Careful, in 60% of all cases, a shot in the arm may be shot in the leg

The report, on injection practices in India, was prepared by the India branch of an international organisation IndiaCLEN and sponsored by the World Bank. The Clinical Epidemiology Unit of AIIMS and the Ministry of Health and Family Welfare were partners in the study. Among the things covered were questionable sterility, re-use as well as wrong habits of those administering the injections.

The consequences are especially serious for India as the magnitude of injection administration is very high in the country: an average of three injections per person per year. It is highest in the below one year age group (5.8), mostly vaccinations, and a little less above one years of age (around 2.8).

In all, 84 centres—69 medical colleges, nine NGOs and six public health institutes—conducted the study across the country. Practices at 2,400 government and private facilities and 1,200 immunisation centres were studied. Around 1,800 injection procedures were observed and 1,200 people interviewed.

The findings:

• About 23.8 per cent of the injections administered were unsafe due to ‘‘questionable sterility’’ while re-use of injection syringes was behind 16.2 per cent of the cases. But in most cases (50.7), the danger crept in from wrong injection habits.

• Government hospitals (68.6 per cent) and immunisation clinics (73.9 per cent) are more likely to be unsafe. But the private facilities are only a little better, at 59.7 per cent.

• Glass syringes (81.1 per cent) are more unsafe than plastic ones.

• In goverment hospitals, 95.1 per cent of the injections are given by pharmacists or nurses, health workers or compounders, 6.4 per cent by helper trainees or assistants, and only 8.2 per cent by doctors or prescribers. In private hospitals, however, 61 per cent of the injections are given by doctors.

• Syringe-disposable techniques are faulty across the country. An estimated 8 per cent of the plastic syringes end up with ragpickers. Around 3.2 per cent of these syringes can be traced back to government hospitals, 15.1 per cent to private clinics and 2.9 per cent to immunisation clinics.

According to the Health Ministry, the study had four main aims. To assess the frequency of injections in India; to determine what proportion was unsafe; what proportion was not required; and what determined the use of injections in the country. ‘‘The methodology used was population-based survey and health facilities-based survey,’’ said an official.

Unsafe injections were judged on both major and minor criterion set by the Government. The major criterion included the use of opened/used syringes and needles, injections given over clothes, needles wiped with a swab, needles touching any surface before use, or use of one syringe needle for more than one patient.

Minor criterion included not wearing gloves or washing hands before giving an injection, drawing drugs from a broken vial, re-capping needle and not flushing glass syringes after use.