Download Proposed Working Draft for the Injection Equipment

FROM BLOOD SAFETY AND TECHNOLOGY 8 APRIL 2002
Proposed Working Draft for the Injection Equipment Section of
Report of the Expert Committee Meeting on the WHO Model
Essential Drug List
Background
Unsafe injection practices, including injection overuse and unsafe practices spread
bloodborne pathogens on a large scale worldwide. While restricting access to
injectable medications is an important element of any strategy to reduce injection
overuse, access to injection equipment must be ensured for those injections that are
necessary.
Evidence generated in immunization services in the 1990’s indicated that when
injection equipment is not directly financed with vaccine, injection practices are
unsafe. 1 In contrast, when disposable injection equipment is supplied together with
essential drugs, injection practices improve dramatically. 2 Best practices for intradermal, subcutaneous and intramuscular injections now recommend that new
disposable injection equipment be preferred to sterilizable injection equipment, 3 as
health systems using disposable injection equipment 4 document safer injection
practices than those using sterilizable injection equipment. 1
The “bundling” policy
To ensure appropriate access to injection equipment and prevent unsafe injection
practices, WHO’s immunization and communicable disease programmes formulated
the “bundling” policy jointly with UNICEF. The bundling policy called for donors
and lenders who financed vaccines to also finance disposable Auto-Disable (AD)
injection equipment and sharps boxes (the bundle being conceptual and financial but
not necessarily physical). This bundling policy formulated for the first time in 1997
for mass immunization campaigns 5 was extended in 1999 to all immunization
services and co-signed by UNFPA and the International Federation of Red Cross and
Red Crescent Societies (IFRC). 6 Since, the bundling policy was endorsed by the
GAVI board in June 2001 and by USAID for the procurement of injectable
contraceptives in 2001.
Proposed change to the essential drug list
While adding injection equipment to the essential drug list would not necessarily lead
to changes in procurement practices, the expert committee proposes that the essential
drug list recommends a bundling adapted to curative health care services. Thus, the
list should mention that anyone financing the purchase of essential injectable drugs
should follow the bundling principle and also finance disposable injection equipment,
diluents and sharps boxes. Auto-disable injection equipment should be preferred when
available. However, availability of curative size auto-disable syringes designed for
therapeutic injections is still limited. This bundling principle should apply to national
stakeholders procuring essential drugs for the national drug policy, donors and lenders
supporting specific programmes (e.g., Tuberculosis) and all in-kind drug donations.
FROM BLOOD SAFETY AND TECHNOLOGY 8 APRIL 2002
References
1
Dicko M, Oni A-Q Q, Ganivet S, Kone S, Pierre L, Jacquet B. Safety of immunization injections in
Africa: not simply a problem of logistics. Bulletin of the World Health Organization 2000; 78: 163-9.
2
Logez S, Accessibility to injection equipment: impact on injection safety, Mission report,
Pharmaciens Sans Frontières Comité International, June 2001.
3
WHO Best practices for intradermal, subcutaneous and intramuscular injections. WHO/BCT/01.02
4
Hofmann CA. Presentation made at the annual meeting of the Safe Injection Global Network (SIGN),
New Delhi, August 2001. WHO/BCT/DCT/01.04.
5
6
WHO-UNICEF policy statement for mass immunization campaigns. WHO/EPI/LHIS/97.04 REV.1
WHO-UNICEF-UNFPA. Joint statement on the use of auto-disable syringes in immunization
services. WHO/V&B/99.25.