Download FAQs - IPEN

MIC-Training Manual
Frequently Asked Questions (FAQs)
SECTION 1: RATIONALE FOR MODEL INJECTION CENTRE PROGRAM
(Refer to Session-2)
1.
2.
3.
4.
5.
6.
7.
8.
Why create a Model Injection Centre when every hospital has an injection
room?
The AIPI study reported that nearly 2/3rd (63%) of all injections administered in
India were found to be unsafe. This unsafety arises from a combination of factors
like:
 use of inadequately sterilized injection equipment
 reuse of disposable syringes/needles, and
 improper technique of giving injections.
These unsafe techniques increase the risk of infection, abscess formation, local
reaction to the recipients and more dangerously carry the risk of transmitting
various blood borne diseases like Hepatitis B, Hepatitis C, HIV. Thus, the need of
the hour is to have Model Injection Centres to overcome the above mentioned
unsafe practices.
What are the main factors contributing to transmission of blood borne
pathogens through injections?
 Re-use of syringes and needles
 Overuse of therapeutic injections
 Lack of awareness of risks
 Shortages of injection devices
 Poor waste disposal practices and
 Lack of appropriate waste infrastructure
 Inadequate sterilization
What are blood borne pathogens?
Infectious agents transmitted through exposure to blood or blood products.
What is Hepatitis B?
Hepatitis B is caused by a virus and transmitted by exposure to blood or blood
products or during sexual intercourse. It causes acute and chronic hepatitis.
Chronic hepatitis B can cause liver disease, cirrhosis and liver cancer.
What is Hepatitis C?
Hepatitis C is caused by a virus and transmitted by exposure to blood or blood
products. Hepatitis C is usually chronic and can cause cirrhosis and primary liver
cancer
What is HIV-AIDS?
Human Immunodeficiency Virus is a virus mainly transmitted during sexual
intercourse or through exposure to blood or blood products. HIV causes the
Acquired Immunodeficiency Syndrome (AIDS)
What is a safe injection?
A safe injection does not harm the recipient, does not expose the provider to any
avoidable risk, and does not result in any waste that is dangerous for the
community.
What are the various risks of unsafe injection to recipient, injection giver
and community?
The various risks of unsafe injection to recipient, injection giver and community
are:
FAQs
1
MIC-Training Manual
1.
9.
10.
11.
12.
13.
14.
15.
16.
2
increased risk of infection, abscess formation, local reaction to the
recipients
2.
risk of transmitting various blood borne diseases like Hepatitis B, Hepatitis
C, HIV, to the injection givers, recipients and the community.
Can you explain what are the differences between safe and unsafe injection
practices?
A safe injection does no harm to the recipient, does not expose the health worker
to any avoidable risk and does not result in waste that is dangerous for the
community. To achieve this, the injection needs to be administered using a sterile
syringe and needle. After administration, sharp equipment needs to be discarded
in a puncture-proof container for appropriate disposal. Any break or departure
from this procedure represents a risk, rendering the injection unsafe.
What are the risks associated with injections?
Blood borne diseases such as hepatitis B, hepatitis C and HIV/AIDS can be
transmitted through unsafe injections due to poor injection practices and injection
overuse indiscriminately.
What diseases can be contracted through unsafe injection practices?
The diseases most frequently transmitted through unsafe injection
practice are hepatitis B (estimated 21 million cases per year), hepatitis C
(estimated 2 million cases per year) and HIV/AIDS (estimated 260,000 cases per
year). In addition, unsafe injections can cause abscesses and lead to
septicaemia. Less frequently, haemorrhagic fevers and malaria can also be
transmitted.
What is Septicaemia?
Severe generalized infection resulting from dissemination of pathogenic
microorganisms and their toxins.
How many people become infected each year due to unsafe injection
practice?
