Injection safety or safe injection practices are measures taken to perform injections in an optimally safe manner for patients, healthcare providers, and others.

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These are some of our Frequently Asked Questions

These are some of our Frequently Asked Questions

Injection safety or safe injection practices are measures taken to perform injections in an optimally safe manner for patients, healthcare providers, and others.

A safe injection does not harm the recipient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous for the community. Injection safety includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider, and also to prevent harms such as needle stick injuries.  

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About 16 billion preventive and curative injections are given each year in developing and transitional countries. Over 95% of all injections given are curative (therapeutic): for every vaccination given, 20 therapeutic injections are administered. Because injections are so common, unsafe injection practices are a powerful engine to transmit blood borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

  • Hepatitis B virus: HBV is highly infectious and causes the highest number of infections: in developing and transitional countries 21.7 million people become infected each year, representing 33% of new HBV infections worldwide

  • Hepatitis C virus: Unsafe injections are the most common cause of HCV infection in developing and transitional countries, causing two million new infections each year and accounting for 42% of cases.

  • Human immunodeficiency virus: Globally nearly 2% of all new HIV infections are caused by unsafe injections. In South Asia up to 9% of new cases may be caused in this way. Such proportions can no longer be ignored.

Because infection with these viruses initially presents no symptoms, it is a silent epidemic. However, this is a kind of infection transmission that can be easily controlled. Meanwhile, the consequences of this silent epidemic are increasingly recognized.

HBV, HCV, and HIV cause chronic infections that leads to disease, disability and death a number of years after the unsafe injection. Those infected with hepatitis B virus in childhood will typically suffer from chronic liver disease by the age of 30 years, at the prime of their life. This has a dramatic effect on national economies.

3.1 Annual Cost of Unsafe Injections to Healthcare Systems

A recent study indicated that each year unsafe injections cause an estimated 1.3 million early deaths, a loss of 26 million years of life, and an annual burden of US$ 535 million in direct medical costs. In 2008, unsafe medical injections incurred US $119 billion in productivity losses and the costs of treating nosocomial HIV, HBV, HCV, bacteraemia and injection site abscesses worldwide. The global incremental cost effectiveness ratio of introducing reuse prevention syringes for all medical injections is 0.0187, indicating that this intervention would be cost-saving. In no region does the cost per disability adjusted life year gained by preventing injection equipment reuse exceed average annual earned income. 

In the United States, for example, where HBV and HCV infection are not common, the overall cost of HBV and HCV is estimated at US $1.3 billion. In many developing countries, the proportion of the population infected with HBV and HCV exceeds 10 times the prevalence seen in the USA, and in many of these countries, unsafe injections account for a large proportion of new cases of HBV and HCV infection. Thus, the cost of unsafe injection practices in developing countries is high.

*The cost of unsafe injections by M.A. Miller & E. Pisani: Bulletin of the World Health Organization, Vol. 77, no 10, 808-811.

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Today the average price of a needle and syringe with reuse prevention features is $0.12. Forty eight different syringes with reuse prevention features meet WHO specifications for therapeutic injections.

During the annual review, hospitals should carefully examine the safety syringe products that are currently being used and should also evaluate all of the new options that exist. There are three main safety syringe technologies now available to hospitals to help prevent needlestick injuries:

  • Retro-fitted: A conventional syringe with an add-on piece, such as a cap, sheath, or shield that covers the needle.

  • Manually retractable: Operating with a simple “Push, Pull, Snap” mechanism to manually withdraw the needle into the syringe barrel and snap off the plunger.

  • Automatically retractable: A spring-activated safety syringe that automatically draws the needle back into the syringe barrel after use.

Each of these safety syringe designs has its pros and cons, and it is important for the hospital to consider all aspects of each design. In fact, it is much better to compare and contrast examples of the three technologies rather than to compare different products from one technology. Adopting this approach will ensure a better appreciation of what the market has to offer.

Hospitals may be most familiar with retro-fitted designs, as this was the first type of safety syringe widely introduced for the prevention of needlestick injuries. Retro-fitted designs incorporate a safety mechanism, usually attached to the needle and not to the syringe itself, which can be used to cap the needle. Retro-fitted syringes can impede certain procedures, to the point where a clinician may remove the safety mechanism completely in order to proceed – something that negates the usefulness of the device entirely. In addition, when using the safety mechanism to disable the needle, the clinician’s fingers may still come into close proximity with the needle, raising the possibility of needlestick injuries. And since the safety mechanism may be able to be removed after being engaged, it is possible for the syringe to be reused, which can be extremely dangerous. 

