SAFE INJECTION PRACTICESAFE INJECTION PRACTICE

Sources: CDC, One and Only Campaign, www.southernnevadahealthdistrict.org

What is Injection Safety?Injection safety includes practices intended to

prevent transmission of infectious diseases between one patient and another, or between a

patient and healthcare provider, and also to prevent harms such as needlestick injuries

A safe injection does not harm the recipient, does not expose the provider to any risks and does not

result in waste that is dangerous for the community

Safe Injection Practices The CDC recommends the following apply to theuse of needles, cannulas that replace needles, and, where applicable intravenous delivery system1. Use aseptic technique to avoid contamination of

sterile injection equipment2. Do not administer medications from a syringe to

multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulas, and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient.

Safe Injection Practices 3. Use fluid infusion and administration sets (i.e.

intravenous bags, and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag or administration set.

4. Use single-dose vials for parental medications whenever possible

5. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use.

Safe Injection Practices 6. If multi-dose vials must be used, both the needle

or cannula and syringe to access the multi-dose vial must be sterile.

7. Do not keep multi-dose vials in the immediate patient treatment area and store in accordance with the manufacturer’s recommendations; discard if sterility is compromised or questionable.

8. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.

Why follow Safe Injection Practices?Why follow Safe Injection Practices?• Safe injection practices are a set of measures to

perform injections in an optimally safe manner for patients.

• In the last decade, more than 150,000 patients in the United States were advised to get tested for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV due to the reuse of syringes and misuse of medication vials.

Why follow Safe Injection Practices?Why follow Safe Injection Practices?• CDC reports 35 outbreaks of viral hepatitis

acquired by the action of healthcare providers between 2008 - 2012. Of these 33 (94%) occurred in a non-hospital setting.– Hepatitis B (total 19 outbreaks, 153 outbreak

associated cases, > 10,000 persons notified for screening

– Hepatitis C (total 16 outbreaks, 160 outbreak associated case, > 90,000 at-risk persons notified for screening)

Why follow Safe Injection Why follow Safe Injection Practices?Practices?

• In ASC, single specialty endoscopy clinics, there were 9 outbreak associated infections and over 60,000 people were tested for hepatitis and HIV. There were an additional 106 infections that could have been linked to these centers.

• 1% to 3% of healthcare providers reuse the same needle and/or syringe on multiple patients.

How Does it Happen???How Does it Happen???

Understanding the basics of TransmissionUnderstanding the basics of Transmission

TRANSMISSION OF PATHOGENS VIA CONTAMINATED EQUIPMENT OR MEDICATIONS

SOURCEInfectious person,e.g. chronic, acute

CASESusceptible,

non-immune person

CONTAMINATED EQUIPMENT OR

MEDICATION

Some of the incorrect practices Some of the incorrect practices that have resulted in transmissionthat have resulted in transmission• Using the same syringe to administer medications to

more than one patient, even if the needle was changed• Using a common bag of saline or other IV fluid for more

than one patient, and – Leaving an IV set in place for dispensing fluid– Accessing the bag with a syringe that has already been used

to flush a patient’s IV or catheter

• Accessing a shared medication vial with a syringe that has already been used to administer medication to a patient

PREVENTIONPREVENTION• Healthcare providers should not provide any

avenue for transmission of bloodborne viruses• Entirely preventable

– Standard Precautions / Aseptic Technique• Aseptic techniques for handling parenteral medications,

administering injections, and sampling blood• Use aseptic technique to avoid contamination of sterile

injection equipment

• Use single-dose vials for parenteral medications, whenever possible

SIZE DOES NOT MATTER

SIZE DOES NOT MATTER

SDVs and MDVs can come in any shape and size. Do not assume that a vial is an SDV or MDV based on size and volume of medication. ALWAYS check the label !!!

Source: www.southernnevadahealthdistrict.org

Single Dose Vials (SDV)Single Dose Vials (SDV)• A single dose vial (SDV) is approved for a

single procedure or injection• SDVs typically lack an antimicrobial

preservative. Do not save leftover medications from these vials. Harmful bacteria can grow and infect a patient.

• DISCARD AFTER EVERY USE!

Multiple-Dose Vial (MDV)Multiple-Dose Vial (MDV)• A multiple-dose vial (MDV) is recognized by it’s FDA-

approved label. • Although MDVs can be used for more than one patient

when aseptic technique is followed, ideally even MDVs are used for only one patient.

• MDVs typically contain an antimicrobial preservative to help limit the growth of bacteria. The preservatives have no effect on bloodborne viruses.

• Discard MDVs when the beyond-use date has been reached or any time the sterility of the vial is in question.

READ THE LABEL !

READ THE LABEL !

PREVENTIONPREVENTION• Needles, cannulae and syringes are sterile, single-use

items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient

• If you are using a SDV and it has already been accessed (e.g. needle puncture) throw it away

• If it is MDV, double check the expiration date and visually inspect to ensure there is no visual contamination.

• When in doubt, throw it out!When in doubt, throw it out!

PREVENTIONPREVENTION• Use a new needle and syringe for every

injection• Be sure to clean your hands immediately

before handling any medication• Disinfect the medication vial by rubbing the

top with alcohol before drawing up medication

• Draw up the medication on a clean surface.

REALIZE WHAT IS AT STAKEREALIZE WHAT IS AT STAKE

• A person’s life and well-being• Business license• Professional license or certification• Accreditation status

Example right here at homeExample right here at homeOklahoma Pain Remediation Clinic• Anesthetist filled single syringe with sedation

medication to treat up to 24 sequential patients– Medication administered though heparin locks

• Look back investigation for entire two year time period of clinic operation– Serologic results for 795/908 (88% patients)

• 71 (9%) clinic-associated HCV infections• 31 (4%) clinic-associated HBV infections

• US $25 million settlement

Oklahoma State Dept. of Health