Health Advisory
INFECTION PREVENTION IN OUTPATIENT SETTINGS:
SAFE INJECTION PRACTICES

The Division of Public Health is currently working with the Centers for Disease Control (CDC) to investigate the source of bacterial infection in a group of patients following anesthetic injections from a Delaware health care provider. Some of the patients had to be admitted to the hospital due to the infections. This communication serves to remind providers that single-use vials are intended for single use only and typically lack any antimicrobial preservative to help prevent the growth of potential contaminating bacteria.

Background

Over the past several decades, there has been a shift in healthcare delivery from the acute, inpatient hospital setting to a variety of ambulatory care settings. Vulnerable patient populations rely on frequent and intensive use of ambulatory care to maintain or improve their health. It is critical that this care be provided under conditions that minimize or eliminate risks of healthcare-associated infections.

All healthcare settings, regardless of the level of care provided, must be equipped to observe Standard Precautions.  Standard Precautions include: 1) hand hygiene, 2) use of personal protective equipment, 3) safe injection practices, 4) safe handling of potentially contaminated equipment or surfaces in the patient environment, and 5) respiratory hygiene/cough etiquette.

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 during preparation and administration of parenteralmedications.

Unsafe practices that have led to outbreaks and patient harm include 1) use of a single syringe, with or without the same needle, to administer medication to multiple patients, 2) reinsertion of a used syringe, with or without the same needle, into a medication vial or solution container to obtain additional medication for a single patient and then using that vial or solution container for subsequent patients, 3) preparation of medications in close proximity to contaminated supplies or equipment, 4) inappropriate use of single/multi-dose vials.

Key Recommendation for Safe Injection Practices in Ambulatory Care Settings

1. Use aseptic technique when preparing/administering medication.
2. Cleanse the access diaphragms of medication vials with 70% alcohol before inserting a device into the vial.
3. Never administer medications from the same syringe to multiple patients, even if the needle is changed or the injection is administered through an intervening length of intravenous tubing.
4. Do not reuse a syringe to enter a medication vial or solution.
5. Do not administer medications from single-dose, ampoules, or bags of intravenous solution to more than one patient.
6. Do not use fluid infusion or administration sets for more than one patient.
7. Dedicate multi-dose vials to a single patient whenever possible. If multi-dose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area.
8. Dispose of used syringes and needles at the point of use in a sharps container that is closable, puncture-resistant, and leak-proof.
9. Adhere to federal and state requirements for protection of healthcare providers from exposure to bloodborne pathogens.

Additional Information:

For more specific information, call DPH Bureau of Epidemiology 1-888-295-5156 or refer to the following websites:

• Questions about Single-dose/Single –use Vials
  http://www.cdc.gov/injectionsafety/providers/provider_faqs_singlevials.html
• Questions about Multi-dose Vials
  http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html
• Safe Injection Practices to Prevent Transmission of Infections to Patients
  http://www.cdc.gov/injectionsafety/IP07_standardPrecaution.html
• Injection Safety – Information for Providers
  http://www.cdc.gov/injectionsafety/providers.html
• Injection Safety – FAQ Regarding Safe Practices for Medical Injections
  http://www.cdc.gov/injectionsafety/providers/provider_faqs.html
• Guide to Infection Prevention for Outpatient Settings
  http://www.cdc.gov/HAI/pdfs/guidelines/standatds-of-ambulatory-care-7-2011.pdf
• Infection Prevention Checklist for Outpatient Settings
  http://www.cdc.gov/HAI/pdfs/guidelines/ambulatory-care-checklist-07-2011.pdf
• Medscape CME Activity:  Unsafe Injection Practices: Outbreaks, Incidents, and Root Causes
  http://www.medscape.org/viewarticle/745695

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