Document

!
"!
!"#$%&%'#()(*$+))+'*+',-./$"0"1$+'*+'02+3+4#$#+'5'#"6$&%'&+#-)$78+'9-./$"0"1$/&+'*+'02+3+4#$#+'#+4&$:$%'!;9<#''
'
=)")#%'*+',"/$&$")'4+0(&$:'(83'9<;>!;9<'78$'+::+#&8+)&'*+/',4%0?@+6+)&/'/()18$)/'A'
!
$%!&'()*+','-'./!%00123!&4/52')363+.!%,*1&%,-3!)*21!-4%+%-7(3!&3(!/08%+.'--*+(!&3!(%+9!)1/-3:/(!%2!6*73+!&42+3!)'5;13!
(21!-3!&*'9.<!/52')363+.!2.'-'(/!)%1!3=36)-3!)*21!-3!(2':'!0*21%+.!&2!-%0.%.3<!&2!)1*>'-!&3(!-')'&3(!(%+92'+(!3.!&3!-%!?"0<!%!
)316'(!%2=!@ABCDB@A!&3!,*+'>'31!-321!*>>13!&3!(31:'03(!%2=!0-'3+.(E!F'3+!523!-3(!)1/-G:363+.(!(%+92'+(!3>>30.2/(!%2!6*73+!
&42+3!)'5;13!(21!-3!&*'9.!)2'((3+.!(36,-31!'+*>>3+('>(!3.!,/+'+(<!.*2(!-3(!)1/-G:363+.(!(%+92'+(!(*+.!&3(!%0.3(!%2.*1'(/(!
1/9'(!)%1!-3(!-*'(!(21!-3(!)1*>3(('*+(!&3!-%!(%+./!1/9-363+./3(!H"II"J!K!!!
!
!L!MNE!!!H"J!$*1(52O'-!&*++3!&3(!(*'+(!6/&'0%2=!P!2+!)%1.'02-'31<!+2-!+3!&*'.!%00*6)-'1!2+!&3(!%0.3(!%2.*1'(/(!:'(/(!%2!
)%1%91%)83!HMJ!(%2>!&%+(!-3(!0%(!(2':%+.(!K!%J!'-!3(.!636,13!%2.*1'(/!P!%00*6)-'1!03.!%0.3!)%1!2+3!-*'!(21!2+3!)1*>3(('*+!&3!
-%!(%+./Q!*2!,J!-O3=/02.'*+!&3!-O%0.3!%2.*1'(/!-2'!%!/./!&/-/92/3!)%1!2+!636,13!:'(/!P!-O%-'+/%!%JE!"II"<!08%)E!"R<!)%1E!MN!H"JQ!
"IIR<!08%)E!"R<!%++3=3!S<!%1.E!TE!U!!
!
V+!)1/-G:363+.!(%+92'+!H)*+0.'*+!:3'+32(3!*2!)1/-G:363+.!%2!6*73+!&42+3!)'5;13!(21!-3!&*'9.J!3(.!&/>'+'!0*663!/.%+.!
2+!%0.3!%2.*1'(/!K!
L!$%!)1%.'523!&O'+.31:3+.'*+(!(21!-3!.'((2!('.2/!(*2(!-3!&3163<!(*2(!-%!(21>%03!&3(!625232(3(<!P!-%!(21>%03!&3!-%!0*1+/3!*2!
&3(!&3+.(<!*2!%2C&3-P<!7!0*6)1'(!-3!&/.%1.1%93!&3(!&3+.(E!U!
!
W3!)-2(<!-3(!93+(!52'!%))-'523+.!2+3!)1*0/&213!&3!)1/-G:363+.!(%+92'+!&*':3+.!.3+'1!0*6).3!&42+!031.%'+!+*6,13!&3!
0*+('&/1%.'*+(!13-%.':3(!P!-%!(;13./E!!!!
!
A=.1%'.!&2!WHO$best$practices$for$injections$and$related$procedures$toolkit!HMX"XJ!&3!-4Y19%+'(%.'*+!6*+&'%-3!&3!-%!D%+./!K!
V+3!)8-/,*.*6'3!3>>30.2/3!&3!6%+'G13!+*+!(/021'.%'13!)32.!9/+/131!&3(!3>>3.(!'+&/('1%,-3(!083Z!-3(!)%.'3+.(Q!&3!.3-(!
3>>3.(!(*+.!1%13(<!6%'(!)32:3+.!'+0-213!2+3!&*2-321!*2!2+3!300876*(3!%2!('.3!&3!-%!)'5;13<!-4/:%+*2'((363+.<!-4%..3'+.3!
