Seychelles injection safety and waste management assessment 25th June-7th July2009 Seychelles is a multi-ethnic tri-lingual state with its origin from three continents: Africa, Asia and Europe. It is an upper middle income developing country organised into 25 districts with a 2009 estimated midyear mid-year population of 87,409. Seychelles has been using predominantly disposable syringes and needles for both curative and preventive interventions including immunization and it is feared that reuse may be common outside the health care system. Whilst there is great awareness on the risks posed by health care waste to health workers and the community in general, there is no policy on health care waste disposal. Most wards and outpatient facilities use safety boxes, but these boxes are not properly mounted and recapping of needles is often practiced. Waste segregation is not common except in the maternity ward, exposing health workers and workers handling waste to the risk of infection. Seychelles being small has one final disposal site where health care waste is incinerated using liquefied petroleum gas incinerator. The incinerator operators are not trained in the care and maintenance and operation leading to the production of black sooty smoke. The incinerator emits the sooty effluent into a habitable neighborhood which causes lot of complaints and criticism of the hospital. Fear has been expressed about the dangerous nature of this emission and the hospital had requested WHO to assist to assess the function and safety of the incinerator. A holistic injection safety and health care waste management assessment which will lead to the development of a comprehensive health care waste management policy and guidelines. Objective of the surveyo To review the current status of injection safety, including therapeutic and preventive injections.o To assess the health care waste management systemo To propose environmentally friendlier incinerators for health care waste. Specific objectiveso To determine whether a health facility where injections are given or procedures undertaken with needle and syringe meets necessary requirements for staff competence, equipment, supplies, and waste disposal;o To determine whether the critical steps of an injection administration are executed according to recommended best practices;o To identify the unsafe practices that may lead to infections and that should be targeted by injection safety interventions;o To estimate the proportion of healthcare facilities where injection practices are safeo To determine the status of the health care waste management system in the health facilitiesStudy designA cross sectional, observational study will be carried out using WHO Questionnaire. It will consist of:A structured observation of equipment and supplies available at the facility, A structured observation of all injections given and other skin piercing procedures conducted given during the visit in hospital and veterinary clinic.An interview of injection providers and supervisors.Interview and curriculum search for Injection safety in NIHSS (pre- service institution)An interview of the incinerator operators and their supervisorsStudy areaAll government and private facilities and veterinary clinic will be studied Day unitsHospitalsLarge Health centreSmall health centrePre-service institutionVeterinary clinicDisposal sites for used injection equipment and other Health waste materials[/list] Two consultants for injection safety and Health care waste management recruited by WHO are assisting in this survey from 25thJune -7th July 2009. It is hoped that the finding and recommendations of this assessment will help in the development of injection safety and health care waste policy and strategic plan