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

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