Recently added This page was added on 11 June 2018.
Guidance on intradermal injection expanded.
Guidance on intradermal injection expanded. This chapter assimilates the best practices for delivering injections in health-care and related facilities. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). The chapter outlines recommended practices, skin preparation, preparation and administration of injections, and related health procedures. Best injection practices described are aimed at protecting patients, health workers and the community. This section describes the following practices that are recommended to ensure the safety of injections and related practices: Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis (25). It is the best and easiest way to prevent the spread of microorganisms. Hand hygiene should be carried out as indicated below, either with soap and running water (if hands are visibly soiled) or with alcohol rub (if hands appear clean). Perform hand hygiene BEFORE:
Perform hand hygiene AFTER:
You may need to perform hand hygiene between injections, depending on the setting and whether there was contact with soil, blood or body fluids. Avoid giving injections if your skin integrity is compromised by local infection or other skin conditions (e.g. weeping dermatitis, skin lesions or cuts), and cover any small cuts. Indications and precautions for hand hygiene are shown in Table 2.1. Health workers should wear non-sterile, well-fitting latex or latex-free gloves when coming into contact with blood or blood products (26). Indications for glove use in injection practice are shown in Table 2.2. Masks, eye protection and other protective clothing ARE NOT indicated for the injection procedures covered by this document unless exposure to blood splashes is expected. Table 2.3 shows the skin preparation protocols for different types of injection. To disinfect skin, use the following steps (27–29):
DO NOT pre-soak cotton wool in a container – these become highly contaminated with hand and environmental bacteria. DO NOT use alcohol skin disinfection for administration of vaccinations. The steps outlined above are summarized in Table 2.4, below. Health-care settings should ensure that an adequate supply of single-use devices is available, to allow providers to use a new device for each procedure. When using a sterile single-use device (i.e. a syringe and hypodermic needle that is not separated or manipulated unless necessary (7):
Types of medication containers and recommendations on their use are given in Table 2.5. Practical guidance on giving medications
Injections should be prepared in a designated clean area where contamination by blood and body fluids is unlikely (1, 7). Three steps must be followed when preparing injections.
Wipe the access diaphragm (septum) with 70% alcohol (isopropyl alcohol or ethanol) on a swab or cotton-wool ball before piercing the vial, and allow to air dry before inserting a device into the bottle.
Labelling
An aseptic technique should be followed for all injections. General
Reconstitution
Needleless system
Delay in administration
Important points
Use of best practices can help to prevent sharps injuries to health workers (31–33). Further information on this topic can be found in Chapter 4. To avoid sharps injuries:
Use of sealed, puncture and leak-proof sharps containers helps to prevent access to used devices (24, 34). To ensure that waste is dealt with safely:
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