&42+!+31>!*2!2+!8/6%.*63E!$3(!/:/+363+.(!'+&/('1%,-3(!52'!*+.!/./!-3(!6'32=!&*0263+./(!-4*+.!/./!&%+(!&3(!03+.13(!&3!
.1%+(>2('*+!(%+92'+3<!*[!&3!6%2:%'(3(!)1%.'523(!&3!)*+0.'*+!:3'+32(3!*2!&3(!%+*6%-'3(!%+%.*6'523(!*+.!63+/!P!&3(!
8/6%.*63(!3.!P!&3(!,-3((213(!&3(!(.120.213(!%+%.*6'523(!)1G(!&2!)*'+.!&43+.1/3!&3!-4%'92'--3'E!
V+!%2.13!)1*,-G63!)*21!-3(!)%.'3+.(!3(.!523!('!2+!/08%+.'--*+!&3!(%+9!3(.!6%-!)1/-3:/!*2!&/.12'.!)3+&%+.!-3!.1%+()*1.<!-3(!
1/(2-.%.(!)*211%'3+.!\.13!'6)1/0'(!*2!.1*6)321(!)*21!-3!0-'+'0'3+Q!-3!)%.'3+.!)*211%'.!/9%-363+.!&3:*'1!(2,'1!-4'+0*+:/+'3+.!
&4%:*'1!P!13>%'13!-3!.3(.''E!
W3!6%2:%'(3(!)1%.'523(!3+!6%.'G13!&3!-2..3!%+.'C'+>30.'32(3!)32:3+.!)1*:*5231!&3(!'+>30.'*+(!,%0./1'3++3(!%2!('.3!
&43+.1/3!&3!-4%'92'--3!&%+(!-%!)3%2'''E!
V+3!)8-/,*.*6'3!)32.!3=)*(31!-3(!)%.'3+.(!3.!-3(!.1%:%'--321(!&3!-%!(%+./!%2!(%+9!&4%2.13(!)31(*++3(!3.!&*+0!-3(!63..13!P!
1'(523!&3!0*+.1%0.31!&3(!)%.8*9G+3(!P!&'>>2('*+!8/6%.*9G+3E!B3(!)%.8*9G+3(!0*6)13++3+.':!K!
• W3(!:'12(!.3-(!-3!]^F<!-3!]^B!3.!-3!]_^Q!
• W3(!,%0./1'3(!.3--3(!-%!(7)8'-'(Q!
• W3(!)%1%('.3(!.3-(!-%!6%-%1'%E!
$3(!/)'&/6'3(!1%))*1./3(!&48/)%.'.3!F!3+!-'3+!%:30!-42.'-'(%.'*+!&3(!9-20*6G.13(!H-3(!%))%13'-(!2.'-'(/(!)*21!&/.316'+31!-%!
0*+03+.1%.'*+!&2!9-20*(3!&%+(!-3!(%+9J!(*+.!2+!3=36)-3!&3!)1*)%9%.'*+!&3!)%.8*9G+3(!P!&'>>2('*+!8/6%.*9G+3!)%1!
)8-/,*.*6'3:E!
$3(!,-3((213(!0%2(/3(!)%1!&3(!*,`3.(!)*'+.2(!3.!.1%+08%+.(!13)1/(3+.3+.!2+!%2.13!)1*,-G63!)*21!-3(!.1%:%'--321(!&3!-%!
(%+./Q!3--3(!(21:'3++3+.!9/+/1%-363+.!3+.13!-42.'-'(%.'*+!3.!-%!6'(3!%2!13,2.!&42+3!%'92'--3!*2!&42+!&'()*('.'>!('6'-%'13E!!
!
$3(!-*'(!(21!-3(!)1*>3(('*+(!&3!-%!(%+./!1/9-363+./3(!)1/:*'3+.!2+!031.%'+!+*6,13!&43=03).'*+(!52'!)3163..3+.!P!&3(!93+(!
52'!+3!(*+.!)%(!636,13(!&42+3!)1*>3(('*+!1/9-363+./3!&3!)1%.'5231!2+!%0.3!%2.*1'(/!&%+(!&3(!0'10*+(.%+03(!&/>'+'3(E!
$48%,'-'.%.'*+!&42+3!)31(*++3!P!3>>30.231!2+!%0.3!%2.*1'(/!)32.!\.13!%2.*1'(/3!&3!52%.13!6%+'G13(!K!!
a!@%1!%2.*1'(%.'*+!&'130.3!
a!@%1!&/-/9%.'*+!b!(32-3!03--3C0'!(4%))-'523!%2=!@ABCDB@A!

