CDC Report Details Outbreaks from Single-Dose Vials Used for Multiple Patients

The Centers for Disease Control and Prevention (CDC) has released a report detailing two life-threatening outbreaks that occurred when healthcare providers used medication from single-dose/single-use vials for multiple patients undergoing treatment for pain. 

At least 10 patients contracted life-threatening staph or MRSA infections and had to be hospitalized. An additional patient died, and although the cause of death was reported as multiple-drug overdose, invasive MRSA infection could not be ruled out.  

These breaches of basic infection control practices are a stark reminder that CDC recommendations for injection safety must be followed closely with every patient, even during times of medication shortages. In circumstances when individually packaged and appropriately sized single-dose/single-use vials are unavailable (e.g., during national shortage) contents from unopened vials can be packaged into multiple single-use vehicles, provided that the repackaging is performed in accordance with all standards in United States Pharmacopeia General Chapter <797 >. 

Clinicians are encouraged to double check their practices against CDCs Injection Safety Recommendations. In addition, CDC offers healthcare providers a toolkit featuring a narrated PowerPoint presentation that is ideal for staff meetings, seminars and other education opportunities. 

Read the MMWR report, review CDC recommendations, and get educational materials at: