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Use 1 needle and 1 syringe only 1 time, on 1 patient. Sounds simple enough, but continued reports of patients contracting hepatitis from caregivers who failed to switch to a fresh syringe or medication vial tell us that many still misunderstand this basic principle of injection safety. Here are 4 misperceptions about safe injection practices that researchers have identified through interviews with providers and investigations of outbreaks.
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Outpatient Surgery Reader Survey: Have You Ever Reused a Single-Dose Medication Vial? |
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Have you ever used a single-dose medication vial multiple times? More than three-fourths (77%) of the facility managers who answered our online poll last month admitted to doing so, a clear violation of new infection control guidelines. Yes: 77%
SOURCE: Outpatient Surgery Magazine Instapoll, August 2010, n=190 |
Myth #1 Contamination of injection devices is limited to the needle, therefore removing the needle makes the syringe safe for reuse.
Truth Once they're used, both the syringe and the needle are contaminated and must be discarded. A new sterile needle and a new sterile syringe should always be used for each patient and to access medication vials.
Myth #2 IV tubing or valves can prevent backflow and contamination of injection devices.
Truth Everything from the medication bag to the patient's IV catheter is a single interconnected unit. Distance from the patient, gravity or even infusion pressure do not ensure that small amounts of blood won't contaminate the supply.
Myth #3 If you don't see blood in the IV tubing or injection equipment, then there is no risk of cross-contamination.
Truth Pathogens including hepatitis C virus, hepatitis B and HIV can be present in sufficient quantities to produce infection without any visible blood.
Myth #4 Single-use or single-dose vials with large volumes that appear to contain multiple doses can be used for more than 1 patient.
Truth ?Single-use or single-dose vials shouldn't be used for more than 1 patient, regardless of the vial size.
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Study Finds Infection Control Lapses in Two-Thirds of ASCs |
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After the 2008 hepatitis C outbreak at the Nevada endoscopy center, the Centers for Disease Control and Prevention (CDC) developed an infection control audit tool based upon nationally recognized, evidence-based guidelines to help inspectors and providers better assess infection control practices in ASCs. The audit tool, with which you may now be familiar if you're an ASC administrator complying with CMS' conditions for coverage, focuses on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment. A pilot study of the new tool conducted at 68 ASCs in 3 states identified infection control lapses in two-thirds of the facilities. More than half of the pilot ASCs were cited for deficiencies in infection control and 29% were cited for deficiencies related to medication administration. The percentage of inspections with deficiencies related to infection control during the pilot was more than 6 times greater than the percentage of inspections with deficiencies reported to CMS nationally the year before. Common lapses included using single-dose medication vials for more than 1 patient (28%) and improperly handling blood glucose monitoring equipment (46%). For example, 21% of facilities that performed blood glucose monitoring reused the same lancing penlet device for multiple patients — a serious safety lapse that has been linked to hepatitis B virus transmission in long-term care settings. For more results of the study, published in the June 14 issue of the Journal of the American Medical Association, go to www.jama.ama-assn.org/cgi/content/short/303/22/2273. — Kristin Brinsley-Rainisch, MPH |
Getting the message across
In the recent pilot of a new CMS/CDC infection control audit tool (see "Study Finds Infection Control Lapses in Two-Thirds of ASCs"), surveyors found infection control lapses related to injection safety, like the use of single-dose vials for multiple patients, to be common at ASCs. In light of those findings, all surgical facilities, whether freestanding, office- or hospital-based, should reexamine their own practices to make sure they understand the nuances of injection safety and aren't placing patients at risk. To better inform your staff, check out this educational video from the Safe Injection Practices Coalition (www.oneandonlycampaign.org/videos), which describes mistakes providers might make while preparing and administering injections and debunks dangerous misperceptions about injection safety.
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