Vong Sirenda, Perz Joseph F, Sok Srun, Som Seiharath, Goldstein Susan, Hutin Yvan, Tulloch James
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Public Health. 2005 Jun 2;5:56. doi: 10.1186/1471-2458-5-56.
Injection overuse and unsafe injection practices facilitate transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Anecdotal reports of unsafe and unnecessary therapeutic injections and the high prevalence of HBV (8.0%), HCV (6.5%), and HIV (2.6%) infection in Cambodia have raised concern over injection safety. To estimate the magnitude and patterns of such practices, a rapid assessment of injection practices was conducted.
We surveyed a random sample of the general population in Takeo Province and convenience samples of prescribers and injection providers in Takeo Province and Phnom Penh city regarding injection-related knowledge, attitudes, and practices. Injection providers were observed administering injections. Data were collected using standardized methods adapted from the World Health Organization safe injection assessment guidelines.
Among the general population sample (n = 500), the overall injection rate was 5.9 injections per person-year, with 40% of participants reporting receipt of >or= 1 injection during the previous 6 months. Therapeutic injections, intravenous infusions, and immunizations accounted for 74%, 16% and 10% of injections, respectively. The majority (>85%) of injections were received in the private sector. All participants who recalled their last injection reported the injection was administered with a newly opened disposable syringe and needle. Prescribers (n = 60) reported that 47% of the total prescriptions they wrote included a therapeutic injection or infusion. Among injection providers (n = 60), 58% recapped the syringe after use and 13% did not dispose of the used needle and syringe appropriately. Over half (53%) of the providers reported a needlestick injury during the previous 12 months. Ninety percent of prescribers and injection providers were aware HBV, HCV, and HIV were transmitted through unsafe injection practices. Knowledge of HIV transmission through "dirty" syringes among the general population was also high (95%).
Our data suggest that Cambodia has one of the world's highest rates of overall injection usage, despite general awareness of associated infection risks. Although there was little evidence of reuse of needles and syringes, support is needed for interventions to address injection overuse, healthcare worker safety and appropriate waste disposal.
注射的过度使用以及不安全的注射操作会促使血源性病原体的传播，如乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）。关于不安全和不必要的治疗性注射的传闻报道以及柬埔寨较高的HBV（8.0%）、HCV（6.5%）和HIV（2.6%）感染率引发了对注射安全的关注。为了评估此类操作的规模和模式，开展了一项关于注射操作的快速评估。
我们对茶胶省普通人群的随机样本以及茶胶省和金边市的开处方者与注射服务提供者的便利样本进行了调查，内容涉及与注射相关的知识、态度和操作。观察注射服务提供者进行注射的过程。使用根据世界卫生组织安全注射评估指南改编的标准化方法收集数据。
在普通人群样本（n = 500）中，总体注射率为每人每年5.9次注射，40%的参与者报告在过去6个月内接受过≥1次注射。治疗性注射、静脉输液和免疫接种分别占注射的74%、16%和10%。大多数（>85%）注射是在私立机构接受的。所有回忆起其最后一次注射的参与者都报告注射是使用新开封的一次性注射器和针头进行的。开处方者（n = 60）报告称，他们所开的全部处方中有47%包括治疗性注射或输液。在注射服务提供者（n = 60）中，58%在使用后重新盖上注射器针帽，13%没有妥善处理用过的针头和注射器。超过半数（53%）的提供者报告在过去12个月内发生过针刺伤。90%的开处方者和注射服务提供者知晓HBV、HCV和HIV可通过不安全的注射操作传播。普通人群中对HIV通过“不干净”注射器传播的知晓率也很高（95%）。
我们的数据表明，尽管人们普遍知晓相关感染风险，但柬埔寨仍是全球总体注射使用率最高的国家之一。虽然几乎没有证据表明存在针头和注射器的重复使用情况，但仍需要采取干预措施来解决注射过度使用、医护人员安全以及适当的废物处理问题。
