remove the syringe from its plastic wrapping by peeling the
package open from the syringe plunger end.
3. Take off the needle cap without touching the needle.
4. Insert the needle into the vaccine vial. The tip should be in the
lowest part or bottom of the vial.
5. Pull the plunger back to fill the syringe just past the 0.5 ml or 1ml
or 0.05 ml mark.
6. Remove the needle from the vial.
Safe Injection Practices
6. Prepare each dose immediately before administering. Do NOT
prepare several syringes in advance.
7. Proceed with the injection at the appropriate site.
○ No need to aspirate before injection
8. Push the plunger forward and forward and inject the vaccine. At
the beginning or just at the end of the injection, the plunger will
automatically lock so the syringes cannot be used.
9. Do not recap the needle after use.
10. Dispose of the needle and syringes in a safety box.
11. Do not dispose of used needles in an open cardboard box.
Safe Injection Practices
12. Protect the fingers with a small gauze pad before opening
ampules.
13. For MDVP, always pierce the septum with a sterile needle. NEVER
leave a needle stuck in the stopper of the vial.
14. In cleaning, use cotton balls wet with sterile water. There is no
need to use alcohol.
15. Hold the child firmly and anticipate and prevent sudden movement
during and after injecting the vaccine.
Needlestick Injury
Protocol
Source: CPG: Emergency
Department Management
of Community-Acquired
Needlestick Injury
Dispose of Used Syringes and Needles
1. Use Safety Boxes
2. Dispose of sharps waste and injection
equipment
3. Dispose of the filled safety boxes
1. Encapsulation
2. Burial in a disposal pit
3. Puncture-proof box management
4. Supervise and Monitor the Disposal
Safety Box Assembly and Use
Activity 4.3: Safety Box Assembly and Use
Objectives: Familiarize with steps in the assembly of the safety
collection box
Time allotted: 15 minutes
Materials needed:
1. Safety Collection Box
4.3 Safety Box Assembly and Use
Activity 4.3: Safety Box Assembly and Use
Instructions
1. Facilitator shall demonstrate how the Safety Box is assembled
2. Divide the participants into four groups
3. Distribute Safety Boxes one per group
4. Allow participants to demonstrate how to assemble a Safety Box
5. Discuss good practices in using the Safety Box
Safety Collection Box
Disposing of Used Syringes & Needles and Vials
Disposing of Used Syringes and Needles
Procedures for disposing of sharps waste and injection equipment
● Destroy all injection equipment. AD or disposable mixing syringes
and needles should be used only once.
● NEVER dump used syringes and needles in open areas where
people might step on them or children might find them.
● Do not dispose of or dump needles and syringes with other kinds
of waste.
● Bottles and vials should be placed on a separate receptacle or
box. Ideally, these should be sterilized before disposing of the pit.
Disposing of Used Syringes and Needles
Procedures for disposing of sharps waste and injection equipment
● Close the container when the safety box is three-quarters full or
immediately after the immunization session.
● Do not transfer used syringes and needles from safety boxes to
other containers.
● Find a safe place to bury the box.
● Burning as a method of waste disposal is prohibited.
○ Rule XXVIII of Republic Act No. 8749 otherwise known as
“Philippine Clean Air Act of 1999."
Disposing of Used Syringes and Needles
Two methods are recommended for disposal of immunization waste
1. Encasement in a concrete septic vault.
○ The concrete septic vault is a standard rectangular design
usually built at the back of health facilities, in landfills or
cemeteries.
○ The vault openings are above the ground to prevent water
intrusion.
Disposing of Used Syringes and Needles
2. Burial in a waste pit. There are two basic burial pit designs:
○ With a cement floor
○ With bottom clay layers.
○ Vaults and pits are constructed between 2 to 55 meters
above the water table.
