What are the differences between safe and unsafe injection practices?

A safe injection does no harm to the recipient, does not expose the health worker to any risk, and does not result in waste that is dangerous for the community. To achieve this, the injection needs to be prepared with clean hands in a clean area, using medication drawn from a sterile vial. The injection must be administered using a sterile syringe and needle. After administration, sharp equipment needs to be discarded in a puncture-proof container for appropriate disposal. Any break or departure from this procedure represents a risk, rendering the injection unsafe. Among unsafe practices, syringe or needle re-uses between patients without sterilization is associated with the highest risk of blood borne pathogen transmission. 

The diseases most frequently transmitted through unsafe injection practice are hepatitis B, hepatitis C, and HIV/AIDS. Hepatitis B and C represent the highest burden of disease associated with unsafe injection practice. Contrary to public perceptions, hepatitis B and hepatitis C are transmitted respectively 100 and 10 times more through unsafe injection practices than HIV/AIDS. In addition, unsafe injections can cause abscesses and lead to septicemia. Less frequently, hemorrhagic fevers and malaria can also be transmitted.

There are following 2 types of Reuse Prevention Syringes  :

1. Reuse Prevention Syringes with voluntary disabled activation (after giving
injection doctor / nurse may or may not activate the disabling mechanism if they so desire).
 
2. Reuse Prevention Syringes with Involuntary disabled activation (during injection the disabling mechanism gets activated automatically).

What is the cost of KOJAK ?

Could you briefly describe the KOJAK auto-disable syringe?

The KOJAK Syringe is a non reusable, disposable, auto-disable syringe with a safety plunger that breaks off after a single use. The KOJAK syringe is available with a detachable or fixed needle. It can be used for all kinds of Injection practices as is the case for a standard disposable syringe. The Barrel incorporates 2 locking rings and the plunger incorporates lockable fins and an easy break link. Once the Injection is given the fins of the plunger get locked onto the rings of the barrel and any attempt to reuse will cause the plunger to break. 

How is the KOJAK syringe different from other AD syringes?

The KOJAK syringe differs from the other AD syringes. Standard AD Syringes are designed for immunization only with a fixed needle and only 0.5ml dosage or 1ml dosage. KOJAK can be used for any immunization or curative Injection and is available in the most commonly used sizes of 2ml, 3ml, 5ml and 10 ml. Other sizes are also under development. KOJAK Syringe permit aspiration, which is not possible in most AD designs.  

We do not recommend KOJAK for collecting blood. A winged blood collection set with safety shield to prevent needle stick injury along with evacuated tube is a safer option. The plunger of KOJAK has an easy break link, which can break during blood collection, if plunger withdrawal is too rapid. Some nurses however do use KOJAK without facing any problem by using a bigger gauge of needle size e.g.21G and slowly withdrawing plunger.

Sometimes KOJAK breaks while filling with Penicillin, why  ?

This depend upon the needle gauge size used and speed of pulling back the plunger. For highly oily / viscous Injections 18G or 19G needle should be used and plunger pulled slowly. Then there would be no breakage.

What are the flexibility advantages of using Kojak AD Syringes ?

Kojak permits aspiration (critical for subcutaneous immunization injections)
Kojak can be used for reconstitution and mixing of drugs.
Kojak is available with any gauge of needle favored by the user.
Kojak is available in fixed as well as detachable needle design options.
Kojak is affordable.

What is SELINGE?

SELINGE is a synonym for a plastic single-use, non-reusable, auto-disable syringe. It is our humble contribution to the English dictionary. 

Which manufacturer’s instructions, are  critical, while giving injections ?

Before giving injection, one must read in detail the instructions given in the packaging insert of the injection and one should verify if injections are to be given

• Intra-muscular
• Subcutaneous
• Intravenous

Caution to be followed : Do not inject the medication intravenously, which is meant for injecting intra-muscular or subcutaneous.

Aspirate the syringe for checking whether the needle is inside the blood vessel/vein prior to injecting.

Some intra-muscular and subcutaneous Injections if given intravenously can result in Anaphylactic shock/fatal reaction and thus result in a wasteful injection, as it may not achieve intended immunity / recovery.

What is the solution to the problem of injections due to unsafe injection ?

• Policy on Hospital Waste Disposal
• Policy for Safe Injections
• Use of AD Syringes in the curative & immunization segment.
  
  

Whether, it is advisable to use Kojak in O.T ?

Kojak can be the right choice for giving single dose injections, whereas in case of giving multiple dose through single syringe during emergency, we do not strongly recommend the use of Kojak, as chances of plunger getting locked are there, if the  plunger is inadvertently pushed till the end, while giving a dose.

Can we use a single KOJAK  for heparin flushing of IV Cannulas for multiple patients   ?

This would be an unsafe practices leading to cross contamination. Remember one syringe one injection.

Whether reconstitution & mixing dry powder can easily be done in case of Kojak syringes ?

Yes, reconstitution & mixing dry powder both can be done using Kojak Syringes. The following steps are to followed to safely reconstitute vaccine :

1. Read the label on the diluents vial to be sure that it is the diluents provided by the
     manufacturer for that specific vaccine and vial size.

2. Cool the diluents to 2-8 C prior to use to avoid thermal shock to the vaccine. Make
     sure that you allow enough time for sufficient cooling.

3. Check to make sure the expiry date of the vaccine and diluents vials has not
     passed.

4. Open the vaccine vial.

5. Open the diluents and draw the entire contents of the diluents vial into the mixing syringe.

6. Empty the entire contents of diluents into the vaccine vial.

7. Discard the used mixing syringe and needle.

8. Do not leave the mixing needle in the vial; this is common mistake that leaves the vial open to contamination.

9. Roll the vial between your fingers to mix the contents until all of the vaccine powder has dissolved. If necessary, note the date and time the vial was mixed.

10. Keep the reconstituted vaccine cool by placing the vaccine inside slits cut in the top of a foam pad that has been cut to fit a vaccine carrier. WHO recommended this technique to keep vaccine cold and protected from sunlight. Other techniques for keeping the vaccine cold-such as placing the vial inside a cup of ice-can damage or remove the vaccine vial label.

11. Discard all reconstituted vaccine 6 hours after reconstitution, or at the end of
 the session, whichever comes first.

12. Withdraw the vaccine from the vial using the same needle and syringe that will
 be used to inject the vaccine.