Sunday, 27 September 2009

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Treatment that can kill

Standard practices have been stipulated in all healthcare facilities to prevent contamination from used needles. But they are not being followed. Union Health Minister Kiran Walia who did the rounds of five government hospitals in Delhi - Aruna Asaf Ali, Ambedkar, Lok Nayak, Susrut Trauma Centre and Babu Jagjeevan Ram - was shocked to find that the needle destroyer used to break used needles and prevent their re-use was “defunct”. Walia issued a show-cause notice to the doctor at Lok Nayak Hospital’s ART clinic where she saw used needles strewn around instead of being destroyed. 

At least 5% of HIV infections worldwide are from contaminated injections, according to an article in AIDS Review (January 2008) by Dr M Ganzak and Dr P Barss. The authors note that healthcare-associated HIV transmission receives little attention though it is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally – or they may find themselves before courts for causing HIV infections.  

The authors review the epidemiology of healthcare-related HIV in rich and poor regions, noting that HIV can be transmitted to patients and donors of blood products during artificial insemination, by improperly sterilised sharps, by dialysis and organ transplantation.  

They conclude that the situation in many low-income countries is “alarming, with transmission ranging from frequent to endemic”.  

Some years ago, a review in the Bulletin of the WHO used published articles and unpublished WHO reports to quantify the prevalence of unsafe injections and to assess their impact on blood-borne infections. It calculated that each person in the developing world receives an average of 1.5 injections per year; the ill or hospitalised may be exposed to 10-100 times as many. The majority of these were unnecessary. At least 50% of injections were unsafe in 14 of 19 countries. Eighteen studies reported a convincing link between unsafe injections and the transmission of Hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new Hepatitis B infections to unsafe injections. Three implicated unsafe injections as a major mode of transmission of Hepatitis C.  

In India, a study by INCLEN found that two-thirds of all injections in India are unsafe – responsible for at least 20 lakh Hepatitis B, 4 lakh Hepatitis C and 30,000 HIV infections every year.

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