An assessment of safe injection practices in health facilities in Swaziland

To determine the magnitude and causes of unsafe injection practices in Swaziland.

A safe injection practices questionnaire was administered and injection practice was observed.

A selected variety of health facilities in Swaziland.

Health workers in each facility.

Unsafe injection and collection for disposal practices.

All injections observed involved disposable syringes. Although all injections were given at the correct site, using the correct dosage and equipment, unsafe injection technique was observed. Needles were changed on the same syringe at 8 facilities (31%) and syringes and needles were reused at 2 facilities (8%). Recapping of needles after use occurred at 8 facilities (31%). More than one-quarter of nurses reported having pricked their finger in the previous 6 months; in almost half of these cases this was after administration of an injection. Seven nurses (25%) recalled seeing a case of an abscess or a mild adverse event following an injection in the previous 12 months. Interviewers observed used syringes and needles being placed in a safe container in three-quarters of facilities. Almost all respondents reported that syringes and needles were buried or burned.

Auto-disable syringes should be used for all routine and supplemental vaccination. The increased cost of auto-disable syringes represents only a small increase in the national Expanded Programme on Immunisation (EPI) budget.