WHO estimates that annually 21 million hepatitis B infections, 2 million hepatitis
C infections and 260,000 HIV/AIDS cases are caused by re-use of syringes and
needles without sterilization. The viruses that can be transmitted through unsafe
injections can remain “silent” in the body for a long time before they cause
symptoms. Thus, unsafe injections can lead to a silent epidemic that occurs
many years after the original events.
How many injections are administered annually worldwide?
About 16 billion preventive (immunization) and curative (treatment) injections are
given each year in developing and transitional countries. Over 95% of all
injections given are curative (therapeutic): for every vaccination given, 20
therapeutic injections are administered.
How does overuse of injections lead to the transmission of blood borne
pathogens?
The more injections are given, the more people are exposed to needles and
syringes. In addition, if the use of injections exceeds the availability of injection
equipment, reuse of syringes and needles is likely to occur. Therefore greater the
use, the higher the risk.
What are the reasons for injection overuse?
Patients and health care workers often believe that injections are more effective
(powerful) and act faster than oral medication. In addition, health care workers
can charge an increased fee for injections.
FAQs
MIC-Training Manual
17.
18.
19.
20.
21.
22.
23.
24
25.
26.
Is it difficult to make injections safe?
The strategies to make injections safe are straightforward. They include
community behavior change induced through communication activities in a
supportive environment. Adequate injection equipment must be provided in
sufficient quantities and a reliable waste disposal infrastructure must be made
available. Many success stories suggest that this is an achievable goal.
Why are syringes re-used in the developing world?
Widespread re-use of syringes and needles in the developing world is due to
several factors:
 a lack of awareness regarding the risks associated with syringe re-use
 cultural resistance to waste in countries where resources are scarce
 a lack of supplies of syringes and needles
 the absence of infrastructure for the safe collection and destruction of used
injection equipment, allowing for scavenging and parallel market development
What is the cost of unsafe injections?
First, unnecessary injections waste precious health care resources. Second, the
consequences of unsafe injections lead to death and disability. In 2000, WHO
estimates that 501,000 deaths occurred because of unsafe injections in the past.
In addition, unsafe injections in 2000 will lead to 9 million years of life lost
(adjusted for disability) between 2000 and 2030.
What constitutes safe syringe disposal?
Safe syringe disposal requires that syringes and needles be placed in punctureproof containers (safety box) immediately after use. These boxes must then be
collected for incineration or other forms of destruction.
What number of health workers is affected by unsafe injections?
No exact figure is available. But no health worker should get infected while
giving injection.
Are health care workers not aware of the risks of unsafe injection
practices?
In many cases trained health care workers such as physicians, nurses and
paramedical staff have not been trained in safe injection practices. Often, they
lack the awareness of the risks associated with unsafe practices. In addition, in
some communities, untrained lay persons administer injections outside the
formal health care sector.
Who should be educated first?
First the injection giver / provider and then the community.
How to explain people that they should not be requesting for injections?
By using IEC materials stating the risk of unnecessary injection. Giving examples
where oral medicines are as effective as injections.
What steps should be taken to make the people aware about complications
of injections?
The community should be informed and educated about the complications of
injection through electronic media, pamphlets, wall writings, folk media and
health education sessions
What measures are to be taken on accidental exposure to HIV/AIDS,
Hepatitis B and Hepatitis C by blood contact?
Post Exposure Prophylaxis (PEP) as per state, hospital and NACO guidelines.
FAQs
3
MIC-Training Manual
27.
28.
4
Considering such a large population in India, will this program be able to
reach its objective with limited number of centres?
It is envisaged that after the initial rollout (Phase-I) and stabilization of the
functioning of the MIC network during the first two years of the project, every
partner institution in the network (i.e. the 25 MICs) will be encouraged to identify
four more institutions in their region/state to establish MICs and oversee their
functioning – thus expanding the network to 125 medical colleges / institutions in
the coming years for maximum coverage.
Which are the countries where unsafe injection practices have been
reported?
Worldwide; however it is more common is Sub-Saharan Africa, Asia and former
Eastern bloc countries.