Automatically retractable designs may at first be appealing, as the user does not have to do anything upon completion of the injection to avoid needlestick injuries. Working like a ballpoint pen, the needle automatically retracts into the barrel of the syringe. However, such devices may fail if used incorrectly, and there may be aerosolization if retraction is activated outside of the patient. In addition, automatically retractable safety syringe designs are often significantly more expensive than other options.

Manually retractable syringes have the look and feel of conventional syringes. The safety mechanism is integral to the syringe and functions with a simple Push, Pull, Snap . After pushing to complete the injection, the plunger is pulled back, retracting the needle into the syringe barrel. Snapping the plunger completes the process, permanently disabling the syringe to prevent any possible re-use and reducing the volume for the sharps container. Because the user has control of the mechanism at all times, there is a lowered risk of aerosolization. And the user s hands always remain out of the way of the needle, making it easier to administer injections and reducing the risk of disposal needlestick injuries even further. In addition, manually retractable syringes may be more cost-effective than automatically retractable syringes, which can be important when it comes to a hospitals yearly budget.

When researching new or updated safety syringe options to prevent needlestick injuries, a hospital or healthcare facility should also consider the following:

  • Easy-to-read gradation markings

  • Availability of syringes with low dead space

  • Range of syringe sizes

  • Low dose options, particularly for syringes to be used for insulin

  • Cost

  • Syringes that are easily labeled at the time of use, ideally with a write-on field

Unsafe injection practices are increasingly recognized as a major source of infection with blood borne pathogens. While it is the responsibility of all health care workers, their employers, the public, and national governments to ensure safe and appropriate use of injections, the prevention of blood borne pathogen transmission and other adverse events associated with injections will require improved collaboration between organizations and individuals sharing a common interest in attaining this goal

Needlestick Safety and Prevention Act/

Bloodborne Pathogens Standard

Summary of the Needlestick Law 
[Public Law 106-430, 106th Congress, H.R. 5178]

This landmark achievement for nurses nationwide changed the Bloodborne Pathogens standard under the Occupational Health and Safety Act to provide increased protections to workers from exposure to human immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus, and other viruses and infections. The same year, the Centers for Disease Control and Prevention (CDC) estimated that from 62 percent to 88 percent of sharps injuries potentially could be prevented through use of safer medical devices.

The law requires employers to use work practice controls and safer needle devices that are engineered to eliminate or minimize exposure to bloodborne pathogens resulting from needlestick injuries. Employers must:

  • Demonstrate that they are reviewing new technology that can reduce risk of exposure to bloodborne pathogens by updating exposure control plans and documenting the decision-making process on implementing such technology.

  • Maintain a sharps injury log to track the type and brand of device used, the department or area where the incident occurred, and an explanation of the incident. The log must be maintained in a manner to protect the confidentiality of the injured employee.

  • Solicit input from employees responsible for direct patient care in the identification, evaluation and selection of effective safety devices and work practice controls, as part of the ongoing exposure control plan development process. Efforts to encourage staff input must be documented in the plan.

Learn more information about Needlestick Safety and Prevention Act:

Canada: Safe needles laws spread further

The Service Employees International Union (SEIU) Canada is applauding a commitment from the provincial government in Manitoba to convert from conventional to safety-engineered medical sharps devices. ‘Legislation is absolutely vital to protect the workers and people of Manitoba from these potentially deadly injuries,’ said Sharleen Stewart, Canadian international vice-president with SEIU. ‘We must have mandatory use of safety-engineered devices in every workplace – anything less will give us less.’ Ted Mansell, SEIU Canada’s health and safety coordinator, points to the legislation in the US, as well as an announcement made by the neighbouring province of Saskatchewan last month, as a model (Risks 182). ‘Both of those jurisdictions have realised that in order to avoid a patchwork of protection, the conversion must be done across the board,’ he said. ‘If not, we will have some workers protected, others not protected and the on-going threat of used needles in public spaces.’

The WHO strategy for the safe and appropriate use of injections

UNICEF-WHO-UNFPA joint statement on use of auto-disable syringes in immunization services. 

Federal OSHA’s Revised Bloodborne Pathogens Standard – Published 1/18/01


 APIC position paper: Safe injection, infusion, and medication vial practices in health care

UK NHS: Prevention of Occupational Exposure to Blood-Borne Viruses Policy


EU Directive to prevent injuries and infections to healthcare workers from sharp objects such as needle sticks

Latin America – Policy and Legislation to protect healthcare workers from occupational exposures to bloodborne pathogens


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