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Safe Injection
Practices
SITUATION
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Confirmed patient-to-patient
transmission of blood borne
& other pathogens in US healthcare
facilities
Transmission have been linked to
unsafe injection practices
BACKGROUND
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Past Decade, US
> 35 reported outbreaks of viral
hepatitis among patients
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> 250 confirmed cases since 2008
Outbreaks linked to unsafe injection
practices
> 90,0000 patient notifications re:
potential exposures to blood borne
pathogens
Mar 2012
BACKGROUND •
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Orthopedic clinic-DE
7 patients / 5 same procedure date
All admitted to hospital for Rx of septic
arthritis or bursitis
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6 pts. and 1 HCW had MSSA w/ indistinguishable
PFGE type
Reuse of single-dose vials of bupivacaine
for multiple patients
Apr 2012
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Outpatient Pain Management clinic – AZ
3 patients / same procedure date
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1 Pt. developed MRSA mediastinitis &
bacteremia
2 Epidural steroid injections / 1 stellate
ganglion block
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Contrast medium drawn up in procedure
room
Change in vial size due to drug shortages
• Unsafe injection practices place
ASSESSMENT
patients at risk
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Use of single-dose vials for multiple
patients
Contamination of multi-use vials &
containers via reuse of
needles/syringes
• Other related consequences
include:
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Negative media
Malpractice suits
Disciplinary action by licensing
boards
ASSESSMENT
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Variable practices exist and may
differ between health care facilities
/ settings
Healthcare facilities MUST develop
processes to
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Assure policies/protocols set clear
expectations
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Assess existing practices
Evaluate existing products
Educate and train staff on safe injection
practices
RECOMMENDATIONS
Assure policies/protocols set clear expectations
Injection Practices
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Aseptic technique is used to avoid contamination of sterile injection equipment.
Used syringes, needles and cannulas are discarded at the point of use in an approved sharps container immediately after
use.
Single-dose vials are used whenever possible and discarded immediately after use on a single patient.
Medications are not administered from a syringe to multiple patients, even if the needle or cannula on the syringe is
changed.
Needles, cannulae, and syringes are sterile, single-use items and should not be reused for another patient or to access a
medication or solution that might be used for a subsequent patient.
A syringe or needle/cannula is considered contaminated once it has been used to enter or connect to a patient's
intravenous infusion bag or administration set.
Medication is not prepared in one syringe to transfer to another syringe.
A sterile syringe and needle/cannula is always used when entering a vial--never one that has been used on another
patient.
Vials are discarded 28 days after opening, unless specified by the manufacturer, or sooner if sterility is questioned or
compromised.
Multi-dose vials are not kept in the immediate patient treatment area and are stored in accordance with the
manufacturer's recommendations.
A needle, cannula, or spike device is never left inserted into a medication vial rubber stopper because it leaves the vial
vulnerable to contamination.
Fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) are used for one patient only and
discarded appropriately after use.
Bags or bottles of intravenous solution are not used as a common source of supply for multiple patients.
Once IV solution bags have been spiked; administration must begin within 1 hour.
All opened vials, IV solutions and prepared or opened syringes that were used in an emergency situation are discarded.
RECOMMENDATIONS
Assess Existing Practices
TIPS
• Include all settings
where injections may
be administered
• Targeted audits/mock
surveys
• Annual IP Program
Review
RECOMMENDATIONS
Evaluate Existing Products
TIPS
• Single dose vials whenever
possible
• If not possible, review
alternatives
• Use multi-dose vial as single-dose vial
• Can Pharmacy support drawing doses in
controlled setting (e.g. in pharmacy under
laminar hood)?
• Work closely with
Pharmacy
• Targeted audits/mock
surveys
RECOMMENDATIONS
Educate and train staff on safe injection practices
http://www.cdc.gov/injectionsafety/1anOnly.html
References
1. CDC -The One & Only Campaign - Injection
Safety
2. HICPAC. 2007 Guideline for Isolation
Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings.
June 2007
3. Sue Dill Calloway. Safe Injection Practices
Presentation. 2012
4. MMWR. Invasive Staphylococcus aureus
Infections Associated with Pain Injections
and Reuse of Single-Dose Vials — Arizona
and Delaware, 2012. July 13, 2012 /
61(27);501-504
Questions for the CHAIN Gang??