FAQs
MIC-Training Manual
SECTION 2: TECHNIQUE OF SAFE INJECTIONS
(Refer to Session 3)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
What is an injection?
A method of administering a substance such as a drug into the skin,
subcutaneous tissue, muscle, blood vessels, or body cavities, usually by means
of a needle.
Why should we use running water for washing hands? Couldn’t we use
stored water?
Hands can be contaminated when dipped in a basin of water/ stored water.
Standing water can easily become contaminated, even if antiseptic is used. In
the absence of running water staff member can pour water over one another’s
hand to rinse.
If tap water used for hand washing is contaminated, then how can we get
infection free injection?
Normal drinking water and soap should be used for washing hands.
How to wear gloves (Steps)?
Steps and figures are given in training manual.
If we practice no touch technique what is the need for washing hands?
As a precautionary measure washing hands is mandatory.
Why should we cut the ampoule all round its neck and not simply break it?
Smashing open the neck/top of the ampoule with a vial or any other solid object
creates a potential danger of scattering glass shreds inside the ampoule and
outside on the floor/table/injection couch and can also cause splinter injury to the
giver.
What if files are not available for cutting ampoules?
If file is not available then we can use serrated knife.
Why should we use spirit (alcohol) for site disinfection?
It kills pathogens/micro organisms on the skin surface
What is the need to wait for 30 seconds after cleaning the injection site with
spirit (alcohol) swab before injection?
We must wait for 30 seconds for the spirit to dry. This is necessary for the alcohol
to have its effect on the bacteria.
What are the appropriate steps for preparing the injection site?
Injection site has to be cleaned before giving injection. This is necessary to
reduce bacteria present on the skin at the injection site.
1. Spirit swabs would be preferably used for cleaning the injection site.
However, boiled swabs and swabs soaked in clean water can also be used
particularly in outreach conditions.
2. Clean the skin in a circular motion starting from the centre of the site moving
towards its periphery.
3. Allow 30 seconds for the spirit to dry. This is necessary for the alcohol to
have its effect on the bacteria.
Any medication for which spirit should not be used for cleaning before an
injection?
Spirit swab should not be used while injecting vaccines specially BCG.
Why shouldn’t we rub injection site after giving the injection?
It might cause infection / tissue damage / leak / oozing
Should the I.V drip sets be cleaned before infusion?
No, they are already sterilized.
How do you decide on the various injection sites and the route of
administration?
FAQs
5
MIC-Training Manual
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
29.
6
Though injections are given through a wide variety of routes, the most common
are: the most common are: the intradermal (ID), subcutaneous (SC),
intramuscular (IM) and intravenous (IV). It depends on type of drug, age of
patient and volume of drug to be injected. So there are different sites for making
intramuscular, subcutaneous, intradermal and intravenous (IV) injections. For
example, the three main sites used for giving intramuscular injections are: Arm
(on the deltoid muscle), Antero-lateral aspect of middle one third or the mid thigh
and Buttocks (outer upper quadrant of the gluteus maximus muscle)
Which is the best site for giving intramuscular injection?
 Deltoid is the preferred site in adults.
 In children the anterolateral site is preferred
Why anterolateral site is preferred in children for giving intramuscular
injection?
For any intramuscular injection one requires adequate muscle bulk. In children
quadriceps is most developed that is why it is the preferred site.
What is the difference between intramuscular and deep intramuscular?
There is no difference between intramuscular and deep intramuscular.
Can intramuscular and subcutaneous injections be given on the same
limb?
It should be preferred to give on different limbs if both have to be given at the
same time.
Why full needle should go in for intramuscular injection?
Because, the muscle lies at a deeper plain and the needle should go into the
muscle.
In children, why subcutaneous injection is given at an angle of 45 degrees
to skin surface?
If angle is more than 45 degree, the chances of the needle entering the muscle is
high.
How to ensure that one is not going deep while giving subcutaneous
injection?
Ensure proper subcutaneous technique (pinching of skin & angulation at 45
degrees).
What is a single use syringe?
