Safe Injection Practices

Definition

• Practices that ensure injections are given in a manner that does not harm the recipient, does not expose the provider to unnecessary risk of blood-borne infections and does not result in any waste that is dangerous for the community (WHO 2010, updated IPAC 2022)

Importance in Pediatrics

• Children receive multiple injections (UIP schedule, therapeutic injections, RBSK interventions)
• Higher vulnerability due to immature immune system and repeated exposure in hospitals/OPDs
• Unsafe injections contribute to 1.67 million HBV, 0.34 million HCV and 0.16 million HIV infections annually worldwide (WHO estimates)
• In India: ~20–30% of injections still unsafe; major source of iatrogenic transmission of BBVs in children

Risks of Unsafe Injections

• Recipient: Transmission of HBV (most common), HCV, HIV, abscess, sepsis, paralysis (inappropriate site)
• Provider: Needle-stick injury (NSI) → seroconversion risk
• Community: Reuse of syringes, open burning → environmental hazard

Core Components (The “Bundle”)

1. Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation

2. Aseptic Technique

• Hand hygiene (alcohol-based hand rub or soap-water) before and after procedure
• Use of sterile single-use syringe and needle (auto-disable syringes preferred in UIP)
• Skin preparation with 70% isopropyl alcohol swab (allow to dry)
• No recapping of needles

3. Single-Use Policy

• Never reuse syringes/needles
• Auto-disable (AD) syringes mandatory for all immunizations under UIP/U-WIN
• Prefilled syringes/ampoules opened only for single patient

4. Safe Sharps Disposal

• Immediate disposal into puncture-proof, leak-proof sharps container (blue/white bin) at point of use
• Fill to ¾ capacity → seal and transport as per Biomedical Waste Management Rules 2016 (amended 2018/2022)
• Treatment: Autoclaving/shredding/incineration at Common Biomedical Waste Treatment Facility (CBWTF)

5. Post-Exposure Prophylaxis (PEP) Protocol

• Immediate wound wash with soap-water
• Report NSI → baseline testing of source and exposed person
• PEP for HIV (within 2 hours), HBV (if unvaccinated), HCV (monitoring)

Pediatric-Specific Considerations

• Use shortest possible needle (25–27G for IM in infants); vastus lateralis preferred site <12 months
• Distraction techniques, sucrose analgesia, proper positioning to reduce pain
• Vaccine-specific: Cold chain maintenance + AD syringes for all UIP antigens
• Integration with RBSK (DEIC injections), SNCU/pediatric wards, school health
• AB PM-JAY/ABDM linkage: Record every injection in digital health record for traceability

National Guidelines & Implementation (2026)

• MoHFW Injection Safety Guidelines 2022 (updated under NTEP/IPC)
• Mandatory training for all healthcare workers (ANM, ASHA, doctors) under NHM
• Surveillance: Monthly reporting of NSI and unsafe injection events through HMIS/ABDM
• Convergence: UIP (U-WIN AD syringes), RBSK, RKSK, NTEP (TB injections)
• Monitoring: District-level Injection Safety Committees; audits using WHO checklist

Key Performance Indicators

• 100% use of AD syringes in immunization
• Zero recapping of needles
• 100% sharps disposal in designated containers
• NSI incidence <1 per 1000 injections
• 100% PEP compliance within 2 hours