Addet Primary Hospital Standard Operating Procedures (SOP) for
Injection Safety in Health Facilities
Purpose: The purpose of this SOP is to guide healthcare providers on proper safe
injection activities
I. Administering Injections following set National Standards
Healthcare providers in health facilities must follow set injection administration
standards when injection medications are provided. So when you provide medications
in injection forms follow the following national standards to prevent the patient from
unnecessary and avoidable injection injuries
Prepare a well laid up tray including emergency drugs for management of
possible drug reactions
Wash hands with soap and water. Alcohol could be used as a secondary step
after soap and water except for EPI injections
Dry up hands.
Check for the integrity of vial/ampoule for expiry date, breach, leaks,
particles and other contaminations
Make sure that the right dose, formulation and route are used for the right
patient
For medications that need to reconstituted (powder forms) it should be done
according to the manufacture’s instruction and use the correct solver
Draw the right dose as prescribed, including expelling the air using right
injection equipments
Ensure aseptic technique while giving the injection
Administer the drug at the correct site
Dispose the used syringes and needles immediately into sharp containers
A patient should be kept in the room for at least 5 minutes after the injection
has been given and be observed for any possible adverse effect or event
Thank the patient
Record the date and time of injection administered
II. Preventing injection equipments and medications from contaminations
Injection equipments and medications can be contaminated and cause harms to
patients due to absence of proper handling. To avoid contaminations of injection
equipments and medications strictly follow the following
Prepare each injection in a clean designated area where blood or body fluid
contamination is unlikely
Use single dose vials rather than multi dose vials unless you are in a position
where you can’t get one dose vial
If multi dose vials must be used , always pierce the septum with a sterile
needle and avoid leaving the needle in place in the stopper of the vial
Select pop- open ampoules rather than ampoules that require use of a metal
file to open
If you are using an ampoule that requires a metal file to open, protect fingers
with a clean barrier when opening the ampoule
Inspect medicaments and discard those with visible contamination or breaches
of integrity
Follow product specific recommendations for use, storage and handling
Swabbing of a new vial tops or ampoules with an antiseptics or disinfect is
unnecessary. If swabbing with an antiseptic is selected for use, use a clean ,
single use swab and maintain product specific recommendation contact time
Discard a needle that has touched any non sterile surface
III. Preventing injuries to healthcare providers during administration of
medications in injection forms
One of the reasons for promoting safe injection is to protect healthcare providers from
unnecessary and avoidable cross infections and injuries. So to protect yourself from
infections and injuries related to unsafe injections
Practice proper hand washing at proper times
Wear proper personal protective equipments when you give injections
Don’t try to recap needles after giving injections
Drop used needle and syringe into safety box
IV. Preventing injuries and cross infections to other third parties due to unsafe
injections
People who come to health facility due to different reasons other than for his/her own
medical care reasons must be protected from harms and cross infections due to unsafe
injection practices in the health facility. Protect those people by doing the following
Put safety box at your arms reach
Dispose used syringes and needles in the safety box
Properly dispose the safety box when it gets filled 3/4th of its volume
Instruct waste handlers to wear heavy duty gloves when they dispose safety
boxes
Make sure that safety boxes are incinerated properly
