Assessment of Injection Practices in Medical Facilities of China
Principal Investigators：Cao Yang, Chen Jie
Advisor：Yvan Hutin (WHO,Geneva)
Shao Ruitai，Deputy Director-General, Department of Disease Control, Ministry of Health, China
Wang Yu，Deputy Director-General, Department of Health Management, Ministry of Health, China
Zhang Chaoyang，Deputy Director-General, Department of Community and Woman Health, Ministry of Health, China
Wang Panshi，Director, Department of Disease Control, Shanghai Bureau of Health, China
Yan Shijie，Director, Department of Health Management, Shanghai Bureau of Health, China
Medical Technology Assessment and Research Center, Fudan University, China
Department of Hospital Management, School of Public Health, Fudan University, China
Healthcare facilities of Shanghai, China
Cao Yang，PH.D student of Department of Hospital Management, School of Publish Health, Fudan University, China
Chen Jie，Special Representative of The Director-General of WHO, Professor of Fudan University, China
Anke Tijtsma，Associate Professional Officer, Assistant to Dr. Chen Jie, WHO
Chen Xinbao，Professor of Department of Health Economics, School of Public Health, Fundan University, China
Cao Jianwen，Deputy-Director, Department of Hospital Management, School of Public Health, Fudan University, China
Dai Baozhen，Dean of School of Nursing, Fundan University, China
Chen Yinyao，Department of Hospital Management, School of Public Health, Fudan University, China
Huang Jianyan，Department of Hospital Management, School of Public Health, Fudan University, China
China includes more than one fifth of the world's population and thousands of millions of injections are delivered every year in the country while reports suggest that unsafe practices occur, leading to the transmission of bloodborne pathogens, including hepatitis B virus, hepatitis C virus, and HIV. Though poor injection practice is one of the major public health problems in China, there are few information available from systematic survey to describe unsafe injection practices and there is little experience available to integrate programmes linking the community with the health system to achieve safe and appropriate use of injections in China. In order to provide evidence to base a regional initiative for the safe and appropriate use of injections in a sector-wide approach that would assist in the management reformation of health care system and medical facilities, the Medical Technology Assessment and Research Center (MTARC) of Fudan Universit and the Safe Injection Global Network (SIGN) in WHO cooperate and carry out a pilot study to gather information, analysis and assess the situation of injection safety in Shanghai, China.
In the study we reviewed documents concerned, used a toolbox provided by SIGN to interview local informants, observed health facilities and injection procedures directly, and used focus group discussions and standardized questionnaires to collect semi-quantitative and qualitative information among injection prescribers, providers, auxiliary staff/workers handling healthcare waste and general population.
The sites we studied in the survey included 6 hospitals from urban area and 8 health care facilities from rural area. In each study site, a convenience sample was selected which include 5-10 injection prescribers , 5-10 injection providers and 10 prescriptions from each prescriber. The focus group discussions of patients, injection prescribers, injection providers and auxiliary staff/workers handling healthcare waste were held respectively. A quota sampling method was used to select the samples of general population which included 400 people from urban area and 400 people from rural area . The proportion of sex and age of samples were consistent with the data of Shanghai of the Fifth Census of China.
In the survey, we found that 47.81% (47.54% in urban area and 48.07% in rural area) prescriptions included at least one injection. Of 806 community people interviewed, 25.43% (15.88% in urban area and 34.98% in rural area) reported receiving an injection in the last three months. The ratio of therapeutic and immunization injections was 8.74:1 (5.45:1 in urban area and 10.43:1 in rural area). Proportion of health care facilities using sterilizable injection equipment was 1/14, using disposable injections equipment was 14/14 and no facility uses auto-disable injection equipment. The average number of injections per capita and per year is 4.40 (1.99 in urban area and 6.81 in rural area).
As in many other cultures, injections are probably popular in China. Even at this time of rising awareness about AIDS, the popularity of injection remains high in Shanghai. This phenomenon is more obvious in rural area. A number of elements suggest that healthcare workers may contribute to injection overuse. Sharps injuries happened frequently among injection providers and medical waste handlers. Educational message is urgently needed in community population. It could be argued that immediate steps need to be taken to reduce the harm of current injection hygiene practices. An obvious starting point is to advocate for the use of fewer injections and more oral medication. A second course of action involves in auto-disable (AD) syringes using. A functional provision, management, supervision and waste handling system of injection has been constructed in Shanghai. Disposable syringes and needles have been completely accepted by practitioners and patients. Most people have been aware of the association between injections and infections.
Planning for a short term injection safety campaign and for a longer term national strategy should be made. Activities should be conducted to (1) promote safer practices and behavior change, (2) introduce auto-disable syringes and new sharps containers into using, and (3) manage sharps waste appropriately. Efforts to reduce injection overuse and to achieve injection safety would fit in the objectives of the health system reforms.