The potential adverse effects of unsafe injection practices are not typically seen immediately, but can have catastrophic consequences for patients and for providers, says The Joint Commission.
The Joint Commission, in its latest Sentinel Event Alert, is warning healthcare providers that serious blood-borne and bacterial infections are among the consequences of misusing single-dose/single-use and multiple-dose vials.
Thousands of patients have been adversely affected by misuse of contaminated vials, The Joint Commission reports. It cites information from the Centers for Disease Control, which has tracked at least 49 outbreaks since 2001 due to incorrectly administered injectable medical products. Of those, 21 involved the transmission of hepatitis B or C; the other 28 were outbreaks of bacterial infections.
Since 2007, nineteen outbreaks have been caused by the misuse of single-dose vials. Seven were blood-borne pathogen infections; 12 were bacterial infections. All outbreaks occurred in outpatient settings; eight were in pain remediation clinics.
Another recent study by the CDC and Centers for Medicare & Medicaid Services found that two-thirds of ambulatory surgical centers had lapses in basic infection control practices. Twenty eight percent of those surgical centers also reused single-dose vials on multiple patients.
A major contributing factor to the misuse of vials is widespread lack of adherence to safe injection practices. For example, the misuse of vials frequently involves healthcare workers reusing single-dose vials. As single-dose vials usually lack preservatives, they can easily foster bacterial growth between uses.
A recent survey of 5,446 healthcare practitioners found that:
- 6% admitted to sometimes or always using single-use vials on multiple patients.
- 15% admitted to reusing syringes to re-enter a multiple-use vial numerous times for the same patient.
- 6.5% of those who admitted reusing syringes admitted to saving multiple-use vials for use on other patients.
- Half of the 51 healthcare professionals who reported reusing syringes with multiple-use vials in multiple patients were in hospital settings.
Another cause of infections linked to improper administration of injectable medications is the nurse, physician, or technician who is opioid-addicted.
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Sometimes the urge to re-use vials can be prompted by medication and supply shortages and high costs. But any savings achieved by reusing these products would be outweighed by other costs if even one patient develops an adverse clinical reaction to them, The Joint Commission maintains.
Of the known victims of these preventable outbreaks, many required prolonged, sometimes life-long, follow-up care. Some died. The costs of caring for these patients and containing an outbreak can be crippling to an organization. Furthermore, providers found to have caused harm can expect to face significant legal ramifications and disciplinary action.
Tips for Clinician Leaders
The CDC's One & Only Campaign, which aims to raise awareness of safe injection practices among healthcare workers, offers specific tips for managers. These include
- Ensuring that there are enough supplies on hand to ensure safe injections
- Providing a medication preparation area that is separate from the patient care area
- Arranging for infection control training
The Joint Commission urges staff to always follow safe injection practices, including correct aseptic technique, hand hygiene, and one-time only use of needles and syringes. It also urges medical professionals to discard single-use vials after one use.
If a single-use vial must be entered multiple times, a new needle and syringe should be used for each entry, TJC recommends. Also, the unused contents of multiple opened single-use vials should never be combined, and opened single-use vials should never be stored for later use.
Multiple use vials should be confined to use by a single patient whenever possible to avoid contamination, and a fresh needle and syringe should be used for each entry.
The Joint Commission also urges the education of patients and caregivers who use injectable medical products as part of a home health regimen and the creation of a culture in all care settings where staff feel prepared to report errors, near misses and adverse events.
Lena J. Weiner is an associate editor at HealthLeaders Media.