Öz

Injection is an invasive intervention and is one of the most commonly used medical procedures in the world. Non-adherence to an aseptic technique in injection application causes a serious risk in terms of blood-borne pathogens and bacterial nosocomial infections. It is known that unsafe injection practices are common in low-income countries. However safe injection practices have gained importance due to report of growing number of outbreaks resulting from unsafe injection practices also in developed countries recently. One of the major causes of unsafe injection is the reuse of syringes. Safety syringes are designed to prevent reuse. Today, safety syringes are used routinely in immunization applications in many countries. However, those are advised to be commonly used also in the therapeutical applications. In this review, the misuse of syringes, and the safety syringes and the necessity for using them are discussed in the light of the relevant literature

Anahtar Kelimeler

• Syringe, safety syringe, injection safety, unsafe injection

Enjektörün Hatalı Kullanımı ve Güvenli Enjektörler

Öz

Enjeksiyon bir invaziv girişimdir ve dünyada en sık kullanılan medikal işlemlerden biridir. Enjeksiyon uygulamalarında aseptik tekniğe bağlı kalınmaması, kan kaynaklı patojenler kadar bakterial nozokomiyal enfeksiyonlar açısından da ciddi risk oluşturmaktadır. Güvenli olmayan enjeksiyon uygulamalarının düşük-gelirli ülkelerde yaygın olduğu bilinmektedir. Bununla birlikte son zamanlarda gelişmiş ülkelerde de giderek artan sayıda salgınların rapor edilmesi nedeniyle güvenli enjeksiyon uygulamaları önem kazanmıştır. Güvenli olmayan enjeksiyonların en önemli nedenlerinden biri, enjektörlerin yeniden kullanımıdır. Güvenli enjektörler, yeniden kullanımı engellemek için tasarlanmıştır. Günümüzde pek çok ülkede güvenli enjektörler bağışıklama uygulamalarında rutin olarak kullanılmaktadır. Ancak tedavi edici uygulamalarda da kullanımının yaygınlaştırılması önerilmektedir. Bu derlemede enjektörün kullanım hataları, güvenli enjektörler ve kullanım gerekliliği ilgili literatür doğrultusunda tartışılmaktadır.

Anahtar Kelimeler

• Enjektör, güvenli enjektör, enjeksiyon güvenliği, güvenli olmayan enjeksiyon

Kaynakça

1. endoscopy clinic in Las Vegas- Nevada
2. –2008. Clin Infect Dis 2010;51(3):267-73. 10. Labus B, Armour P, Middaugh J, Rowley P
3. Sands L, Sizemore J, (Southern Nevada
4. Health District Outbreak Investigation Team).
5. Outbreak of Hepatitis C at Outpatient Surgical
6. Centers Public Health Investigation Report.
7. Las Vegas, Nevada. 2009 http://www.south
8. ernnevadahealthdistrict.org/download/out