An all-plastic syringe designed for a single use, with a separate, steel needle.
However, because there is no mechanism to prevent re-use, this type of syringe
may in fact be used more than once.
What is sterilizable syringe?
Plastic and glass syringes with steel needle. This type of syringe is designed for
re-use after proper cleaning and sterilization in a steam sterilizer or autoclave.
What is an AD syringe?
AD syringe is Auto Disable syringe which gets locked after single use and hence,
can not be used more than once.
How many types of AD syringes are there?
There are two types active and passive auto disable syringes.
Which type of AD syringe is good, Active / Passive?
Both are at par.
What is the difference between AD syringe and disposable plastic
syringes?
AD syringes:
1. Cannot be reused as they get locked after a single use
FAQs
MIC-Training Manual
30.
28.
31.
2. Patient to patient disease transmission is affectively prevented as they have
inbuild locking mechanism after single use.
3. They cost less than the disposable plastic syringes.
Disposable plastic syringes:
1. Can be reused by scrupulous providers as there is no locking system.
2. Patient to patient disease transmission is a possibility when reused as they
are not designed for sterilization through boiling / autoclaving and reuse.
3. They cost slightly more than the auto disable syringes.
How to use an AD syringe?
 Remove the syringe and needle from plastic wrapping
 Take off the needle cap without touching the needle
 Insert the needle into the vaccine vial.
 Pull the plunger back to fill the syringe while keeping the needle tip
in the fluid at all times.
 Remove the needle from the vial.
 To remove air bubbles hold the syringe upright and tap the barrel.
 Locate the injection site, clean the site as discussed.
 Push the plunger forward and inject the vaccine
 Cut the hub of the syringe in the hub cutter and put the syringe in
the puncture proof safety box.
Why shouldn’t we draw back the plunger to pump / push air into a vial
when using an AD syringe?
The plunger of an AD syringe can go back and forth only once, so one should not
draw up air to inject into the vial as this will disable the syringe.
What are the common errors in giving injections?
Hands NOT washed before injection/Gloves not worn
Syringe and needle flushed before drawing medication
Needle touching any surface before injecting
After administering injection syringe/needle put back on tray
Recapping of plastic syringes done
Syringe/Needle Reused after inadequate sterilization
Multidose Vial NOT wiped clean before withdrawing medication
Wiped needle with a swab before injection
Injection site NOT cleaned
Injection given over clothes
Glass Syringes
1. How many times a glass syringe and needle can be used?
A reusable glass syringe could be used for about 40 times after sterilizing it every
time. Reusable needles could be used 10 times after sterilizing it every time.
2. Why is sterilization of glass syringes and needles necessary?
Sterilization of glass syringes and needles and other equipments used for giving
injection and immunization is absolutely essential because if proper sterilization
procedures are not followed, chances of adverse reaction will increase. If the
glass syringes and needles are not properly sterilized there are chances of
transmission of various infections, including HIV / AIDS.
3. What should be done with a glass syringe and needle immediately
after use?
FAQs
7
MIC-Training Manual
Immediately after use of syringe and needle it must be flushed and soaked in
clean water and then allow it to dry. Syringes and needles must be steam
sterilized for 20 mins at a temperature between 121° C and 126° C.
4. Can antiseptics be used to sterilize syringes and needles?
Do not use antiseptic solution to sterilize syringes and needles.
5. What are the different modes of sterilizing glass syringes and needles?
There are several ways of sterilizing syringes and needles. In the programme,
following methods are used:
 Steam sterilizer (double rack)
 Autoclave
 Boiling
6. What is the appropriate time required for sterilizing?
Sterilization by steam autoclaving with temperature 121° C to 126° C for 20
minutes is sufficient to kill the germs. If autoclaving is not possible syringes and
needles may be boiled. Keep boiling for 20 minutes continuously.
7. What are the steps involved in sterilization of glass syringes?
 Before sterilization items must be thoroughly cleaned; as germs can
survive in dirt or organic matter during the process of sterilization.
