Media reports of outbreaks and infections caused by unsafe injection practices in healthcare facilities especially in outpatient settings seem to confirm the Centers for Disease Control and Prevention (CDC) statistics that since 1999, more than 125,000 U.S. patients have received letters alerting them of potential exposure to infection with hepatitis viruses or human immunodeficiency virus (HIV) due to unsafe injection practices such as the reuse of syringes.
And in a little more than a decade, the lack of adherence to safe injection practices by healthcare professionals has resulted in more than 30 outbreaks of viral hepatitis and other healthcare-acquired infections (HAIs) in the U.S. For example, a patient notification resulting from unsafe injection practices at an endoscopy clinic in Las Vegas in 2008 required health officials to alert more than 50,000 patients who had been potentially exposed to bloodborne pathogens. This patient notification, response and testing is estimated to have cost between $16 million and $21 million.
To address these alarming trends, the CDC and the Safe Injection Practices Coalition (SIPC) has launched the "One & Only Campaign," a public health initiative to help raise awareness among patients and healthcare providers about safe injection practices, and to eradicate outbreaks resulting from unsafe practices, including reusing single-use medical devices. According to organizers, the goal of the One & Only Campaign is to ensure patients are protected every time they receive a medical injection, and that this can be attained by empowering patients and re-educating healthcare professionals about safe injection practices. Creating and strengthening a culture of patient safety is critical, and campaign organizers emphasize that focus on the message behind the slogan, "One Needle, One Syringe, Only One Time" can be an important driver for proper clinical behavior during injections.
The campaign is currently being piloted in Nevada and New York, states that have experienced significant outbreaks linked to unsafe injection practices in recent years. Upon completion of these state pilot campaigns, the One & Only Campaign will expand to additional states and eventually nationwide, according to organizers. This effort is complimented by the launch of a new educational video from the SIPC for healthcare providers that imparts a 10-minute lesson on safe injection practices.
The video targets the educational needs of individuals who regularly administer or supervise injections; it addresses their responsibility to protect patients from HAIs and promotes evidence-based, common-sense safe injection practices from the CDC. The video demonstrates situations where injections are administered, and also dispels common misperceptions, such as the belief that it is safe to administer medication from single-dose vials to multiple patients. "One infection due to unsafe injection practices is unacceptable," says Michael Bell, MD, deputy director for infection control at CDC and narrator of the video. "Every healthcare provider has the responsibility to ensure that all injections given to patients are safe, and we hope that this video will help make that happen."
Helping to drive the campaign and appearing in the video is SIPC member Evelyn McKnight, AuD, president and co-founder of the Hepatitis Outbreaks National Organization for Reform (HONOReform) Foundation. McKnight was battling a recurrence of breast cancer when she became one of 99 Nebraska cancer patients to be infected with hepatitis C virus because healthcare professionals reused syringes to access a shared bag of saline.
"By addressing the urgent need for education and heightened awareness about safe injection practices, we hope to avoid further tragedies," says McKnight. "Through this and other Coalition-led educational activities, we hope to make outbreaks due to syringe reuse 'never' events. No patient should ever have to worry about contracting a disease while seeking medical care or treatment."
McKnight says that the most important message about safe injection practices that she wants healthcare providers to understand is that "It is never acceptable to reuse disposable medical equipment intended for one-time use (e.g., syringes, IV tubing, needles), even on the same patient," she says. The question is, do healthcare providers lack safe injection-practice knowledge or do they simple ignore protocol? "I believe that medical professionals were taught proper injection practices when they were in training but for a number of reasons (workload pressure, improper instruction by supervisors, etc) adopt shortcuts such as reusing syringes that endanger patients," McKnight says. "Healthcare professionals who reuse syringes may believe that because they have changed the needle, the injection is safe. They have not thought through the likelihood of contamination of the syringe."
McKnight says that key stakeholders can play an important role in promoting safe injection practices. "I encourage manufacturers to design injection systems that utilize safety design to eliminate human error from injection practices. And I encourage hospitals infection preventionists to provide proactive training to clinical staff on safe injection practices on a regular basis."
The SIPC points to recent investigations undertaken by state and local health departments and the CDC that have identified improper use of syringes, needles and medication vials during routine procedures such as administering injections. These practices have resulted in transmission of bloodborne viruses, including hepatitis C virus, to patients; notification of thousands of patients of possible exposure to bloodborne pathogens and recommendation that they be tested for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV; referral of providers to licensing boards for disciplinary action; and malpractice suits filed by patients.
The SIPC says these unfortunate events "serve as a reminder of the serious consequences of failure to maintain strict adherence to safe injection practices during patient care." The organization urges healthcare professionals to carefully review their infection control practices and should ensure that staff:
-- Never administer medications from the same syringe to more than one patient, even if the needle is changed
-- Do not enter a vial with a used syringe or needle
HCV, HBV and HIV can be spread from patient to patient when these simple precautions are not followed. Additional protection is offered when medication vials can be dedicated to a single patient. The SIPC reminds healthcare professionals it is critical that:
-- Medications packaged as single-use vials never be used for more than one patient
-- Medications packaged as multi-use vials be assigned to a single patient whenever possible
-- Bags or bottles of intravenous solution not be used as a common source of supply for more than one patient
-- Absolute adherence to proper infection control practices be maintained during the preparation and administration of injected medications
The SIPC has created free posters and brochures for use in healthcare institutions; visit www.oneandonlycampaign.org/.