!
M!
a!@%1!3=03).'*+(!
a!@%1!3=36).'*+(!
!
B8&"4$/(&$")'*$4+#&+'A'$3(!-*'(!%))-'0%,-3(!P!031.%'+3(!)1*>3(('*+(!&3!-%!(%+./!1/9-363+./3(!&*++3+.!2+3!%2.*1'(%.'*+!
&'130.3!P!031.%'+(!)1*>3(('*++3-(!&43>>30.231!&3(!%0.3(!%2.*1'(/(!*2!&3(!0*6)*(%+.3(!&4%0.3(!%2.*1'(/(E!$3(!636,13(!3+!
1G9-3!&3!03(!)1*>3(('*+(!)32:3+.!3>>30.231!03(!%0.3(!%2.*1'(/(!(4'-(!(4'+(01':3+.!&%+(!-3(!08%6)(!&4%0.':'./!&3!-321!
)1*>3(('*+<!3.!-*1(524'-(!)*((G&3+.!-3(!0*++%'((%+03(<!-3(!0*6)/.3+03(!3.!-3!`29363+.!%))1*)1'/(!)*21!-3(!3>>30.231!
0*+>*16/63+.!%2=!+*163(!&3!)1%.'523!&3!-%!)1*>3(('*+E!
!
C%0%1(&$")'"8'*$4+#&$@+'6%*$#(0+'A'$%!&/-/9%.'*+!*2!-%!&'130.':3!6/&'0%-3!3(.!2+!)1*03((2(!)%1!-3523-!2+3!)31(*++3!
636,13!&42+3!)1*>3(('*+!&3!-%!(%+./!1/9-363+./3!%((*0'/3!P!&3(!%0.3(!%2.*1'(/(!8%,'-'.3!)%1!&/-/9%.'*+!2+3!%2.13!
)31(*++3!P!3>>30.231!2+!*2!)-2('321(!&3!03(!%0.3(!%2.*1'(/(!*2!0*6)*(%+.3(!&4%0.3(!%2.*1'(/(Q!-%!)31(*++3!&3:'3+.!%'+('!
%2.*1'(/3!P!3>>30.231!03(!%0.3(!%2.*1'(/(E!!!$%!&/-/9%.'*+!*2!-3(!&'130.':3(!6/&'0%-3(!&*':3+.!K!
• c.13!&*++/3(!P!-4%:%+03!)%1!-3(!6/&30'+(d%2.*1'(%.321(!%>'+!&3!)3163..13!P!-43=/02.%+.!&3!&/0'&31!&43>>30.231!-%!
*2!-3(!)1*0/&213(!&36%+&/3(!&%+(!&3(!0*+&'.'*+(!)%1.'02-'G13(!(%+(!5242+!6/&30'+!*2!-4%2.*1'(%.321!+3!)1*0G&3!
P!2+3!/:%-2%.'*+!&'130.3E!!!
• c.13!13+&23(!)%1!/01'.!3.!0*6)13+&13!-3(!0*6)*(%+.3(!3((3+.'3--3(E!!
!
B*+(2-.3Z!-4%++3=3!)*21!:*'1!2+!3=36)-%'13!&42+3!&'130.':3!6/&'0%-3!*2!&42+!9%,%1'.!&3!&/-/9%.'*+E!!
!
<3#+,&$")'
$3(!3=03).'*+(!(*+.!&3(!0'10*+(.%+03(<!&/>'+'3(!)%1!-%!-*'<!&%+(!-3(523--3(!-3(!13(.1'0.'*+(!13-%.':3(!P!-43=/02.'*+!&3(!%0.3(!
%2.*1'(/(!+3!(4%))-'523+.!)%(!H)E!3=E!3+!0%(!&42193+03JE!
!
<3+6,&$")/'
$3(!3=36).'*+(!(*+.!&3(!%0.3(!%2.*1'(/(<!*2!&3(!0*6)*(%+.3(!&4%0.3(!%2.*1'(/(<!3=36)./(!&3(!13(.1'0.'*+(!13-%.':3(!P!-321!
3=/02.'*+E!$3(!3=36).'*+(!3+!:'92321!)*21!-3(!%0.3(!%2.*1'(/(!(*+.!'+0-2(3(!&%+(!2+3!1/9-363+.%.'*+!1/9'3!)%1!-3(!-*'(!(21!
-3(!)1*>3(('*+(!&3!-%!(%+./!1/9-363+./3(E!