 Wash separately the syringe and plunger soaking them in clean water.
 Dissolve soap or detergent in water. Draw this solution into the syringe
and needle and squirt it out.
 Rinse it out in a similar manner several times with clean water making
sure that all traces of soap are removed.
 Clean the insides of syringes well and check them before commencing
sterilization, wash all containers, the forceps too.
8. How to use a steam sterilizer?
 Clean the glass needles and syringes with mild soap water and rinse
them with plain water.
 Place the barrels, pistons and needles in the holes of the syringe rack.
 Put the rack lid on the loaded rack and press the clip so that it fixes with
the racks.
 Fill water in the sterilizer base upto the mark.
 Place the loaded sterilizer rack into the sterilizer.
 Put the sterilizer lid on the sterilizer base, matching the arrow marks on
the base and the lid and turn it clockwise to close it.
 Put the sterilizer on stove.
 As steam starts coming out of presence value, wait for 5 minutes,
reduce the flame.
 Keep it on flame for another 15 minutes.
 Remove the sterilizer from the stove and allow it to cool.
 Open the lid only when the glass syringes and needles are required.
 Turn the lid upside down and keep the forceps on it.
 Use the forceps to assemble the syringes.
9.
How to use a portable steam sterilizer?
 Take the rack out on a table
 Place the larger syringes in larger holes and smaller syringes in smaller
holes.
 Place barrel and plunger separately.
8
FAQs
MIC-Training Manual

10.
11.
12.
Put the rack lid on the rack and squeeze the clip on the lid so that it fits
into the hole in the rack.
 There is a mark inside the sterilizer base. Fill water upto this mark. If you
have hard water in your centre, use boiled water.
 Lift the rack by clip in the rack lid. These will be required to reassemble
the syringes in immunization session.
 Put the sterilizer lid on the sterilizer base, press down on the top handles
of the lid and turn it clockwise to close the sterilizer.
 Check that safety valve is closed.
 Sterilizer lid has a pressure valve too. Before you start sterilizing, close
the pressure valve by pushing the lever down.
 Place the sterilizer on a stove. After sometime, steam starts coming out
of pressure valve. Count 5 minutes from this point and then reduce the
flame. Keep it for 15 minutes. Lift the sterilizer from the stove and place
it on a firm place.
 Release the steam by lifting up pressure valve.
 Takes long time to cool down. So, sterilize your equipment well in
advance of the session.
What are the different parts of a steam sterilizer (double rack)?
It consists of following parts: Sterilizer base, syringe rack, syringe rack lid and
sterilizer lid.
How to pack (for autoclaving)?
Packing syringes:
 Wrap each set of barrel, piston and needles in gauze or cotton cloth.
 For this, cut pieces of gauze 20 cms long from a roll.
 Use one piece of gauze for each syringe.
 Check that the barrel and the plunger are a pair and that the plunger fits
into barrel properly.
 Wrap the gauze first around the plunger and then round the barrel.
 Pack the gauze-wrapper glass syringes neatly in the container for
sterilization.
How to use autoclave?
 Put water upto the mark
 Place autoclave on a stove
 Open side holes of the dressing drum.
 Put loaded drum in the autoclave
 Put the lid of the autoclave on the body and tighten the screws diagonally,
i.e. tighten the screws opposite one another before going on to the next
pair.
 After sometime the needle on the pressure gauge starts moving.
 When it registers 15 lb pressure (p.s.i) note the time. Let it remain at 15 lb
pressure for 20 minutes.
 Put off the burners.
 Let it cool/let of the steam.
 Remove the lid by loosening the screws on the lid.
 Remove the dressing drum and close the side holes by moving the side
wall cover and lock it.
FAQs
9
MIC-Training Manual
13.
14.
15.
Is boiling a safe mode of sterilizing?
