Although the majority of U.S. healthcare professionals are following recommended safe injection practices, some are putting patients at risk through the reuse of syringes and single-dose vials, according to a peer-reviewed study authored by the Premier healthcare alliance in the December issue of the American Journal of Infection Control.
Increasing reports of outbreaks of hepatitis B and C viruses and bacterial infections more than 50 outbreaks nationwide have resulted in infections in hundreds of patients and more than 100,000 have potentially been exposed. The majority of these outbreaks resulted from unsafe injection practices and lapses in basic infection control and aseptic technique.
Premier surveyed 5,500 U.S. healthcare professionals to gain a fuller understanding of current injection practice patterns and to guide outreach, education and prevention efforts. Results showed that:
- Six percent, or 318, sometimes or always use single-dose/single-use vials on more than one patient;
- Nearly 1 percent, or 45, sometimes or always reuse a syringe, only changing the needle for use on a second patient; and
- Fifteen percent, or 797, reported reuse of a syringe to enter a multi-dose vial.
- Of this group, 6.5 percent, or 51, reported saving vials for use on another patient, representing approximately 1 percent of all respondents.
- Half of the 51 reported working in hospital settings, and the other half reported working in non-hospital settings such as ambulatory surgical centers and physician offices.
Dr. Joseph Perz of the Centers for Disease Control and Prevention (CDC) says, The survey revealed that a dangerous minority of providers engage in unsafe practices such as syringe reuse. This is not acceptable. Safe practice is not optional; its a basic expectation anywhere injections are delivered.
CDC guidelines recommend that single-dose vials should not be used for multiple patients. The guidelines also recommend syringes and needles should be used only once, not reused for another patient or to access a medication or solution that might be used for a subsequent patient.
For example, when a syringe is reused to draw up additional medication for a single patient, the medication vial becomes contaminated. Any subsequent use of either the syringe or the vial on another patient places that second patient at risk of infection.
Premiers study confirms that confusion regarding labeling of medication vials, lack of awareness and education about safe practices, and mistaken beliefs about the risks associated with syringe reuse all contribute to the problem
Reducing risk to patients from unsafe injection practices will require surveillance, oversight, enforcement, and provider and patient education, says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute® and co-author of the study. Most important will be the safety culture of the organization to empower patients to speak up and healthcare professionals to take responsibility for preventing colleagues from engaging in unsafe practices.
Premier also recommends reducing risks through partnerships among professional, governmental and non-governmental organizations with a focus on the redesign of devices, products and processes.
Evelyn McKnight was one of 99 patients who became infected with the hepatitis C virus at an oncology clinic in Fremont, Neb.
I was infected during chemotherapy for breast cancer due to healthcare professionals not following safe injection practices, says McKnight, president and co-founder of the Hepatitis Outbreaks National Organization for Reform (HONOReform), a national advocacy organization dedicated to safe medical injections for patients. This survey sheds light on the extent of unsafe practices and the need for a collaborative effort to solve this problem.
HONOReform and Premier are members of the Safe Injection Practices Coalition (SIPC), a collaborative partnership of healthcare-related organizations that promote safe injection practices in all U.S. healthcare settings. SIPC developed the One & Only Campaign, a public health education and awareness program aimed at educating healthcare providers and patients about safe injection practices. A free educational video for healthcare providers, developed by SIPC, is also available from Premier at www.premierinc.com/injectionpractices.
Organizations which shared this survey with their members include: American Academy of Anesthesiologist Assistants; Accreditation Association for Ambulatory Health Care; American Association of Critical-Care Nurses; American Society of Health-System Pharmacists; Association for Professionals in Infection Control and Epidemiology; Infusion Nurses Society; Pittsburgh Regional Health Initiative; Society for Healthcare Epidemiology of America; Society of Gastroenterology Nurses and Associates; and Innovatix.