!
B8&4+'
$3!)1/-G:363+.!&42+!/08%+.'--*+!&3!(%+9!P!)%1.'1!&42+3!:3'+3!*2!3+!)'52%+.!-%!)3%2!+43(.!)%(!(*26'(!%2=!&'()*('.'*+(!&2!
)%1%91%)83!MN!H"J!&3!-%!-*'!('!-%!)31(*++3!52'!)1/-G:3!-4/08%+.'--*+!&3!(%+9!3(.!36)-*7/3!)%1!2+!-%,*1%.*'13!6/&'0%-!*2!2+!
03+.13!&3!)1/-G:363+.!%2.*1'(/!3+!:31.2!&3!-%!$*'!%2.*1'(%+.!&3(!-%,*1%.*'13(!6/&'0%2=!3.!&3(!03+.13(!&3!)1/-G:363+.E!!!
$%!)-2)%1.!&3(!@ABCDB@A!+3!.1%:%'--3+.!)%(!&%+(!03(!-%,*1%.*'13(!%2.*1'(/(E!
!
$3(!@ABCDB@A!52'!(*28%'.3+.!3>>30.231!&3(!)1/-G:363+.(!(%+92'+(!&*':3+.!K!
• ?052/1'1!-3(!0*6)/.3+03(!3.!*,.3+'1!-%!031.'>'0%.'*+!)%1!3=%63+!3.!&/6*+(.1%.'*+!&3!-321(!8%,'-3./(!)1%.'523(!P!
3>>30.231!-4%0.3!&3!6%+'G13!0*6)/.3+.3E!!!!
• e*21+'1!%++23--363+.!&3!-%!&*0263+.%.'*+<!%2!6*63+.!&2!13+*2:3--363+.!&2!(.%.2.!&3!@ABCDB@A<!%..3(.%+.!-321!
031.'>'0%.'*+!3.!-4%2.*1'(%.'*+!&43>>30.231!-4%0.3!('9+/3!)%1!-3!L!&/-/9%+.!U!3.!()/0'>'%+.!-%!9%663!&3!0-'3+.(!3.!-3(!
0*+&'.'*+(!&%+(!-3(523--3(!-4%0.3!)32.!\.13!3>>30.2/E!
• e%'13!13031.'>'31!%++23--363+.!-321(!0*6)/.3+03(!P!)1/-3:31!&3(!/08%+.'--*+(!&3!(%+9!%>'+!&4%((2131!-321!
0*6)/.3+03!0*+.'+23E!
!
$3(!636,13(!52'!+4*,.'3++3+.!)%(!-%!>*16%.'*+!%))1*)1'/3<!-%!031.'>'0%.'*+!H*2!-%!13031.'>'0%.'*+J!3.!-4%2.*1'(%.'*+!1352'(3!
&2!&/-/9%+.!+3!(*+.!)%(!%2.*1'(/(!P!3>>30.231!2+!)1/-G:363+.!(%+92'+Q!-3!&/>%2.!&4*,.3+'1!-%!>*16%.'*+!%))1*)1'/3<!-%!
031.'>'0%.'*+!H*2!-%!13031.'>'0%.'*+J!3.!-4%2.*1'(%.'*+!1352'(3!&2!&/-/9%+.!%++2-3!-%!0*2:31.213!&4%((21%+03!)*21!03!(31:'03E!
!
!
!
!
!
!
!

!
f!
!
!
!

!
g!
!
!
!

!
h!
!
!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
'!S%-3+%!^E!B*6)-'0%.'*+(!*00211'+9!>1*6!&'%9+*(.'0!:3+3)2+0.213E!i*21+%-!*>!e%6'-7!@1%0.'03<!"IIM<!fgHhJKhRMbhRgE!
''!D*!7*2O13!9*'+9!.*!0*--30.!%!,-**&!()30'63+K!%+!'+.1*&20.'*+!.*!)8-3,*.*67E!VD?<!B*--393!*>!?631'0%+!@%.8*-*9'(.(<!MXXNE!
'''!j*1-&!^3%-.8!Y19%+'Z%.'*+!3.!%-E!W*!+*!8%16K!'+`30.'*+!(%>3.7!'+!.83!0*+.3=.!*>!'+>30.'*+!)13:3+.'*+E!j%(8'+9.*+<!WB<!i*8+!D+*k!_+0<!MXXhE!
