In 2009, an assessment of injection practices in Fumeng County (Liaoning Province) and Wulong County (Chongqing Municipality) (random sample of 29 hospitals, 40 village clinics and 400 villagers) was conducted and the results were compared with a prior 2001 assessment (same area, same WHO assessment tool). In 2009, all facilities in Fumeng and Wulong used new, disposable syringes compared with 34% in both counties in 2001. Moreover, 59% (95% CI 37-80%) and 74% (95% CI 55-94%) of providers in Fumeng and Wulong, respectively, collected used sharps safely compared with 33% (95% CI 20-45%) and 36% (95% CI 20-53%) in 2001. In Fumeng and Wulong, respectively, 5% (95% CI 0-15%) and 50% (95% CI 25-76%) of facilities discarded injection devices in the regular trash compared with 7% (95% CI 2-12%) and 64% (95% CI 47-80%) in 2001. Between 2001 and 2009, the annual average number of injections per person increased from 1.8 to 6.3 (95% CI 4.5-8.1) in Fumeng and was stable [3.4 and 3.1 (95% CI 1.9-4.3)] in Wulong. Overall, between 2001 and 2009, sterilisable injection devices disappeared and disposal practices improved. However, unsafe practices persisted, which should be improved. Use of injections to administer medications may be increasing and must be reduced.