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WHO Best Practices for Injections and Related Procedures Toolkit. Geneva: World Health Organization; 2010 Mar.

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WHO Best Practices for Injections and Related Procedures Toolkit.

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A collection of pus (dead neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g. splinters, bullet wounds or injecting needles). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

Acquired immunodeficiency syndrome (AIDS)

Morbidity resulting from infection with the human immunodeficiency virus.

Administrative controls to reduce exposure

A method of minimizing patient or employee exposures through enforcement of policies and procedures, modification of work assignment, training in specific work practices, and other administrative measures designed to reduce the exposure.

Alcohol-based hand rub

An alcohol-containing preparation (liquid, gel or foam) designed for application to the hands to reduce the growth of microorganisms. Such preparations may contain one or more types of alcohol with excipient (a relatively inert substance used as a carrier for the active ingredients of a medication) or other active ingredients and humectants.

Antigen (or immunogen)

Any substance that can be recognized by the adaptive immune system and prompt an immune response.

Antseptc handwashing

Washing hands with water and soap or other detergents containing an antiseptic agent. Recommended when carrying out an aseptic technique.


Antimicrobial substances applied to living tissue or skin to prevent infection. They differ from antibiotics, which destroy bacteria within the body, and from disinfectants, which are used on nonliving objects. Some antiseptics are true germicides, capable of destroying microbes whereas others are bacteriostatic and only prevent or inhibit their growth.

Aseptic technique

The manner of conducting procedures to prevent microbial contamination. An aseptic technique alters the method of hand hygiene, PPE worn, the location and physicial characteristics where a procedure is conducted, the use of skin antisepsis and disinfectants in the environment, the manner of opening of packages and the use of sterile supplies.

Auto-disable (AD) syringe

A syringe designed to prevent reuse by locking or disabling after giving a single injection, Several types of AD syringes are commercially available.

Biohazard (biological hazard)

A risk to the health of humans caused by exposure to harmful bacteria, viruses or other dangerous biological agents, or by a material produced by such an organism.

Bloodborne pathogens

Pathogenic microorganisms in human blood that are transmitted through exposure to blood or blood products, and cause disease in humans. Common pathogens of occupational concern include hepatitis B virus, hepatitis C virus and human immunodeficiency virus.

Colour coding

Designation of different colours for the storage of different categories of health-care wastes.


The act of spreading microbes (bacteria and viruses) from one surface to another. Since bloodborne viruses can live on objects and surfaces for up to a week, and other pathogens for months or more, microbes could be spread when surfaces are not disinfected correctly or equipment is not cleaned and sterilized between patients.


The process of removing pathogenic microorganisms from objects and equipment to make them safe to handle.


Killing of infectious agents outside the body by direct exposure to chemical or physical agents. Disinfection is necessary only for diseases spread by indirect contact.


Intentional burial, deposit, discharge, dumping, placing or release of any waste material into or on any air, land or water. In the context of this document, disposal refers to the storage and subsequent destruction of injection or blood sampling equipment to avoid reuse or injury.

Elimination of hazard

Administration of medications by ways other than injection (e. g. use of tablets, inhalers).

Engineering controls

Methods of isolating or removing hazards from the workplace. Examples include sharps disposal containers and safer medical devices (e.g. sharps with engineered sharps-injury protections and needleless systems), laser scalpels and ventilation, including the use of ventilated biological cabinets (laboratory fume hoods). In the context of sharps injury prevention, engineering controls means control that isolates or removes the bloodborne pathogens from the workplace.

Hand hygiene

Any type of hand cleansing.


Washing hands with soap and water, and drying thoroughly afterwards with single-use towels.

Hepatitis B infection

Hepatitis caused by hepatitis B virus (HBV) and transmitted by exposure to blood or blood products, or during sexual intercourse. It causes acute and chronic hepatitis. Chronic hepatitis B can cause liver disease, cirrhosis and liver cancer.

Hepatitis C infection

Hepatitis caused by a hepatitis C virus (HCV) and transmitted by exposure to blood or blood products. Hepatitis C is usually chronic and can cause cirrhosis and primary liver cancer.

Hepatitis D infection

Hepatitis caused by the hepatitis D virus (HDV), a defective virus that needs HBV to exist. HDV is found in the blood of persons infected with the hepatitis B virus.

Hierarchy of controls

A concept developed in occupational health industrial hygiene to emphasize prevention. The hierarchy, in order of priority for their efficacy in controlling exposure to hazards and preventing injury or illness resulting from exposure hazards, is as follows:

See also fact sheet 4 of the Joint ILO/WHO guidelines on health services and HIV/AIDS (77) for the application of the hierarchy of controls to the hazard of bloodborne pathogen exposure and needle-stick injuries.

Human immunodeficiency virus (HIV)

A virus mainly transmitted during sexual intercourse or through exposure to blood or blood products. HIV causes acquired immunodeficiency syndrome (AIDS).