Only when autoclaving or pressure sterilizing is not possible for want of
equipment, syringes and needles are sterilized by boiling. Allow glass
syringes and needles to cool before use, keeping it covered. Since it takes a
long time for glass syringes and needles to cool, try to sterilize them well in
advance of the session. Never use hot glass syringes and needles as heat
will destroy the vaccines.
What are the steps in handling glass syringes and needles?
 Wash hands with soap and water. It removes many bacteria but not all.
Be careful not to touch any other object after washing your hands.
 Use sterile forceps to pick up syringe and needle from the covered
container.
 Use separate syringe and needle for every immunization.
 Use forceps to pick up a barrel and put it in your other hand.
 Use forceps to pick up a plunger and put it in the barrel.
 Use forceps to pick up a needle. Hold the needle by its adapter and fit it
to the adapter of the syringe.
 Turn the needle & fit it securely.
 Be careful, adapter of the glass syringe breaks easily.
 Now hold the syringe carefully in your hand.
What are the steps of boiling needle and glass syringes?
Place the forceps upright leaning against the wall of the container making
sure that the latter is not so big that the forceps fall flat into the pan. If that
happens, while you try to take out the forceps your fingers will touch the water
and contaminate it and the sterilized syringes.
Cover the container with a lid. Check the boiling time by seeing the clock.
Count the time only after the boiling actually starts. At this stage, the setting in
gas/stove can be “decreased” but should be kept in such a manner that the
water continues to boil for the full 20 mins. Do not add any item into the pan
after boiling starts. After boiling, drain off all the water. Use the syringes and
needles only when they cool down. Always keep the lid of the container closed
when not taking out the syringe.
Use sterilized glass syringes and needles
10 FAQs
MIC-Training Manual
SECTION 3: HANDLING AND DISPOSAL OF INJECTION RELATED WASTE
(Refer to Session 4)
1.
What is Biomedical waste?
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Bio-Medical Waste" is any waste, generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining
thereto or in the production or testing of biologicals.
What is Infectious waste?
Infectious wastes are human tissues, anatomical waste, organs, body parts,
placenta, animal waste (tissues/cell cultures), any pathological/surgical waste,
microbiology and biotechnology waste (cultures, stocks, specimens of
microorganisms, live or attenuated vaccines, etc). cytotoxic pathological wastes
are included too, soiled waste (swabs, bandages, mops, any item contaminated
with blood or body fluids)
What is Health Care waste?
Apart from the hospital waste, it is the waste originating from 'minor' or 'scattered'
sources- such as that produced in the course of healthcare undertaken in the
health care establishments like laboratories, blood banks etc., and including
home care (dialysis, insulin, injections, etc.).
What is the importance of proper disposal of waste?
Proper disposal of waste is important to avert
i. Injury to health care providers by sharps and risk of infection to them
ii. Spillage of sharps in environment and potential danger of community getting
infection and needle stick injury
iii. Recycling of infected needles and syringes leading to spread of infections
through blood borne pathogens
How frequent should the waste be disposed off?
i. Any waste generated has to be segregated at the point of generation
ii. Biomedical waste can’t be stored beyond 48 hours as per existing guidelines.
What if the hub cutter is at the other corner of the room?
Please make arrangements to keep the hub cutter at arm’s length where you
administer injection to prevent accidental sharps injury.
Where exactly to cut while hub cutting?
At the junction of the hub with syringe.
What is safety box?
Safety box is a box recommended by WHO to store sharps. It is so designed that
you can put sharps in it but if it is toppled, contents will not spill out and it is
puncture proof.
Which guidelines to use for waste disposal?
We have to follow Biomedical Waste Handling Rules notified by the Ministry of
Environment and Forests, Government of India (Annexure A, of the Training
Manual). However, for different settings Government of India has published
guidelines which conform to these rules and one can refer to these for use in
their settings.
Is there any guideline for small clinics?
Yes, same as answer for Q. 9
General principles are discussed but what about local policies of waste
disposal?
Refer to answer for Q. 9
How small-scale clinics can afford such a costly waste management
program?
