The goal of this activity is to prevent medical transmission of HIV (and other blood borne pathogens) through sharps and medical waste by promoting safe medical waste disposal practices, ensuring an adequate supply of related commodities; decreasing unnecessary injections and improving integration of injection safety and medical waste disposal into all health programs. The activity will support the implementation of environmental friendly medical waste disposal systems that minimize risk of HIV and other infectious diseases transmission to the community. This activity will build the capacity of healthcare workers in handling medical waste and performance of procedures with a risk of exposure to HIV with emphasis on quality systems and evidence based strategies. TBD will focus on integrating Bio-safety, medical waste management, universal precautions and infection control measures into existing programs such as Care & Treatment, Prevention, Counseling & Testing, Reproductive Health and Childhood Immunizations. The TBD will strengthen waste management infrastructure through procurement or construction of incinerators; advocate for injection safety and waste management.

How IM links to PF goals

Unnecessary and unsafe injection practices place staff, patients and the community at risk of infection with HIV and other bloodborne pathogens. National plans for safe, final disposal of all medical waste are crucial to protect the entire community and will require exploration of innovative, low-cost technologies that are easy to deliver and maintain even in remote areas. These coordinated efforts will ensure continued progress in the provision of safe medical injections to meet PEPFAR prevention targets and Millennium Development Goals (MDGs).

Geographic coverage & target populations

This is a national program targeting health care workers and medical waste handlers in all health facilities in the country.

Contributions to Health Systems Strengthening:

This mechanism will contribute to health facility infrastructural support by renovation, installation or construction of incinerators or other waste management systems and implementing pooled and centralized waste management systems. It will also lead to human capacity development through training and support of the health care workers and waste handlers. By preventing HIV and other blood borne infections in the health care workers it will ensure occupational safety and thus a healthy work force.

Ramp-up of antiretroviral therapy (ART) and related interventions, such as counseling and testing, and prevention of mother-to-child transmission (PMTCT) will substantially increase the volume of medical waste and HIV-contaminated sharps generated in health care settings and create a burden on strained or inadequate waste management systems. Increased laboratory testing of HIV-infected persons will also increase the burden. These tests range from the initial HIV test to monitoring of CD4/CD8 counts and viral loads. Each test generates HIV-contaminated sharps and other medical wastes. TBD will work with the Ministry of Health (MOH) and PEPFAR medical-injection safety staff on strategies to foster effective waste management in the face of these challenges. Linkages will be established with PEPFAR Blood Safety program for incinerator management and with CDC Infection Control Programs for bio-safety and infection control.

The mechanism will seek to apply cost effective measures in waste management such as having some regional incinerators serving several facilities to reduce costs of running and maintenance. Additionally it will seek to implement the national healthcare waste management plan by leveraging resources from other funding agencies like the Global Fund, the World Bank and other private partners working on the area of waste management. It will use more cost efficient strategies like waste segregation to ensure only infectious waste is segregated while some of the hospital general waste like paper and plastics is recycled. This will minimize the use of incinerators thus lowering running costs.

Health Related Wrap-around issues: With the rapid scale up of HIV and other health programs, there has been a large increase in injections, blood collections and associated medical waste generated. PATH will lead efforts to strengthen injection safety and medical waste management which is cross cutting in all health programs. This will lead to reduced transmission of not only HIV but other blood borne pathogens thus reducing disease burden among the health workers and the community. There will also be improved health care worker safety which will lead to better retention of human resource. Additionally PATH will directly train health workers on issues of waste management as well as IPC.

Includes 693,516 central funds - one time only for 2010.

