Patients receiving an injection don’t expect to leave the hospital or clinic with a newly acquired infection, like hepatitis, yet that’s been happening with alarming frequency – and the culprit may surprise you.
The CDC has identified the misuse of multi-use drug vials as the cause of at least 19 widespread infection outbreaks since 2007. These outbreaks involved both viral and bacterial pathogens, and they occurred both in hospitals and in outpatient settings like pain clinics, chemotherapy centers, etc. Going back even farther, to 2001, the CDC reports that over 150,000 patients had to be notified that they may have been exposed to a bloodborne pathogen after receiving an injection or infusion from a potentially contaminated source. This is, indeed, cause for alarm.
In response to a growing concern that multi-use vials are being used in unsafe ways that can spread infection, the Joint Commission issued a Sentinel Event Alert on June 16, 2014. It is called “Preventing Infection from the Misuse of Vials.” The CDC has also created its One and Only Campaign, which includes a variety of resources to help providers refresh their knowledge of vial use standards.
As a nurse, you are on the frontline of care. You’re in the best position to keep patients safe, so it’s important that you familiarize yourself with this alert through the link provided above (it will allow you to download a PDF). You should also re-familiarize yourself with the protocols established by your employer’s infection control team, and always speak up if you see another provider breaking protocol.
As always, the number one thing you should know about injection safety is that needles and syringes are always single-use devices – you should never put a used needle back into a vial to draw up additional medication. And it goes without saying that you should never stick a patient with a used needle. Most likely you don’t have to be reminded of this cardinal rule. Providers seem to be paying less attention to vials, however, and how they should be used.
What you should know about single-use vials
If a vial is not clearly labeled as being meant for multiple-use, you should assume it is a single-use vial. The basic rule is this: use a single-use vial for a single patient during the course of a single procedure. Never administer medication from single-use vial or IV bag to multiple patients, no matter how much is left in the vial. You may be tempted to disregard this rule because you’re trying to avoid waste, especially if there are medication shortages where you work – don’t give in to this temptation.
Single-use vials do not contain preservatives or agents to prevent the growth of microbes, so once the rubber diaphragm has been punctured they must be used or discarded within an hour in most settings.
There may be a rare occasion, when you’re titrating a dose for example, when you need to enter a single-use vial more than once during a single procedure on a single patient. Use a new needle and new syringe for each entry, and then discard the vial, no matter how much is left in it. (Never combine the leftover contents of single-use vials.)
What you should know about multi-use vials
The CDC recommends limiting the use of multi-use vials in order to reduce the risk of contaminated medications being injected into patients. It also states that a multi-use vial should be dedicated to a single patient wherever possible.
Once the rubber diaphragm has been punctured, a multi-use vial should be assigned a use-by date that is no more than 28 days in the future, unless the manufacturer’s guidelines say otherwise.
Before each use, providers must also remember to rub the vial top vigorously with alcohol for 15 seconds and allow it to dry before puncturing. Again, use a new needle and new syringe for each entry.
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