Infection control

A health-care organization's program, including policies and procedures, for the surveillance, prevention and control of health-care associated infections. Such a program includes all patient care and patient care support departments and services. Examples of infection control measures include immunization, hand hygiene, antimicrobial stewardship, review of facility constructions, supervision of disinfection and sterilization, surveillance, use of protective clothing and isolation.


Percutaneous introduction of a medicinal substance, fluid or nutrient into the body. This may be accomplished most commonly by a needle and syringe, but also by jet injectors, transdermal patches, micro-needles and other newer devices. The injections are commonly classified by the target tissue (e. g. intradermal, subcutaneous, intramuscular, intravenous, intraosseous, intra-arterial, peritoneal).

Intradermal injection

A shallow injection given between the layers of the skin, creating a “weal” on the skin.

Intramuscular injection

An injection given into the body of a muscle.


Within a blood vessel.

Intravenous injection

An injection given into a vein.

Jet injector

A needle-free device that allows the injection of a substance through the skin under high pressure.


A blood-sampling device to obtain a capillary sample of blood for testing. It is most commonly used by people with diabetes during blood glucose monitoring. The depth of skin penetration can be adjusted by selecting lancets of different lengths.


Penetrating stab wound caused by a needle.

Occupational exposure

Exposure to materials that results from the performance of an employee's duties.

Other potentially infectious materials

Body fluids that are potentially infectious for HIV, HBV and HBC, including:

  • semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
  • any unfixed tissue or organ (other than intact skin) from a human (living or dead);
  • cell or tissue cultures, or organ cultures containing HIV;
  • culture medium or other solutions containing HIV, HBV or HCV;
  • blood, organs, or other tissues from experimental animals infected with HIV, HBV or HCV.


Piercing mucous membranes or the skin barrier such as subcutaneous, intramuscular, intravenous or arterial routes, through such events as injections, needle-sticks, cuts or abrasions.


A microorganism capable of causing disease.

Personal protective equipment (PPE)

Specialized equipment worn by an employee to protect against a hazard. PPE includes gloves, lab coats, gowns, aprons, shoe covers, goggles, glasses with side shields, masks and resuscitation bags. The purpose of PPE is to prevent blood and body fluids from reaching the workers’ skin, mucous membranes, or personal clothing. It must create an effective barrier between the exposed worker and any blood or other body fluids.


The act of drawing or removing blood from the circulatory system through an incision or puncture in order to obtain a sample for analysis and diagnosis.

Post-exposure care and prophylaxis for HIV

Preventive interventions offered to manage the specific aspects of exposure to HIV, and prevent HIV infection in exposed individuals. The services include counselling, risk assessment, HIV testing (based on informed consent), first care and, when needed, the provision of short-term (28 days) antiretroviral drugs, with follow-up and support.

Post-exposure prophylaxis (PEP)

A medical response given to prevent the transmission of bloodborne pathogens after potential exposure. It is available for HIV and hepatitis B.


Relating to or of the nature of protein.

Quality control

A management function whereby control of the quality of raw materials, assemblies, produced materials and components; services related to production; and management, production and inspection processes is exercised for the purpose of preventing undetected production of defective material or the rendering of faulty services.


The act of replacing a protective sheath on a needle. Recapping needles using two-handed methods increases the risk of needle-stick injuries and is not recommended. However, where such action is unavoidable, the one-hand scoop technique reduces the risk of needle-sticks.

Safe injection

An injection that does no harm to the recipient, does not expose the health worker to any risk and does not result in waste that puts the community at risk.


Any object that can penetrate the skin; sharps include needles, scalpels, broken glass, broken capillary tubes and exposed ends of dental wires.

Sharps container

A puncture-resistant, rigid, leak-resistant container designed to hold used sharps safely during collection, disposal and destruction. Sometimes referred to as a “sharps box” or “safety box”.

Sharps injury

An exposure event occurring when any sharp penetrates the skin.

Sharps protection devices

A sharp or needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids. The device has a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

Single-use syringe

A sterile syringe intended for the aspiration of fluids or for the injection of fluids immediately after filling (ISO 7886-1).

Solid sharp

A sharp that does not have a lumen through which material can flow; for example, a suture needle, scalpel or lancet.

Standard precautions

A set of practices designed to prevent the spread of infection between health workers and patients from contact with infectious agents in recognized and unrecognized sources of infection. Such precautions are recommended for use with all patients, regardless of patient diagnoses or presumed infectious status. Key elements include hand hygiene, cleaning of the environment, reprocessing of equipment between patients, use of personal protective equipment, placement of patients with known infection or colonization into isolation, laundry management, injection safety, preventing exposure to bloodborne pathogens, waste management and respiratory hygiene.


Free from living microorganisms.

Subcutaneous injection

An injection delivered under the skin.

Syringes with reuse prevention features

A sterile single-use hypodermic syringe of a design such that it can be rendered unusable after use (ISO 7886-4).

Work practice controls

Techniques that reduce the likelihood of exposure by changing the way a task is performed.

Copyright © 2010, World Health Organization.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

Bookshelf ID: NBK138489


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