Injection Practices: rapid assessment and proposed Action Plan

As Albania was planning a mass measles/rubella  vaccination campaign for November 2000, the World Health Organization carried out a rapid assessment of both injection practices as well as healthcare waste management.

The aim being to propose both a detailed, short-term injection safety plan for the campaign and key elements of a potential longer-term safe and appropriate use of injections initiative for Albania.

Assessment methods

Meetings with key public health stakeholders were held to obtain information, facilitate problem recognition, and identify the role that each could play in a safe and appropriate use of injection initiative. In addition, nine healthcare facilities were visited in three districts to observe practices and to collect semi-quantitative information from physicians, nurses, and patients.


Injection frequency: the sample analysis showed that nearly one third of all prescriptions include at least one injection. A review of these prescriptions indicated that most therapeutic injections prescribed were unnecessary. Raising awareness both amongst physicians, nurses and the population about alternatives to injections would help reduce the amount of sharp waste produced.

Sharp waste disposal: key informants and nurses reported that in most cases, in the absence of a functional healthcare waste management system, sharps waste was discarded using the regular waste disposal system, which expose people who scavenge domestic waste to accidental needlestick injuries. Nationally, approximatively one third of all hospitals separate healthcare waste in Albania.

HCW treatment systems: Only a dozen incinerators dedicated to the incineration of healthcare waste are present in the country. Most explain this situation by the absence of a national strategy, the absence of training, and the absence of adequate equipment.


Short term (campaign)

  • Initiate integrated communication activities for injection safety targeting physicians (supervision), nurses (injection administration and waste collection), and the population (consumer demand for safety) with a particular emphasis on nursing practices;
  • Ensure use of AD syringes and sharps boxes purchased through "bundling";
  • Ensure appropriate sharps waste management;
  • Monitor effectiveness of injection safety efforts through a combination of (a) routine reporting by each vaccination centre and (b) an injection safety validation assessment during the vaccination campaign.


Longer term

  • Activities should be conducted to reduce the incidence of unnecessary injections, promote healthcare workers’ protection, and implement universal precautions.
  • Supplying and financing mechanisms should be studied to ensure universal availability of sharps containers and consistent quality of injection equipment.
  • Policies and plans should be implemented to ensure comprehensive waste management from production to disposal; training at all levels; and choice of appropriate, affordable, and environment-friendly waste treatment options.