Safe Injection Practices SITUATION • • Confirmed patient-to-patient transmission of blood borne & other pathogens in US healthcare facilities Transmission have been linked to unsafe injection practices BACKGROUND • Past Decade, US > 35 reported outbreaks of viral hepatitis among patients • • • > 250 confirmed cases since 2008 Outbreaks linked to unsafe injection practices > 90,0000 patient notifications re: potential exposures to blood borne pathogens Mar 2012 BACKGROUND • • • Orthopedic clinic-DE 7 patients / 5 same procedure date All admitted to hospital for Rx of septic arthritis or bursitis • • 6 pts. and 1 HCW had MSSA w/ indistinguishable PFGE type Reuse of single-dose vials of bupivacaine for multiple patients Apr 2012 • • • Outpatient Pain Management clinic – AZ 3 patients / same procedure date • 1 Pt. developed MRSA mediastinitis & bacteremia 2 Epidural steroid injections / 1 stellate ganglion block • • Contrast medium drawn up in procedure room Change in vial size due to drug shortages • Unsafe injection practices place ASSESSMENT patients at risk • • Use of single-dose vials for multiple patients Contamination of multi-use vials & containers via reuse of needles/syringes • Other related consequences include: • • • Negative media Malpractice suits Disciplinary action by licensing boards ASSESSMENT • • Variable practices exist and may differ between health care facilities / settings Healthcare facilities MUST develop processes to • Assure policies/protocols set clear expectations • • • Assess existing practices Evaluate existing products Educate and train staff on safe injection practices RECOMMENDATIONS Assure policies/protocols set clear expectations Injection Practices 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Aseptic technique is used to avoid contamination of sterile injection equipment. Used syringes, needles and cannulas are discarded at the point of use in an approved sharps container immediately after use. Single-dose vials are used whenever possible and discarded immediately after use on a single patient. Medications are not administered from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae, and syringes are sterile, single-use items and should not be reused for another patient or to access a medication or solution that might be used for a subsequent patient. A syringe or needle/cannula is considered contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set. Medication is not prepared in one syringe to transfer to another syringe. A sterile syringe and needle/cannula is always used when entering a vial--never one that has been used on another patient. Vials are discarded 28 days after opening, unless specified by the manufacturer, or sooner if sterility is questioned or compromised. Multi-dose vials are not kept in the immediate patient treatment area and are stored in accordance with the manufacturer's recommendations. A needle, cannula, or spike device is never left inserted into a medication vial rubber stopper because it leaves the vial vulnerable to contamination. Fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) are used for one patient only and discarded appropriately after use. Bags or bottles of intravenous solution are not used as a common source of supply for multiple patients. Once IV solution bags have been spiked; administration must begin within 1 hour. All opened vials, IV solutions and prepared or opened syringes that were used in an emergency situation are discarded. RECOMMENDATIONS Assess Existing Practices TIPS • Include all settings where injections may be administered • Targeted audits/mock surveys • Annual IP Program Review RECOMMENDATIONS Evaluate Existing Products TIPS • Single dose vials whenever possible • If not possible, review alternatives • Use multi-dose vial as single-dose vial • Can Pharmacy support drawing doses in controlled setting (e.g. in pharmacy under laminar hood)? • Work closely with Pharmacy • Targeted audits/mock surveys RECOMMENDATIONS Educate and train staff on safe injection practices http://www.cdc.gov/injectionsafety/1anOnly.html References 1. CDC -The One & Only Campaign - Injection Safety 2. HICPAC. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. June 2007 3. Sue Dill Calloway. Safe Injection Practices Presentation. 2012 4. MMWR. Invasive Staphylococcus aureus Infections Associated with Pain Injections and Reuse of Single-Dose Vials — Arizona and Delaware, 2012. July 13, 2012 / 61(27);501-504 Questions for the CHAIN Gang??