Wednesday, April 27, 2011

Unsafe Injections Are Common, Especially in Poor Countries

The weekly Safe Injection Global Network newsletter has arrived in my inbox. As always, I'm stunned by how many new incidents are uncovered every week that demonstrate how dangerous lapses of safety can be in hospitals, even in countries with very well funded health services.

A survey of 87 facilities in the US found that hemodialysis patients were twice as likely to be infected with hepatitis C virus (HCV) as non-hemodialysis patients.

222 endoscopy patients in New Orleans are being contacted because they may have been exposed to HIV, hepatitis or other diseases through unsterile equipment. This is the second such incident this year. The last time, 360 patients were contacted. The period covered this time is over 7 months. The risk may be small, but it was a long lapse, and the hospital is rightly taking no chances.

In Alberta, 226 patients are being screened HIV and HCV because a care worker was found to be positive for both viruses. Again, the risk to patients is low, but these things can't be left to chance. Apparently, the investigation revealed no breaches of infection control practices.

A report suggests that thousands of patients who have attended a certain Veterans' Affairs dentist need to be screened. This is not the first article about the same dentist, but the dentist in question was working for 18 years in the clinic and failed to change gloves and to sterilize equipment between patients.

The problem might even date back to the mid 1970s. Two patients have already been identified as having hepatitis B virus (HBV), but only a few hundred have been screened so far. This whole episode is in need of clarification. Former patients must now be wondering if other practitioners could have done the same, and how long it will take before they are informed.

The use of multi-dose flasks of vitamin C in an Australian health facility has been demonstrated to have resulted in at least three people being infected with HCV. Inadequate infection control was 'apparent'.

The point I am making is that health facility acquired infections occur, there are lapses in procedures, mistakes made and what not. But in Western countries, where such occurrences often don't represent a very high risk to patient safety anyway, an investigation is carried out. Sometimes people are disciplined, controls are tightened up, effort is made to ensure that adverse events don't happen again.

In developing countries, where health facilities are in short supply, underfunded, understaffed, underequipped, lacking in written procedures and trained personnel who can (and do) follow them, the risk that people could be infected with a serious disease is very high when adverse events occur.

The fact that there are very few articles about such events in developing countries, and even fewer about investigations and patients being contacted to be screened, is very suspicious indeed. Only an idiot would conclude that such events never occur. So the question arises as to whether anyone is even checking for them, if they are recognized, if they are reported and if anything can be done, or if anything is done, when these breaches occur.

Another recent article finds that patient safety incidents are underreported and, as a result, policy is biased. In other words, the extent of patient safety issues is not even well established in Western countries, let alone in developing countries.

Finally, an article looks at 'deliberate, extreme' underreporting of hospital acquired infections in Mongolia and the strategies that health personnel use to avoid accurate reporting.

Unsafe injections occur everywhere, but in some countries, effort is made to establish to what extent and to identify remedial action that can be taken. But in many countries, no such effort is made. On the contrary, the whole issue is ignored, denied or swept under the carpet.

In some countries, unsafe injections are very common and are known to cause tens of millions of serious infections, such as HIV, HBV and HCV. But in these countries, no remedial action is taken and, worse than that, UNAIDS and other institutions simply deny that unsafe injections is a problem.

How, in the light of so much evidence that unsafe injections are very common, especially in poor countries, UNAIDS can claim that as little as 2-2.5% of HIV is transmitted by this route, I can not understand. But this bias results in biased policy, policy that concentrates on sexual transmission. And biased policy results in biased spending, with hardly anything going towards non-sexual HIV transmission.

Unsafe injections and other forms of non-sexual HIV transmission clearly make a considerable contribution to HIV transmission in high prevalence countries. It is the job of UNAIDS to work out the exact extent of this contribution and ensure that funding for adequate prevention measures is provided to countries. Otherwise, high HIV transmission rates will continue to destroy the lives of millions of people every year.


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