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Executive Summary: A Review of SIGN Recommendations 1999 – 2008

Worldwide, each year, the overuse of injections and unsafe injection practices combine to cause an estimated 21 million hepatitis B virus infections, 27 million hepatitis C virus infections and 260,000 HIV infections.

The Safe Injection Global Network (SIGN) is an international alliance of stakeholders working to achieve safe and appropriate use of injections worldwide. SIGN was launched in October 1999 and meets annually to review progress and recommend action. As the network developed and evidence accumulated of risks to patients and health care workers, the role of SIGN was expanded to include related infection control, sharps injury prevention, lancets and phlebotomy procedures.







In SIGN’s ten years of existence, 316 consensus recommendations were made to guide the worldwide implementation of the SIGN strategy for the safe and appropriate use of injections. The key elements of the strategy are the development of national injection safety policies and plans, ensuring quality, safety and equitable access to injection equipment, and the appropriate, rational and cost effective use of injections. 

 SIGN recommendations were holistic and complex, addressing 21 categories of work. The major focus was on injection safety, the use of sector wide approaches to implement injection safety strategies and device introduction, access and standards, advocacy and behaviour change, health worker safety and health care waste management.

National safe injection coalitions were established in Egypt, India, Cambodia, Uzbekistan, China, Bangladesh, Guinea and Uganda, Vietnam, USA, Russia, Pakistan and recently in Nepal. By 2008, 62 countries had performed an injection safety assessment, 7 countries had rapid assessments and 10 countries had reassessments.  59 countries have national injection safely plans, with a further 16 countries developing national plans.

GAVI provided immunization injection safety support to 71 countries for up to three years during 2002-2009, and allocated US $110 million to purchasing an estimated 2.5 billion RUP syringes. RUP syringes and safety boxes were introduced in medical services beyond immunization in 30 GAVI assisted countries.  PEPFAR through USAID and USCDC supported comprehensive medical injection safety programs in 14 countries, training more than 200,000 healthcare workers since 2004 and providing essential commodities for safe medical injections.

Developing countries growing emphasis on injection safety is spreading beyond immunization to other medical services and programmes. 59 countries of the 90 countries for which we have data have national injection safety plans. Lower price differentials for injection devices with reuse prevention features have reduced the cost of safety to national budgets contributing to more equitable access.

The work and achievement of SIGN and its partners assisting countries has been tremendous.  It is a great achievement that SIGN has set the policy framework, developed the technical tools, and engaged more than 90 countries in addressing unsafe injections.


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