FAQs
11
MIC-Training Manual
Refer to answer for Q. 9. There are alternatives for different scenarios and some
of them are very cheap and practicable in all settings.
Is their any significance for imparting colour code to the waste bins?
The color codes are to identify type of waste in these bags and to facilitate
terminal disposal.
What is the color codes of bags used for waste disposal?
i. For household waste and non-biomedical waste like packing material, needle
caps, and empty vials, any color bag can be used except yellow, blue and
red. Commonly black/ green bag is used for such type of waste.
ii. For Biomedical Waste different color bags which can be used are
13.
14.
Color Coding
Color coding and the type of container
for disposal of bio-medical wastes
Type of Container
Waste category
Yellow
Plastic Bag
Cat.1, Cat.2 & Cat.3,
Cat.6
Cat.3, Cat.6 and Cat.7
Red
Disinfected
Container/Plastic Bag
Blue/White Translucent
Plastic Bag / puncture
proof container
Cat.4, Cat.7
Black
Plastic Bag
Cat.5 and Cat.9 and
Cat.10 (solid)
Treatment options as
per Schedule I
Incineration/Deep Burial
Autoclaving / Micro
waving / Chemical
Treatment
Autoclaving/Micro
waving / Chemical
Treatment and
destruction/shredding
Disposal in secured
landfill
Note: Annexure A SCHEDULE II of the Training Manual.
15.
16.
17.
18.
What if facilities for incineration are not available?
Segregate the biomedical waste as per guidelines and hand over to the
concerned authorities (municipal / govt.).
What is chemical treatment and how is it to be done?
All infectious equipment and waste should be first treated with chemicals for
disinfection and then sent for terminal disposal or recycling. Expose the items to
be disinfected to 1% hypochlorite solution for at least one hour.
What should be the depth of biomedical waste pit?
What is terminal disposal?
Terminal disposal refers to the final mode of disposal after segregation of waste.
The different methods are
i. Incineration
Yellow Bags
ii. Deep burial
iii. Chemical disinfection and shredding
iv. Autoclaving
Blue/ Red Bags
v. Micro waving
vi. Burial pit
Needles &Sharps
19.
20.
What should be done if a terminal waste disposal facility does not exist?
Refer to the Q. 16
What are the benefits of waste management?
Waste management leads to cleaner and healthier surroundings
Incidence of nosocomial infections reduced
Cost of infection control within the hospital reduced
12 FAQs
MIC-Training Manual
22.
23.
21.
22.
23.
24.
Disease and death due to reuse and repackaging of infectious
disposables is eliminated
Incidence of Occupational health hazards reduced
Segregation and appropriate treatment of medical waste reduces
cost of waste management and generates revenue
What happens if Plastics are dumped in an Incinerator?
Plastics, especially chlorinated plastics, when incinerated at low temperature
release toxic carcinogenic gases like Dioxins and Furans
Apart from the waste segregating and disposing aspects, do I have to
maintain any Records?
1. An Annual Report has to be submitted to the State Pollution Control Board
by 31st January every year, including the categories of waste and their
quantification. So this involves daily quantification of waste. The Air and
Water Consent forms should also be filed.
2. Every authorized person has to maintain records related to generation,
collection, reception, storage, transportation, treatment, disposal and/or any
form of handling of biomedical waste, and be subject to inspection and
verification at any time.
3. If any accident occurs at any institution or the site, the authorized person …
shall forthwith record in the stipulated form.
4. Payment of Authorization fee
What are Sharps?
Sharps consist of Needles, Scalpels, Blades, Broken Glass files, serrated knives
etc., which have the capability to injure by piercing and cutting the Skin.
How do I dispose Sharps?
Sharps should be contained in a Sharps pit, or could be encapsulated in Plaster
of Paris, Concrete etc.
Hospital waste management - whose responsibility, is it – doctors, nurses,
cleaning staff?
It is a collective initiative and shared responsibility of all viz., doctors, nurses,
cleaning staff, all employees and administrators. Segregation & appropriate
disposal is responsibility of the person who generates the waste.
