Improving injection safety and waste management: Lessons from Swaziland

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1 Improving injection safety and waste management: Lessons from Swaziland Samson Haumba Country Director Nokuthula Mdluli Improvement Advisor 1

2 Background and purpose In Swaziland, HIV prevalence is 26% in the year-old group With the scale-up of HIV services, there is increased diagnostic and therapeutic injection-related procedures such as phlebotomies and health care waste generation The purpose of the activity is to make medical injections safer thus reducing the risk of transmission of HIV and other blood-borne pathogens like Hepatitis B and Hepatitis C by: Ensuring safe phlebotomies; Improving injection safety practices; Improving health care waste management practices especially handling and disposal of sharps; Improving uptake of post exposure prophylaxis (PEP) among HCW who get needle pricks Health care worker engagement to address fear and stigma related to care of HIV patients needing injections 2

3 Activities under the project 1. Support the implementation of standards related to improving injection safety and waste management practices using quality improvement approaches 2. Evaluate the impact of improving safe injection practices on increasing health worker engagement and attitudes towards caring for PLHIV 3

4 Scale of injection safety and waste management activities MOH (EPI, EHO) ASSIST Project staff 4 out of 4 regions 20 health facilities 20 QI teams out of million 4

5 Interventions Implementing standards for reducing unsafe injection practices Compliance to safe injection practice and procedure Proper use and availability of equipment and supplies Proper health care waste management practices Waste segregation, securing and disposal Increasing health worker safety Prevention of sharps injuries to health care workers Occupational risks and management (HBV, HCV) Management of needle stick HIV exposure (PEP) Training, quality improvement projects, and coaching Health facility injection safety teams, wellness staff and managers Injection safety, health care waste management, and quality improvement 5

6 Preliminary results Baseline (Sept 2013) Oct Dec 2014 Jan Mar 2015 Apr June Compliance with safe injection procedures (7 criteria) 2. Compliance with safe injection practices in the facility (7 criteria) 3. Health care worker safety (5 Criteria) 4. Health care waste management practices (6 criteria) 5. Policies, guidelines, job aids (4 criteria) 6. Equipment and Supplies (4 Criteria) 7. Availability of structures for QI knowledge for service providers (3 Criteria ) 6

7 Challenges Inadequate resources to meet the actual need for safe injections and waste care disposal Inadequate involvement of senior managers in enforcing standards on injection safety in health care facilities Inadequate health care worker engagement, which reduces motivation thus compromising compliance to standards at all points Lack of information and training on safety-engineered devices Limited access to technological solutions to ensure health care worker safety i.e., safety-engineered devices 7

8 Lessons learnt Applying quality improvement science and collaborative learning is improving compliance to standards Availability of appropriate equipment and supplies for injection safety and health care waste management is critical to seeing actual improvement Stewardship and political commitment from MOH improves sustainability of interventions 8

9 Acknowledgements Ministry of Health Expanded Programme on Immunization Environmental Health Unit Health Promotion Unit Clinical Services (curative) PEPFAR funding support through USAID USAID ASSIST staff, URC 9

10 Thank you Samson Haumba: Nokuthula Mdluli: Related resources posted on: eaming-injection-safety-healthcare-delivery 10