A National Program for Promotion of Infection Control and Safe Injections

In Egypt

Annual Meeting of the Safe Injection Global Network

SIGN, 2002

Ministry of Health and Population

PartnersUSAIDWHO

Ford FoundationNamru-3

A National Program for Promotion of Infection Control and Safe Injections

In Egypt• Background• Goals and objectives of the program• Findings of baseline assessment• Strategic approach of the program• Communication Strategy to prevent BBPs transmission

– Objectives– Target audiences– Messages– Means– Material

Blood-borne pathogens transmission in Egypt

• Major public health problems

• 10-15% of the population have HCV infection

• Prevalence of HBV is 4%

• Three epidemics of Aids were reported in Egypt since 1993

• Treatment of infected persons is a burden on the economy of Egypt

Nosocomial Infections

• Emerging as important public health problem throughout the world - increase in antimicrobial resistance - high cost of health care - increased morbidity and mortality

• Particular problem in countries with rapid development of health care services and introduction of new technology - infection control is not a well recognized discipline

Risk Factors Associated with HCV Transmission in Egypt

Reference Study Risk Factors

El-Zayadi ’99

Cross-section

Unsafe injections, dental procedures, invasive medical

Kumar ’98

Cross-section

Household transmission

El-Sayed ’97

Cross-section

Schistosomiasis, surgery

Tibbs ’97

Cross-section

Poor sterilization of medical equipment

Angelico ’97

Cross-section

Schistosomiasis treatment

Risk Factors Associated with HCV Transmission in Egypt

Reference Study Risk Factors

Quinta ’95 Cross section Schistosomiasis treatment

Bassily ’95 Cross section History of selling blood, IDU

Nanaway ’95 Cross-section Transfusions,

El-Sakka ’94 Case Control Unsafe injections,

Darwish ’93 Cross section Schistosomiasis, injections

Hyams ’90

Case Control (non-A non-B)

Transfusion, medical injections

Framework of the national program to promote infection control and safe injection practices in

Egypt

• Promotion of safe injection practices in the community

• Promotion of infection control practices in health care facilities

• Safe blood transfusions

• Pilot project in 2 governorates - transition to a national program

 Reduce HCV transmission and hepatitis related chronic liver disease

Reduce transmission of hospital-acquired infections in the health care setting

Improve quality of health care services through

promotion of infection control

Program Goals Program to promote infection control

Promotion of infection control in Health Care Facilities

- Implement standard precautions for infection control - Promote safety of injections - Reduce occupational risk of BBP infection

 Prevention of transmission of BBP’s in the Community

- Promote safe injection practices - Educate the general public on BBP transmission

Program Objectives Program to Promote Infection Control

Methods Community-based survey

• Standard questionnaires

• 6 rural villages

• 2 urban cities

• 720 households

• 4197 persons interviewed

Baseline AssessmentInjection practices at community level

Community-based surveys

Quantitative assessment Measure injection frequency

Describe types of injections

Identify injection providers

Estimate unsafe injections

Qualitative surveys Explore beliefs and attitudes towards injections

Aim of the Survey

Baseline Assessment Infection Control Practices in HCF

• Governorate-wide random sample of public and private health care facilities (98 health facilities)

• 53 public health care facilities

• 16 private hospitals

• 29 private dental clinics

Baseline AssessmentInfection Control Practices in HC

Health Facility Surveys

Infection control practices (Observation and interview)

Assess infection control practices

Prescription survey

Health Care worker survey

Qualitative Survey

Measure prescription frequency

Assess Occupational risk

Explore motivational factors of HCW

Aim of the Survey

Proportion of Households Reporting at Least One Person Who Received an Injection in the Previous Three

Months; Survey in Sharkia and Qena, 2001

71.9 72

0102030405060708090

100

Sharkia Qena

Governorate

Percent of households that reported

injection recipient

No. persons No. (%) reporting Site surveyed injection in past 3 mos

Sharkia 2599 720 (27.7%)

Qena 1598 381 (23.8%)

Total 4197 1101 (26.2%)

Frequency of Injections among Residents of Qena and Sharkia, 2001

Site Mean No.of No. of injections injections/person per person per year in the past 3 mos

Sharkia 1.2 4.8

Qena 0.9 3.6

Total 1.05 4.2

Estimated Number of Injections/ Person/ Year Survey in Sharkia and Qena, 2001

Type of Injections Received Survey Sharkia and Qena, 2001

16%

77%

7%

Immunization

Therapeutic

Other

Who administers injections in Community-based survey

31.7

64.8

41

21

6 1.3

18.8

7.6

0

20

40

60

80

100

Gov

ernm

ent

Info

rmal

s

Pharm

acy

Privat

e

Sharkia Qena

Prescribers of injectionsCommunity-based Survey

5 4

39 37 46 49

6 2 29

0

20

40

60

80

100

Percent

Sharkia Qena

Challenges: • 70% household prevalence rate of injections (3mos) • 26% individual based prevalence rate of injection ( 3 mos) • 84% therapeutic injections• 4.2 injections/person/year• 281 millions of injections yearly in Egypt • 8.4% of injections are unsafe (23 millions injections) • 20-40% of injections provided by the informal sector• 37-49% of injections are prescribed by doctors