9. breaks/final-hepc-investigation-report.pdf
10. Erişim: 07.07.2014 11. Hutin YJ. Injections given in healthcare set
11. tings as a major source of acute hepatitis B in
12. Moldova. Int J Epidemiol 1999;28(4):782-6. 12. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane
13. M. Unsafe injections in the developing world
14. and transmission of bloodborne pathogens: a
15. review. Bull World Health Organ 1999
16. (10):789-800. 13. Pandit NB, Choudhary SK. Unsafe injection
17. practices in Gujarat, India. Singapore Med J.
18. 49 (11): 936-9. 14. Perz JF, Thompson ND, Schaefer MK, Patel
19. PR. US Outbreak Investigations Highlight the
20. Need for Safe Injection Practices and Basic
21. Infection Control. Clin Liver Dis 2010;14(1): 137-51; x. 15. Pugliese G, Gosnell C, Bartley JM, Robinson
22. S. Injection practices among clinicians in
23. United States health care settings. Am J In
24. fect Control 2010;38(10):789-98. 16. Williams IT, Perz JF, Bell BP. Viral hepatitis
25. transmission in ambulatory health care set
26. tings. Clin Infect Dis 2004;38(11):1592-8. 17. Kane A, Lloyd J, Zaffran M, Simonsen L, Kane
27. M. Transmission of hepatitis B, hepatitis C and
28. human immunodeficiency viruses through un
29. safe injections in the developing world: model
30. based regional estimates. Bull World Health
31. Organ 1999;77(10):801-7. 18. DSÖ, Best Practices for injections and related
32. procedures toolkit. 2010. http://whqlibdoc.who.
33. int/publications/2010/9789241599252_eng.pdf
34. Erişim: 07.07.2014 19. Alter MJ. Healthcare should not be a vehicle for transmission of hepatitis C virus. J Hepatol
35. 48(1):2-4. 20. Wilson WO. Infection control issue: Under
36. standing and addressing the prevalence of un
37. safe injection practices in healthcare. AANA J
38. 76(4):251-3. 21. Schaefer MK, Shehab N, Perz JF. Calling it
39. multidose doesn’t make it so: Inappropriate
40. sharing and contamination of parenteral med
41. ication vials. Am J Infect Control 2010; 38(7):580-1. 22. Macedo de Oliveira A, White KL, Leschinsky
42. DP, Beecham BD, Vogt TM, Moolenaar RL, et
43. al. An outbreak of hepatitis C virus infections
44. among outpatients at a hematology/oncology
45. clinic. Ann Intern Med 2005;142(11):898-902. 23. Trépanier CA1, Lessard MR, Brochu JG, De
46. nault PH. Risk of cross infection related to the
47. multiple use of disposable syringes. Can J
48. Anaesth 1990;37(2):156-9. 24. CDC and the Safe Injection Practices Coali
49. tion (SIPC). The One & Only Campaign. http://
50. www.oneandonlycampaign.org/.
51. Erişim Tarihi:12.076.2014. 25. Perry AG. Potter PA. Klinik Uygulama Becer
52. ileri ve Yöntemleri. Aştı TA, Karadağ A, ed
53. itörler. Adana: Nobel Kitapevi Yayın Dağıtım
54. ve Pazarlama Ltd.Şti.; 2011. p.609, 693-707. 26. Taylor C, Lillis C, LeMone P, Lynn P. Skill
55. Checklists for Fundamentals of nursing: The
56. art and science of nursing care. 7thed.
57. Philadelphia, USD: Lippincott, Williams &
58. Wilkins; 2011 (Skill 29-4). 27. White L. Foundations of Basic Nursing. 2nded.
59. USA. Thomson Delmar Learning. p.420.
60. ISBN: 140182692X, 9781401826925. 28. Rice J. Medications & Mathematics for the
61. Nurse. 9thed. Albany, NY: Delmar Publishers; 2002. p.162. 29. Blogg CE, Ramsay MAE, Jarvis JD. Infection
62. Hazard From Syringes. Br J Anaesth 1974; 46(4):260-2. 30. Pervecal A. Consequence of syringe-plunger contamination. Med J Aust 1980;1(10):487-9. 31. Huey WY, Newton DW, Augustine SC, Ve- jraska, Mitrano FP. Microbial contamination potential of sterile disposable plastic syringes.
63. Am J Hosp Pharm 1985;42(1):102-5. 32. Olivier LC, Kendoff D, Wolfhard U, Nast-Kolb
64. D, Yazıcı MN, Eschey H. Modified syringe de
65. sign prevents plunger-related contamination
66. results of contamination and flow-rate tests. J
67. Hosp Infect 2003;53(2):140-3. 33. Favier B, Gilles L, Latour JF, Desage M, Gi
68. ammarile F. Contamination of syringe plun- gers during the sampling of cyclophosphamide solutions. J Oncol Pharm Pract 2005;11:(1)1- 5. 34. Kiffmeyer TK. Comparative Study of Syringe
69. Contamination by Hazardous Drugs. 2009
70. http://www.equashield.com/pdf/article.pdf
71. Erişim Tarihi: 20.01.2013 35. Gürel E. Sağlık profesyonellerinin aseptik
72. teknik açısından güvenli enjeksiyonlara yöne
73. lik uygulama ve gözlemlerinin belirlenmesi.
74. Marmara Üniversitesi Sağlık Bilimleri En
75. stitüsü Yüksek Lisans Tezi, İstanbul, 2013. 36. Hersh BS, Carr RM, Fitzner J, Goodman TS
76. Mayers GF, Everts H, et al. Ensuring Injection
77. Safety during Measles Immunization Cam
78. paigns: More than Auto‐Disable Syringes and
79. Safety Boxes. J Infect Dis 2003;87(1):299- 306. 37. Safety of Injections: WHO-UNICEF-UNFPA
80. Joint Statement on the Use of Auto-Disable
81. Syringes in Immunization Services. http://
82. www.who.int/injection_safety/toolbox/en/ Bundling.pdf
83. Erişim: 10.07.2014 38. Altaf A. Injection Safety in Pakistan: Auto Dis
84. able (AD) Syringes in the Curative Sector.
85. JPMA 2003;53(11):510.