Abstract:

The objective of this study was to assess Depo-Provera injection practice among health care workers (HCW) in primary health care facilities in kilombero district, Tanzania. The cross sectional descriptive design using structured observation checklist was used to collect data. About 261 HCWs participated in the study to assess best practise of intramuscular injection technics and infection prevention measures. The SPSS descriptive statistics and chi-square tests were used to analyze data. Results indicate that majority of HCWs had adequately practiced infection prevention and intramuscular technics but did not perform well hand washing steps before and after giving injection. Many of them didn’t check labels or shake vials before giving injection. Three quarter practiced critical steps of using sterile syringes, avoiding recapping the needle and use of safety box to discard contaminated sharps, while three quarter of HCW could not practice steps of hand wash before and after giving injection. Three quarter of participants correctly practiced filling drug into syringes, expel air from it, injected deep muscles, aspirated and pushed all drug into the muscles, Secondary graduates and nurse officer with diploma have significantly performed well in injection practice to ensure that before injecting the drug, aspirated through syringes and needle to ensure that the injecting needle is in the muscle and not in the vein. In conclusion, healthcare workers showed adequate practice of injection technics and infection prevention. However hand washing, drug label check and Depo-Provera preparation needs in house training and supervision.

Keywords: injection practice, contaminated waste, Blood borne infection, intramuscular injection technics, infection prevention.

References:

[1]. Bartley N, 2014. Guidelines on the Administration of Intramuscular and Sub-Cutaneous Injections, Retrieved January 16, 2016 from http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Intramuscular-and-Sub-Cutaneous-Injections-Administration.pdf.

[2]. Calvert C, Ronsmans C. (2015). Pregnancy and HIV disease progression: a systematic review and meta-analysis. Journal of Tropical Medicine and International Health, 20(2):122-45. Retrieved June 5, 2016, from PubMed.

[3]. Gyawali S¹, Rathore DS, Shankar PR, Kumar KV. (2013). Strategies and challenges for safe injection practice in developing countries. J Pharmacol Pharmacother. 2013 Jan; 4(1):8-12. doi: 10.4103/0976-500X.107634.

[4]. Hutin Y, Anja Hauri, Linda Chiarello, Mary Catlin, Barbara Stilwell, Tesfamicael Ghebrehiwet, Julia Garner & the Members of the Injection Safety Best Practices Development Group (2003). Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections, Bulletin of the World Health Organization 2003;81:491-500. Retrieved January 20, 2016 from

http://www.who.int/bulletin/volumes/81/7/Hutin0703.pdf.

[5]. Hunter J. Intramuscular injection techniques. Nurs Stand. 2008 Feb 20-26;22(24):35-40.

[6]. Nilsson J, Andrea B. Pembe, Miriam Urasa, and Elisabeth Darj (2013). Safe injections and waste management among healthcare workers at a regional hospital in northern Tanzania. Tanzania Journal of Health Research Doi: http://dx.doi.org/10.4314/thrb.v15i1.8 Volume 15, Number 1, January 2013.

[7]. Pharmacia and Upjohn Company DEPO-PROVERA®, 2009. Medroxyprogesterone acetate injection, suspension: Physician Information. Retrieved from https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=1156.

[8]. Laxmaiah Manchikanti, MD, Yogesh Malla, MD, Bradley W. Wargo, DO, and Bert Fellows, M, 2011. Infection Control Practices (Safe Injection and Medication Vial Utilization) for Interventional Techniques: Are They Based on Relative Risk Management or Evidence? Pain Physician 2011; 14:425-434 • ISSN 1533-315.

[9]. Pepin J, Abou Chakra CN, Pe´pin E, Nault V, 2013. Evolution of the Global Use of Unsafe Medical Injections, 2000–2010. PLoS ONE 8(12): e80948.doi:10.1371/journal.pone.0080948.

[10]. Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine, 2005, 48(6):482–490. Retrieved from

http://www.who.int/quantifying_ehimpacts/global/7sharps.pdf.

[11]. PMTCT Tanzania. National resource centre for prevention of mother to child HIV transmission (2016). Retrieved June 15, 2016 from http://pmtct.or.tz/pmtct-tanzania/pmtct-in-tanzania/.

[12]. Susan A. Dolan, Kathleen Meehan Arias, Gwen Felizardo, Sue Barnes, Susan Kraska, Marcia Patrick, Amelia Bumsted (2016). APIC POSITION PAPER: SAFE INJECTION, INFUSION, AND MEDICATION VIAL PRACTICES IN HEALTH CARE. Retrieved 20 March, 2016 from http://www.apic.org/Resource_/TinyMceFileManager/Position_Statements/2016APICSIPPositionPaper.pdf.

[13]. Tanzania (2004) National Infection Prevention and Control Guidelines for Health Care Services in

[14]. Tanzania. Ministry of Health and Social welfare, The United Republic of Tanzania, Dar es Salaam.

[15]. World Health Organization, 2010. WHO Best Practices for Injections and Related Procedures Toolkit Geneva: 2010 Mar. ISBN-13: 978-92-4-159925-2. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK138491/PubMed.

[16]. World Health Organization. (2008). Revised injection safety assessment tool. Retrieved from http://www.who.int/injection_safety/Injection_safety_final-web.pdf

[17]. World Health Organization, 2015. WHO Guideline on the Use of Safety-Engineered Syringes for Intramuscular, Intradermal and Subcutaneous Injections in Health-Care Settings. Geneva: Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK305368/.

[18]. World Health Organization, 2011. Family planning: a global handbook for providers. WHO regional publication.