Module 4: Ensuring Safe Injection
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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
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Topic Outline
• Components of vaccine safety and quality
• Guidelines on safe injections and proper disposal of
vaccine wastes
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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
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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
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Immunization Safety
Safe Injections Immunization
Vaccine Safety
and Waste Safety
and Quality
Disposal Surveillance
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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Safe Handling of Injections and Syringes
Synthesis for Activity 1
ANSWERS
Check your own paper.
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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
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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
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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
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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
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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
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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
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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
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Syringes
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Parts of syringes
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Parts of Syringes that can be touched
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Parts of syringes that should not be touched
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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.
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Safe Injection Practices
6. Remove the needle from the vial.
7. Prepare each dose immediately before administering. Do NOT prepare
several syringes in advance.
8. Proceed with the injection at the appropriate site.
*No need to aspirate before injection
9. 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.
10.Do not recap the needle after use.
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Safe Injection Practices
11. Dispose of the needle and syringes in a safety box.
12. Do not dispose of used needles in an open cardboard box.
13. Protect the fingers with a small gauze pad before opening ampules.
14. For MDVP, always pierce the septum with a sterile needle. NEVER leave a
needle stuck in the stopper of the vial.
15. In cleaning, use cotton balls wet with sterile water. There is no need to use
alcohol.
16. Hold the child firmly and anticipate and prevent sudden movement during
and after injecting the vaccine.
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Needle stick Injury Protocol
Initial washing of area with soap and water
Dispose needle/syringe safely
Document a detailed history including:
• Time, date, location of incident
• Type of exposure
• Appearance of needle
• Type of needle
• Immunization history
Known source needle user?
Needle user known to be infected?
Take blood for hepatitis B surface antibody+ Deliberate assault?
No to all
to store (serum gel tube) Deep injection?
Large volume injection?
Large-guage hollow bare needle?
Other reason for increased risk?
Assess need for post-exposure prophylaxis based on
patient’s tetanus and hepatitis vaccination status IF YES TO ANY OF THE ABOVE. CONSIDER REFERRAL TO
INFECTIOUS DEASES TEAM
Vaccinated against Unimmunized Vaccinated
Vaccinated against
Unimmunized tetanus: last booster against hepatitis B against hepatitis B
tetanus: last booster
against tetanus < 5 years ago
> 5 years ago
Anti-HBs titre 10 mIU/ml
(see text for details)
Administer first dose of hepatitis B vaccine
Administer first dose Administer booster + hepatitis B immunoglobulin if within 22
No treatment No treatment
Administer
of tetanus vaccine dose of tetanus hours of exposure hepatitis B
necessary necessary
and immunoglobulin vaccine vaccine booster
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Department of Health Acquired Needle stick Injury 30
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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
• Encapsulation
• Burial in a disposal pit
• Puncture-proof box management
4. Supervise and Monitor the Disposal
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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
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Safety Collection Box
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Disposing of Used Syringes & Needles and Vials
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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.
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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."
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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.
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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.
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Maraming salamat po!
.
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