Findings of Baseline assessment Population-based Survey

Qualitative AssessmentPopulation-based Survey

Challenges General rural population prefers

injections - They cure faster- An Injection is easier

to use than tablets- Injections don’t cause

stomach problems - They are useful in serious

diseases - Injection providers are

accessible - Lack of awareness of risks associated with injections

Key findingsHealth care facility Survey

Infection Control Challenges

– No concept of infection control– No hand washing or wearing gloves – Unsafe injections provided– Unsafe sharp disposal– Lack of training – Lack of supplies and material– Inappropriate sterilization methods– Overprescription of injections (23%)– Lack of waste management – High exposure of HCWs to needlestick injuries

Frequency of Needlestick Injuries Health Care Worker Survey

No. % with Annual Mean Group Interviewed needlestick No. of (3 months) needlesticks

Allied HCW 64 27% 1.8Dentists 78 36% 3.9Nurses 683 38% 4.5Housekeepers 229 40% 5.0Doctors 339 31% 5.9Lab techs 92 32% 6.3 TOTAL 1485 36% 4.9

Behaviors Associated with Recent Needle Stick Injury, Health Care Worker Survey 2001

Two Hand recapping

Bending needle

Collection of Garbage

Suturing

Patient causes

Unknown

Hep B Vaccine Coverage among HCWs

No. No Percent

Interviewed vaccinated vaccinated Group Doctors 339 129 38%Dentists 78 30 38%Nurses 683 60 9%Lab techs 92 5 5%Housekeepers 229 8 3%Allied HCW 64 3 5% TOTAL 1485 235 16%

Strategic ApproachNational Program for Promotion of Infection Control

I. Organizational Structure

II. Development of national guidelines for infection control

III. Training and capacity building

IV. Surveillance of nosocomial infections

V. Occupational safety health program

VI. Provision of critical supplies and equipment

VII. Advocacy

VIII. IEC Communication Strategy to prevent transmission of BBPs

IEC communication strategy to prevent transmission of BBPs

• Objectives• Target audiences• Messages• Means• Material• Implementation• Evaluation

IEC communication strategy to prevent transmission of BBPs

Objectives:

Raise the awareness of the public and health care providers to promote injection safety

IEC communication strategy to prevent transmission of BBPs

Target Audiences • All sectors of the rural population

• Health care providers

DoctorsNursesJanitors

IEC communication strategy to prevent transmission of BBPs

Messages• Messages to the public

- Reduce overuse of injections

- Don’t reuse a syringe

• Message to the doctors – Rational use of

injections

• Message to the nurses– Provide a safe injection

IEC communication strategy Means of conveying messages

Radio and TV programs Airing of TV spots in 2003

Continuous Press Release

Community outreach and mobilization for public– Partnership and networking (NGOs and Government)– Disseminate messages through an existing structure– Leadership (community leaders) – Community participation– Volunteers– Reach different social and cultural complexes

Launching of a campaign for prevention of BBPs transmission

• Launching started in September, 2002

• Slogan– Safe injections save lives

• Local activities are focused in two governorates– Sharkia

– Qena

IEC communication strategy to prevent transmission of BBPs

Motivation of health care workers

• Regular meetings with key personnel– Primary health unit directors

– Head nurses of facilities

• Competition between facilities “ Safe sharp disposal”

• Awards

• Recognition

• Certificates

• Community leaders target different groups – Teachers

• illiterate (illiteracy programs)• school children

– Women community leaders (house to house visits to illiterate housewives)

– Religious leaders (men in rural villages)– Students’ unions in universities – Events and meetings

Communication StrategyCommunity outreach and mobilization

Communication Strategy

IEC Material • Process of development of IEC material

– SIGN consultant– Development of image bank– Field Testing of material– Modification of material– Printing and distribution of the material

Communication Strategy

IEC Material • IEC material for the Public

– Community leaflet for the educated– Power point presentation for the illiterate– Posters– Give aways (calendars and others)

• IEC material for health care providers- Good prescribers guide for doctors- Safe injection providers guide for nurses

- Video film (Zahra)

Good Provider’s Guide

PROTECT YOURSELF

Community Leaflet

Communication Strategy to prevent BBP’s transmissionEvaluation

Long term process Community-based indicators

– Injection use– Safety of injections

• Health facility indicators– Prescription rate of injections– Qualitative surveys

Thank you