This study was conducted in order to validate whether or not sterilizable injection equipment is still used in EPI program in Saudi Arabia and to evaluate safe injection practices by health workers during vaccination and safe disposal of vaccination waste, at both governmental and private health institutes in Riyadh and Eastern regions, limited to those institutes that provide vaccination services.
Methodology
A cross sectional study was conducted covering a sample of both governmental primary health centers (GPHCs) and private health dispensaries (PDs) in both Riyadh and Eastern regions. A stratified random sampling technique was used. Final sample size was 60. A questionnaire was used for data collection that included identification data, observational data and general questions.
Results
In Riyadh region, 22 GPHCs and 15 PDs were included in the study. A separate room for vaccination was provided at all GPHCs and 26.7% of PDs. A clean table or tray was used as an area for vaccine preparation at all PDs and 77.3% of GPHCs. Disposable injection equipment was used by all health institutes. Needle cutter sharp boxes were found in 54.5% of GPHCs and only 53.3% of PDs. They were used to discard needles only in 22.7% of GPHCs and 6.7% of PDs. The boxes were closed when they were 3/4 full in 36.4% of GPHCs and 33.3% of PDs. Saudi nationality accounted for 72.7% of governmental health workers (GHWs), whereas non-Saudi nationality represented 86.7% of private health workers (PHWs). All were females. Most of the workers in both sectors had an experience of 1-5 years in vaccination. A clean barrier to break the vaccine ampoules was not used by 36.4% of GHWs and 60% of PHWs. A needle was kept on top of multi-dose vial by 45.5% of GHWs and 6.7% of PHWs. Needle recapping was practiced by 22.7% of GHWs and 80% of PHWs. Manual removal of needles from syringes was practiced by 36.4% of GHWs and 26.7% of PHWs. Only 9.1% of GHWs agreed that incineration was the ideal method for final disposal of sharp medical wastes. In the Eastern region, 15 GPHCs and 8 PDs were included in the study. A separate room for vaccination was provided at all GPHCs and 50% of PDs. A clean table or tray was used as an area for vaccine preparation at all PDs and 86.7% of GPHCs. Disposable injection equipment was used by all the health institutes. Needle cutter sharp boxes were found in 100% of GPHCs and 62.5% of PDs. They were used to discard needles only in 20% of GPHCs. The boxes were closed when they were 3/4 full in 66.7% of GPHCs and 62.5% of PDs. Saudi nationality accounted for 93.3% of GHWs, whereas all the workers in PDs were non-Saudi. All were females. Most of the workers in PD had an experience of 1-5 years in vaccination, whereas 33.3% of GHWs had 6-10 years experience in vaccination. A clean barrier to break the vaccine ampoules was not used by 86.7% of GHWs and all PHWs. A needle was kept on top of multi-dose vial by 46.7% of GHWs and none of PHWs. Needle recapping was practiced by 33.3% of GHWs and 50% of PHWs. Manual removal of needles from syringes was practiced by 20% of GHWs and 12.5% PHWs. Only 26.7% of GHW and 25% of PHWs agreed that incineration was the ideal method for final disposal of sharp medical wastes.
Conclusion
Disposable injection equipment was the only type used in EPI program in Saudi Arabia. However, safe injection practices were not fulfilled by health workers. Medical waste segregation was not followed accurately by most health institutes and most of the health workers did not follow the proper methods of final sharp wastes disposal. This study points to the need for further training and education on safe injection practices and medical waste management.