3 Myths About Safe Injection Practices

Myths about how to safely inject medications are pervasive among healthcare providers and threaten patient safety, Joseph Perz, the leader of the Centers for Disease Control's Division of Healthcare Quality Promotion said last week in a campaign to educate providers.

In an incident that came to light just two weeks ago, children in Colorado were exposed to reused syringes when receiving flu vaccinations in an outpatient pediatric clinic. Dozens of families received letters telling them that their child should be tested for bloodborne viruses such as Hepatitis C and HIV, Perz said. "It's completely unnecessary. Safe injection practices are something that we should all be able to take for granted, and the healthcare system should be able to guarantee."

Perz made his comments during a briefing for providers with officials from Children's Hospital in Denver, the Safe Injection Practices Coalition, the Association for Professionals in Infection Control and Epidemiology, and Premier Healthcare Alliance.

His remarks came on the heels of the release of a Premier survey conducted in May and June last year, indicating that of 5,446 provider respondents, the following engage in unsafe injection practices:

• 6% sometimes or always use single-dose/single-use vials for more than one patient
• 9% sometimes or always reuse a syringe but change the needle for a second patient
• 15.1% reuse a syringe to enter a multidose vial
• 6.5% save that vial for use on another patient.

Perz said that in the last 10 years, studies have identified 33 outbreaks of infectious diseases such as Hepatitis C, and the need to notify more than 125 families who may have been harmed.

"We caution that this is probably just the tip of the iceberg because there are so many issues with detection bias and lack of sensitivity in terms of actually picking up an outbreak and having it reported to the health department and investigated fully," he said. "Many hepatitis cases are, unfortunately, unexplained, and it's an issue that we need to get ahead of."

Perz outlined three myths that he says are pervasive among providers, highlighting the urgent need for education.

1. Contamination of injection devices is limited to the needle.

"This is a technology that's over a century old, but there's a perception that the needle becomes contaminated when used on a patient, but there's the lack of awareness that the needle and syringe are one unit. Removing a needle does not make the syringe safe for use, and in fact, that's a very, very dangerous practice."

2. The presence of some intravenous tubing or a valve prevents backflow and contamination of injection devices. "That's always false. We need to consider everything, from the needle and syringe or the medication bag all the way to the patient as a single, interconnected unit, and take great caution to avoid any temptation to reuse syringes in that context."

3. If there's no blood, there's no risk. "People forget that germs are not visible to the naked eye. We've unfortunately have encountered situations where healthcare workers thought they somehow had a sterile field because they were injecting through a short length of IV tubing and only saw clear fluid. That's another dangerous myth."

He added that needles and syringes should always be thought of as single-use devices, never used for more than one patient or reused to draw up medication. Healthcare workers should not administer medications from a single dose vial or IV bag to multiple patients and multi-dose vials should be eliminated or dedicated to single patients whenever possible.

Susan Dolan, epidemiologist with the Children's Hospital in Denver, said safe medication use is tougher for some hospitals that may be resource-strapped.

"Cost becomes a huge barrier. If It's cheaper to have a multi-dose vial versus a single dose vial and throwing unused medication away, that's a hard thing in this culture of being green and saving and trying to do more with less," she said. "Larger facilities are funded and have resources to help with these efforts, but when care moves out to these alternative care settings, that's where perhaps there aren't infection preventionists and there may be care providers who may not be aware of these issues, that's where some of our bigger challenges happen."

Perz said that enforcement is becoming a more important component. "We've heard from people with the Centers for Medicare & Medicaid Services and the Joint Commission as to how they are more carefully reviewing infection practices as part of infection control and basic safety assessments when facilities are inspected," he said. "However, not all healthcare facilities in the U.S. are subject to that kind of review and oversight. So it's important to rely on educational outreach to get the message out."

The coalition makes numerous recommendations, including efforts to conduct better education of providers, develop medical tools that use "safety-by-design" concepts that make impossible or difficult to use the device unsafely, and evaluate safer practices and safety signals.