title: Evaluation of immunization injection safety in China, 2010: achievements, future sustainability.
abstract: OBJECTIVE
  The study objectives were to evaluate injection practices in China in the post GAVI project era and provide guidance for policy makers to update national standards for injection practices and further improve vaccination services.
  
  
  METHODS
  We conducted a national stratified, cross-sectional survey in October 2010, according to WHO recommended sampling methods. First, we stratified China into three regions (Eastern, Central and Western) based on economic criteria. Second, in each region, we selected eight counties with a probability proportional to population size. Third, in each selected county, we selected (a) 10 townships at random among the list of townships of the county and (b) the one county level hospital.
  
  
  RESULTS
  With respect to the risk to the patient, we never observed open injection equipment lying around or needles left in the septum of multi-dose vials. We never observed sterilizable injection devices syringes in any of the facilities. The proportion of facilities using sharps containers was highest in the East (85%), intermediate in the West (79%) and lowest in the Central region (56%). In 2009, auto-disable syringes and safety boxes were used in 78% and 79% facilities in GAVI supported areas of the Western region, respectively. Only one facility presented evidence of attempts to re-sterilize disposable injection equipment in the Eastern region.
  
  
  CONCLUSIONS
  Use of AD syringe and sharps containers increased in vaccination services in China, especially in GAVI supported areas, leading to sustainable progress in terms of elimination of reuse of injection devices. However, risk to patients still existed, including persisting use of standard disposable syringes and attempts to re-use disposable devices.
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Zhenhua
authors: Z
authors: Wu
authors: Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: Cuifuq@126.com.
authors: Fuqiang
authors: F
authors: Cui
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Yuansheng
authors: Y
authors: Chen
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Ning
authors: N
authors: Miao
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Xiaohong
authors: X
authors: Gong
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Huiming
authors: H
authors: Luo
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Fuzhen
authors: F
authors: Wang
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Hui
authors: H
authors: Zheng
authors: Consultant on Immunization Policy, Mercer Island, WA, United States.
authors: Mark
authors: M
authors: Kane
authors: Centers for Disease Control and prevention, Atlanta, USA.
authors: Stephen C
authors: SC
authors: Hadler
authors: World Health Organization office in China, Beijing, China.
authors: Yvan J
authors: YJ
authors: Hutin
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Xiaofeng
authors: X
authors: Liang
authors: Chinese Center for Disease Control and Prevention, Beijing, China.
authors: Weizhong
authors: W
authors: Yang
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D006302:Health Services Research; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D014611:Vaccination / Q000009:adverse effects*; D014612:Vaccines / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D014612:Vaccines
keywords: Evaluation; Immunization; Injection safety