The World Health Organisation has unveiled a new policy and global campaign on the safety of injections, with the aim of cutting infections from diseases such as HIV and hepatitis.

Under the new policy, WHO is urging countries to adopt safety-engineered syringes or “smart” syringes that have features that prevent reuse.

“The new policy and global campaign represent a decisive step in a long-term strategy to improve injection safety by working with countries worldwide. We have already seen considerable progress,” said Edward Kelley, director of WHO’s service delivery and safety department.

Countries are expected to transition to the exclusive use of the new “smart” syringes by 2020.

However, the syringes cost at least twice the price of those without safety features. The latter go for between $0.03 and $0.04 when procured by a UN agency for a developing country.

In that regard, WHO is calling on donors to support the transition to the “smart” devices, and is expecting that prices will drop over time as demand rises.

The organisation is also calling for policies and standards for the procurement and safe use and disposal of syringes that have the potential for re-use in situations where they remain necessary, such as in programmes for people who inject drugs.

Continued training of health workers in injection safety — which the WHO has supported for decades — is another key recommendation.

WHO is calling on manufacturers to begin or expand, as soon as possible, the production of “smart” syringes that meet the organisation’s standards for performance, quality and safety.

The syringes are being engineered with safety features including devices that protect health workers against accidental needle injury, also called “needle stick” injuries, and consequent exposure to infection. A sheath or hood slides over the needle after the injection is completed to protect the user from being injured accidentally by the needle and potentially exposed to an infection.

Other models include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle retracts into the syringe barrel at the end of the injection.

Needle reuse

The use of the same syringe or needle to give injections to more than one person is driving the spread of a number of infectious diseases worldwide. Millions of people could be protected from infections acquired through unsafe injections if all health-care programmes switched to syringes that cannot be used more than once.

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with the hepatitis B virus, up to 315,000 with the hepatitis C virus and as many as 33,800 with HIV through unsafe injections.

There are 16 billion injections administered every year. Around five per cent of these injections are for immunising children and adults, and five per cent are for other procedures like blood transfusions and injectable contraceptives. The remaining 90 per cent of injections are given into muscles (intramuscular route) or skin (subcutaneous or intradermal route). In many cases these injections are unnecessary or could be replaced by oral medication.

“We know the reasons why this is happening,” said Dr Kelley. “One reason is that people in many countries expect to receive injections, believing they represent the most effective treatment. 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.”