':!j'-,21+!D<!A'`l36%+(!SE!@1*.30.'+9!83%-.8!k*1l31(!>1*6!*002)%.'*+%-!3=)*(213!.*!^_]<!83)%.'.'(<!%+&!*.831!,-**&,*1+3!)%.8*93+(K!>1*6!
13(3%108!.*!)1%0.'03E!?('%+C@%0'>'0!m3k(-3..31!*+!Y002)%.'*+%-!^3%-.8!%+&!D%>3.7<!MXXN<!"fKRb"ME!
@1n((Co(.n+!?<!p%)'.'-!A<!^2.'+!qE!_+.1*&20.'*+!%+&!63.8*&(K!%((3(('+9!.83!3+:'1*+63+.%-!,21&3+!*>!&'(3%(3!%.!+%.'*+%-!%+&!-*0%-!-3:3-(E!
S3+3:%<!j*1-&!^3%-.8!Y19%+'Z%.'*+<!MXXfE!
B3+.31(!>*1!W'(3%(3!B*+.1*-!%+&!@13:3+.'*+E!?!0*6)1383+(':3!'662+'Z%.'*+!(.1%.397!.*!3-'6'+%.3!.1%+(6'(('*+!*>!83)%.'.'(!F!:'12(!'+>30.'*+!'+!
.83!V+'.3&!D.%.3(K!p30*663+&%.'*+(!*>!.83!?&:'(*17!B*66'..33!*+!_662+'Z%.'*+!@1%0.'03(!H?B_@J!@%1.!__K!_662+'Z%.'*+!*>!%&2-.(E!r*1,'&'.7!
%+&!r*1.%-'.7!j33l-7!p3)*1.<!MXXT<!hhHm*E!ppb"TJK"bMhE!
B3+.31(!>*1!W'(3%(3!B*+.1*-!%+&!@13:3+.'*+E!V)&%.3&!VD!@2,-'0!^3%-.8!D31:'03!92'&3-'+3(!>*1!.83!6%+%9363+.!*>!*002)%.'*+%-!3=)*(213(!.*!
^F]<!^B]<!%+&!^_]!%+&!130*663+&%.'*+(!>*1!)*(.!3=)*(213!)1*)87-%='(E!r*1,'&'.7!%+&!r*1.%-'.7!j33l-7!p3)*1.<!MXX"<!hXHm*E!ppb""JKM"bMfE!!
8..)KddkkkE0&0E9*:drrjpd)13:'3kdrrjp8.6-d11hX""%"E8.6!
F3-.1%6'!Ar!3.!%-E!s1%+(6'(('*+!*>!^_]!%+&!83)%.'.'(!B!:'12(!>1*6!%!+21('+9!8*63!)%.'3+.!.*!%!83%-.8!0%13!k*1l31E!?631'0%+!i*21+%-!*>!
_+>30.'*+!B*+.1*-<!MXXf<!f"HfJK"TRb"NhE!
^%21'!?r<!?16(.1*+9!S$<!^2.'+!qiE!s83!9-*,%-!,21&3+!*>!&'(3%(3!%..1',2.%,-3!.*!0*+.%6'+%.3&!'+`30.'*+(!9':3+!'+!83%-.8!0%13!(3..'+9(E!
_+.31+%.'*+%-!i*21+%-!*>!DsW!t!?_WD<!MXXg<!"hH"JKNb"TE!
@3117!i<!i%9931!iE!A@_m3.!&%.%!13)*1.K!'+`21'3(!>1*6!)8-3,*.*67!+33&-3(E!?&:%+03(!'+!A=)*(213!@13:3+.'*+<!MXXf<!THgJKgfbghE!
:!s1%+(6'(('*+!*>!83)%.'.'(!F!:'12(!%6*+9!)31(*+(!2+&319*'+9!,-**&!9-20*(3!6*+'.*1'+9!'+!-*+9C.316!0%13!>%0'-'.'3(!b!r'(('(('))'<!m*1.8!
B%1*-'+%!%+&!$*(!?+93-3(!B*2+.7<!B%-'>*1+'%<!MXXfbMXXgE!r*1,'&'.7!%+&!r*1.%-'.7!j33l-7!p3)*1.<!MXXg<!hgKMMXbMMfE!
W133(6%+!ir!3.!%-E!Y2.,13%l!*>!83)%.'.'(!F!'+!%!+21('+9!8*63!%((*0'%.3&!k'.8!0%)'--%17!,-**&!(%6)-'+9E!!A)'&36'*-*97!%+&!_+>30.'*+<!MXXT<!
"fgHhJK""XMb"""fE!
!
!
!
!
!
!
!
!
!
!
!
!