Medical Injection Safety Program 2004-2009

Key achievementsKey achievements

Waste segregation and sharp waste disposal

At the project’s beginning only 2% of 32 hospitals in the baseline survey had safe sharps

containers, compared to 95% of the 167 reporting facilities at the project’s end.

University Research Co., LLCRoom 1C 13/14 Ministerial Building, Harvey Street, P.O. Box 20470, Windhoek, NamibiaTel: +264 (61) 237-022/24Fax: +264 (61) 237-023

Waste segregation poster displayed in all the facilities

Post-exposure prophylaxis (PEP)

PEP kits are available at some health facilities, and all healthcare workers have access to PEP

through a referral system. Knowledge on obtaining PEP within 72 hours increased from 47% in 2004 to universal by the end of the project.

General hygiene and universal precautions

The level of cleanliness continues to improve for most of the institutions. Hand washing is

becoming a culture for all health care facilities. Hand washing is further reinforced by use of posters both for health care workers and community members.

Capacity building

About 8,500 health care workers were trained in injection safety, waste management and

quality assurance. The capacity of the MOHSS to take over training has improved. On-the-job training in injection safety and waste management is still continuing in most of the facilities. District and regional leadership are more committed in taking corrective actions based on challenges identified during supportive supervision.

Commodities and supplies

The project provided more than 350,000 safety boxes and incorporated the tender and provision

of boxes and color coded bin liners into the central medical stores’ ordering system. Personal Protective Equipment (PPE) for use by healthcare workers were also procured and distributed countrywide.

Behavior change and communication

By using trained community educators, URC in collaboration with MOHSS raised community

awareness about rational use of medicine to reduce demand for unnecessary injections and ensure proper disposal of infectious waste produced by some community members, such as insulin-dependent diabetic patients. By the end of the project, over 63, 000 community members had been reached with injection safety messages.

Namibia

On cover: A nurse prepares an injection for a patient.

How we workedWhat the program was

Under the President’s Emergency Plan for AIDS Relief (PEPFAR), University Research Co., LLC

(URC) assisted the Namibian Ministry of Health and Social Services (MOHSS) to reduce the transmission of HIV and other blood borne pathogens through improving medical injection and healthcare waste management practices in the country. Specifically, the project aimed to reduce per capita injection use to less than one per year, to decrease needle-stick injuries through improved clinical practices, and to promote safe disposal of health care waste.

The program was implemented nationwide in 13 Regions and 327 Facilities. All the 327 facilities are now in compliance with injection safety and waste management practices. The project also covered a number of large private hospitals, independent rural private providers, hospices, prison departments, the community, and nursing schools.

Policies and Guidelines

URC was instrumental in the development and operationalization of policy documents, such as

the National Infection and Prevention and Control Guidelines, National Quality Assurance Policy, and National Waste Management Policy and Guidelines. Over 90% of the facilities are following all the required policies and guidelines. The project also convened a National Injection Safety Working Group to develop or review national policies, an implementation process, and to prepare a national plan.

Safe injection knowledge and practices

Facility quarterly reports showed that the average number of injections prescribed per patient was

less than 0.5 injections per patient visit compared to 1.42 injectable medications that were prescribed per person at the beginning of the project.

A significant achievement was also the reduction in the re-use of syringes and needles: by the end of the project, no facilities re-used their syringes or needles nor sterilized them for general use.

While needlesticks are often under-reported, the best information from interviews, facility reports and site visits was needlesticks decreased in many regions. For example, in the years 2006-2009, needlesticks in the Omusati Region decreased from 24 per year to 7; in Rehoboth District needlesticks decreased from 3 annually to 0 in the last 18 months.

URC worked with MOHSS to strengthen the capacity of the regional and facility-based

managers to promote safe infection and waste disposal practices. The objective of the technical support was to improve both content of care and process of care.

To improve the content of care, compliance with the evidence-based guidelines were improved though training, better communication of guidelines/protocols, and supervision. The process of care was improved through a better understanding of the system, bringing changes in injection practices and by reorganizing care or waste disposal practices.

Improvement Strategies – Balancing Content and Process of Care

Content of care

Evidence-based: - Standards- Protocols- Guidelines

Process of care

Quality Improvement Methodology- Systems- Compliance- Variation- Attitudes/Motivation

Outcomes/Outputs (limited)

Adapted from:Paul Balalden, Patricia Stoltz; A Framework for Continual Improvement in Healthcare; �e Joint Commission Journal on Quality Improvement; October 1997

Improved OutcomesIncreased E�ciency

Training/Support

By the end of the project, no facilities re-used their syringes or needles nor sterilized them for general use.

Two nurses prepare injections in Opuwo Hospital, Namibia

Key achievements