Sultana Habibullah, Salahuddin Afsar.
Assessment of injection practices in public sector expanded programme of immunization clinics in Karachi.
Pak J Med Res Jan ;49(1):1-4.

Background: A safe injection is defined as one that does not harm the receipent, expose the health worker to avoidable risk or result in waste that is harmful to others. Objectives: To assess injection practices in Public Sector Expanded Programme of Immunization (EPI) clinics in three urban towns of Karachi and see if these clinics meet the necessary requirement for staff competence, supply of vaccines, injection equipment and their disposal. Subjects and Methods: This was a health centre based cross-sectional survey conducted in 49 Public Sector EPI clinics from June 2008 to March 2009. These clinics were selected using random table from three urban towns i.e. Saddar, Lyari and Jamshed town of Karachi. Variables of the study were socio-demographic characteristics of the vaccinators including their training qualifications, staff competence, information regarding supply of vaccines, injection equipment, puncture proof safety boxes, maintenance of cold chain and vaccination/medical waste disposal. WHO tool for the assessment of injection safety was used as a questionnaire for the collection of data and it was analyzed on computer package SPSS version 11. Results: Data showed that 35(71%) vaccinators were males and of the total, 38(78%) vaccinators were less than 30 years of age, 45(92%) were trained dispensers but also trained for vaccinations and 4(8%) staff nurses. It was observed that in all clinics disposable syringes were used for BCG and AD syringes were used for DPT, Measles and Hepatitis vaccination. Adequate amount of vaccines, injection equipment and puncture proof safety boxes were available, cold chain for the preservation of vaccines was well maintained, used syringes/needles were not re-used, families did not bring their own syringes for vaccination. Recapping of used syringes was observed in 20% clinics, skin barrier (piece of gauze under the thumb) while breaking vaccine bottles was not practiced in any EPI clinic. All used syringes and needles were thrown in puncture proof safety boxes. There was no history of needle prick injuries among vaccinators. Policy Document for safe injection practice and waste disposal was not found in any EPI clinic and the staff was ignorant about it. Conclusions: The study concludes that in all 49 EPI clinics, injection practice was safe except its method of waste disposal, sufficient amount of vaccines, injection equipment, and puncture proof safety boxes were available and staffs of these clinics were well trained.

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