How do we prevent needle stick injury?
To prevent needle stick injury
Avoid
 recapping of needles
 trying to bend/break the used needles
 manually removing needle from the syringe
 manually transferring used needles from one container to another
Always
 use hub cutter to cut the used needle
 use puncture proof container to store used and cut needles
 dispose off the waste in prescribed manner only
FAQs
13
MIC-Training Manual
SECTION 4: SETTING UP MODEL INJECTION CENTRES
(Refer to Session 5)
1.
2.
3.
4.
5.
6.
7.
How can we implement this program without adequate budget?
This program does not require any expensive equipment or skilled personnel. In
fact, all the equipment is available at your health facility and it is easy to train
personnel from your own facility.
Is it possible for serious patients to get moved to MIC?
Serious patients need not be moved to the MIC
Who will supervise the activities?
The Injection Safety Coordinator (ISC) will supervise the activities
Will there be retraining? If, yes then at what interval?
The issue of retraining will be decided after the evaluation of the first round of the
training is over.
How will you evaluate the working of MIC?
The MIC will be evaluated during the Annual Review Meetings to be held at the
end of the year.
Should we strictly follow the layout?
The layout is a suggested plan. The emphasis is on providing adequate space,
comfortable seating / lying down arrangements for patient. Arrangements of
injection related equipment such that there is no risk of accidental injuries from
sharps to the givers and recipients of injection and the waste handling personnel
at the health facility / MIC.
If a health care provider wants to set up an MIC in his/ her facility who will
manage them?
The health care provider of the facility will manage the Model Injection Centre.
The IndiaCLEN MIC Project members can provide technical and Quality
Assurance support if desired by the proposed Model Injection Centre.
14 FAQs
MIC-Training Manual
SECTION 5: RATIONALITY OF INJECTIONS
(Refer to Session 6)
1.
2.
3.
5.
How can this program be successful without including the private sector?
Your concerns are absolutely right. We share it, and have created scope and
modalities to include private prescribes and injection givers in our training
programs.
How to deal with patients demanding injections?
 Counseling. Empowering them with correct information.
 Telling them that in most of the situations, oral medications are as
effective as the injections – and are much safer as well as cheaper.
 If the patient is taking orally and the oral preparation of the medicine is
available, injections must be avoided since they may involve the risk of
potentially serious complications.
 It must be made clear that THIS FAQ AND EXPLANATION DOESN’T
APPLY TO IMMUNIZATION.
Possibility of more such trainings and more so for the nursing
personnel.
 Yes. We will continue to have similar programs for other trainees, including
the nursing personnel.
 For you, however, it may not be in the form of a similarly structured program.
We have developed a mechanism of an ongoing interaction and partnership
with you. You are encouraged to make a call or write to us for
clarifications/sharing your experiences. You may also visit our MIC and can
have one-to-one conference with SIs or MIC Coordinator, after a prior
appointment.
Importance of public awareness about rationality of injections.
 It is extremely important. Every member of the community is a stakeholder
here.

6.
Clients and attendants derive their injection related notions and ideas through
public perceptions. Rationality is more likely to be an essential part of
“injection prescribing culture” if there is a rising trend of awareness among
the people on this issue.
 One of the goals of MICP is to bring about a positive change in “injection
prescribing culture”. Each one of you is going to function as an ambassador
to promote this culture in your own right and capacity. Not only as an
interface between community and MIC but also as a potential MIC of your
own to initiate a chain reaction.
 The tested methods of mass communication will also be engaged.
When do you consider injections irrational?
Preceding discussions in this program have covered this issue at length.
However, to re-explain it broadly, an injection can be called as irrational if it is
prescribed for the following conditions, in the OPD settings:
 Diarrhea
 ARI
 Undiagnosed fever
 Ambulatory malaria
 Non-specific complains e.g. General Weakness, Uneasiness, Vague Anxiety
(Ghabrahat), etc.
FAQs
15