WHO Adopts New Safety Needle Policy

The World Health Organization (WHO; Geneva, Switzerland) has launched a new policy to make unsafe injections less prevalent by promoting the use of safety-engineered syringes for intramuscular, intradermal, and subcutaneous injections.

WHO is urging countries to transition by 2020 to the exclusive use of the smart syringes, except in select circumstances, such as syringe programs for people who inject themselves with drugs and medication. As part of that initiative, manufacturers are urged as soon as possible to begin or expand their production of smart syringes. Other key strategies recommended are continued training of health workers on injection safety, and the implementation of policies and standards for the procurement, safe use, and safe disposal of syringes that have the potential for reuse.

Several smart syringe design options exist, including a syringe with a plunger that breaks if the user attempts to pull it back a second time, others that have a clip to block the same movement; some syringes utilize retracting needles that prevent a second use. Syringes are also being designed with features that protect health workers from needle stick injuries, such as a sheath or hood that slides over the needle after the injection is completed, which protect the user from being accidental needle-stick injury, and potentially exposed to an infection.

According to WHO, 16 billion injections are administered annually, with 5% of these injections used for immunization, and another 5% used for procedures such as blood transfusions and injectable contraceptives. The remaining 90% of injections are given in an intramuscular, subcutaneous, or intradermal route for administration of medication. WHO therefore stressed the need to reduce the number of unnecessary injections as a way of reducing risk, since in many cases these injections are unnecessary or could be replaced by oral delivery.

“We know the reasons why this is happening. One reason is that people in many countries expect to receive injections, believing they represent the most effective treatment,” said Edward Kelley, MD, director of the WHO service delivery and safety department. “Another is that for many health workers in developing countries, giving injections in private practice supplements salaries that may be inadequate to support their families.”

A 2014 study sponsored by WHO estimated that in 2010 unsafe injections resulted in up to 1.7 million people infected with Hepatitis B virus, up to 315,000 with Hepatitis C virus, and as many as 33,800 with HIV. WHO also cited several cases in which an unsafe injection protocol has led to the unnecessary outbreak of infectious disease. In 2007, a doctor in Nevada (USA) reused hepatitis C-contaminated syringes. In Cambodia, more than 200 children and adults tested positive for HIV, in an outbreak that is thought to have occurred due to unsafe injections.

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