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APIC position paper: Safe injection, infusion, and medication vial practices in health care

https://doi.org/10.1016/j.ajic.2010.01.001Get rights and content

Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings.

Section snippets

Aseptic technique: in less than an ISO 5 environment

  • Perform hand hygiene (handwashing with soap and water or by application of a 60% or greater alcohol-based (In the United States, the alcohol component is predominantly ethyl alcohol (ethanol) or isopropyl alcohol.) hand sanitizer rub that is allowed to dry) before accessing supplies, handling vials and IV solutions, and preparing or administering medications.

  • Use aseptic technique in all aspects of parenteral medication administration, medication vial use, injections, and glucose monitoring

IV solutions

  • Never use IV solution containers (eg, bags, bottles) to obtain flush solutions or for any other purpose for more than 1 patient.

  • Never use infusion supplies, such as needles, syringes, flush solutions, administration sets, or IV fluids, on more than 1 patient.

  • Prepare IV solutions and medications as close to administration as feasible. The time frame that can be allowed between the preparation and initiation of the administration of non-nutrient IV solutions that have been spiked or have had

Flushing

  • Use single-dose containers for flush solutions, whenever possible.

  • If a multi-dose vial must be used, use it for only 1 patient and then discard it. Each entry into the multi-dose vial (dedicated to that patient) must be made with a new, unused sterile needle and new, unused sterile syringe.

Syringes

  • Remove the sterile needle/cannulas and/or syringe from the package immediately before use.

  • Never use a syringe for more than 1 patient even if the needle has been changed between patients. Changing the needle but not the syringe is unacceptable.

  • Use a new syringe and a new needle for each entry into a vial or IV bag.

  • Utilize sharps safety devices whenever possible.

  • Discard syringes, needles, and cannulas after use directly on an individual patient or in an IV administration system.

  • Dispose of used

Vials

  • Always follow the manufacturer's instructions for storage and use.

  • Use single-use or single-dose vials whenever possible.

  • Always use a new sterile syringe and new needle/cannula when entering a vial. Never enter a vial with a syringe or needle/cannula that has been previously used (eg, to inject a patient or access a medication vial).

  • Cleanse the access diaphragm of vials using friction and a sterile 70% isopropyl alcohol,14, 17 ethyl alcohol, iodophor,17 or other approved antiseptic swab. Allow

Blood glucose monitoring devices

  • Assign a glucometer to each individual patient if possible. Clean and disinfect glucometers if they must be shared between multiple patients.

  • Restrict the use of finger stick capillary blood sampling devices to individual patients.

  • Maintain supplies and equipment, such as finger stick devices and glucometers, within individual inpatient rooms, if possible.

  • Use single-use lancets that permanently retract after puncture.

  • Never reuse finger stick devices and lancets. Dispose of them at the point of

HCW

  • Provide the HBV vaccination series to all previously unvaccinated health care personnel whose activities involve contact with blood or body fluids.19

  • Check and document postvaccination titers 1 to 2 months after completion of the vaccination series.19

  • Immediately report body fluid exposures and needlestick/sharps injuries.

  • Ensure that staff preparing or administering injections or other parenteral medications are competent to perform these tasks aseptically.

  • Periodically assess compliance with safe

Conclusion

The use of safe injection practices is critical to prevent microbial contamination of products administered to patients. The ongoing reports of HBV and HCV transmission to patients and ongoing outbreaks of bacterial infections29, 30, 31 indicate that much more is needed to ensure that these preventive practices are being scrupulously followed in all health care settings. HCWs and their managers must understand and practice these procedures safely. Administrators of medical facilities must be

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    Conflicts of interest: None to report.

    Address correspondence to Denise Graham, APIC (Association for Professionals in Infection Control and Epidemiology), 1275 K St, Suite 1000, Washington, DC 20005-4006. E-mail: [email protected]

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