title: Improved injection safety after targeted interventions in the Syrian Arab Republic.
abstract: OBJECTIVE
  Concerns about unsafe injection practices and possible infections with blood-borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the 'Focus Project', which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow-up survey was carried out in February 2004, 2 years after initiation of the project.
  
  
  METHODS
  Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004.
  
  
  RESULTS
  Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non-negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle-stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle-stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001).
  
  
  CONCLUSIONS
  The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well-structured immunization programme to the more diverse curative health services.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Germany. carsten.mantel@charite.de
authors.forename: Carsten
authors.initials: C
authors.lastname: Mantel
authors.forename: Selma
authors.initials: S
authors.lastname: Khamassi
authors.forename: Khaled
authors.initials: K
authors.lastname: Baradei
authors.forename: Haifa
authors.initials: H
authors.lastname: Nasri
authors.forename: Ezzedine
authors.initials: E
authors.lastname: Mohsni
authors.forename: Philippe
authors.initials: P
authors.lastname: Duclos
mesh_terms: D017848:Blood-Borne Pathogens; D003141:Communicable Diseases / Q000453:epidemiology / Q000209:etiology; D019538:Health Care Surveys / Q000379:methods; D006282:Health Personnel / Q000193:education; D006761:Hospitals; D006801:Humans; D007114:Immunization / Q000009:adverse effects*; D017053:Infection Control / Q000379:methods*; D007267:Injections / Q000009:adverse effects*; D017744:Medical Waste Disposal / Q000592:standards; D016602:Needlestick Injuries / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012449:Safety; D013593:Syria / Q000453:epidemiology
chemical_list: D017744:Medical Waste Disposal