Since 2004, the PEPFAR Injection Safety program complements the Kenya Government efforts in achieving injection safety for prevention of medical transmission of HIV. Approaches employed to achieve national safe injection practices include: development and dissemination of national policies and standards on injection safety and medical waste management as well as an integrated infection prevention and control (IPC) policy; training of health workers ; advocacy to decrease injection demand in the community; improved logistics management to eliminate stock out of injection devices, strengthening of facility-level infection prevention and control (IPC) committees ; supplementing injection safety and waste management commodities and strengthening of waste management systems. Advocacy with the government aims to secure the required budget for adequate injection supplies and review of both the essential drug list and various treatment guidelines. To achieve sustainability, local training institutions including the Kenya Medical Training College and medical universities have been assisted to review teaching curricula to include safe injection practices.

In the PEFAR project period a lot of achievement has been met with training of at least 24,000 health care workers which has led to a good impact e.g. a prescription records review (PRR) in western province showed a decrease of injection prescriptions from 27% to 21%. Training combined with strengthened procurement systems also led to an increase of use of puncture proof sharps containers from 56% to 97% in Embu hospital.

Studies have shown that medical transmission of HIV and other blood borne infections may occur through unsafe medical injections, sharps and other medical waste. Inappropriate injection use arises from client demand, prescriber preference and deficient national treatment and procurement policies. The Kenya AIDS Indicator Survey 2007 showed a third of the respondents aged 16 to 64 years had received at least one medical injection within the previous year. It also showed that 46% of the people preferred injections over pills. This demonstrated the widespread use of injections raising issues of safety to the healthcare worker, patient and the community. Failure to systematically provide sufficient injection equipment supplies is a key contributor to widespread re-use of syringes and needles.

REFERRAL AND LINKAGES

Injection Safety principles will be integrated in all HIV program areas that conduct injections and blood drawing procedures for diagnosis and monitoring. This will include trainings to ensure safe practices to prevent injury, offer post exposure prophylaxis and ensure that each program procures safer injection safety and waste disposal commodities. Health facilities will be supported to establish and reactivate IPC committees to advocate for integrated infection prevention measures alongside injection safety and waste management. The care and treatment program will procure enough PEP kits to ensure that all health workers can access PEP services within acceptable duration of time.

STRATEGY OF 2010

From the FY10 all funding for the injection safety will be managed in country. However activities will build on and complement on achievements of PEPFAR-1. They will be in line with the Kenya National Strategic plan-3 (KNASP) and the partnership framework whose objective is to eliminate medical transmission in healthcare settings with emphasis on blood and injection safety. In-service training will be scaled up to ensure universal coverage in areas previously not trained. Cost effective strategies will be used to reach the hard-to-reach areas. Additionally training will be expanded to include phlebotomy safety and other blood drawing procedures. This will be a scale up of what will be piloted in a public private partnership in 8 health facilities in the FY 09. In 2010, safe medical waste management systems will be emphasized. Based on lessons learnt in the first five years and advice from waste management specialists from office of health and safety (OHS) new innovative ways to deal with the ever increasing medical waste will be implemented. This will include purchase and installation of medium sized incinerators and outsourcing of a waste management firm to pilot a centralized waste management system within a region. Infection prevention and control (IPC) committees will be strengthened from the national to facility level to enhance advocacy for injection safety issues including availability and surveillance of PEP in all healthcare facilities; waste management and commodity security. Continued collaboration with other health programs such as TB, Flu, WHO, EPI, reproductive health as well as environmental programs will be sustained. To ensure sustainability injection safety trainings will be integrated into pre-service training curriculum at the medical training colleges and the universities as well as in-service. Also other PEPFAR programs like care and treatment, PMTCT, laboratory, male circumcision and counseling and testing will integrate injection safety principles in their routine work in treatment and blood drawing. These programs will include budgets to procure injection safety commodities and waste management. Using health communication and marketing strategies information aimed at the community to reduce injection demand will be disseminated. The government has continued to increase the procurement of safer injection devices to 60%. With the PEPFAR program progressively reducing commodity procurement, increased investment by the government and other donors will be required for sustainability. However during critical gaps in supplies procurement of these commodities will be supported.