Safe Injection Recommendations Developed by Public and Private Stakeholders to Reduce Infection Risk

Collaboration among stakeholders, adherence to clinical best practices, surveillance, innovative product designs, and provider and patient education are all recommended solutions to eliminate the risk of infections from reuse of syringes and single dose vials and other unsafe injection practices.

These safety recommendations were developed by nearly 200 stakeholders, including representatives from government, public health, clinicians, professional and accreditation organizations, product manufacturers and patients at an open meeting, convened by the Premier healthcare alliance and the Safe Injection Practices Coalition.

In the past decade, failures to follow safe injection practices (e.g., misuse of syringes, needles and vials) have resulted in more than 30 outbreaks of infectious diseases, including hepatitis C, and notification of more than 125,000 patients. Although most providers follow best practices, a peer-reviewed study authored by Premier found 6 percent of providers inappropriately reuse single use vials on more than one patient; 1 percent reuse a syringe, only changing the needle for use on a second patient; and 15 percent reported reuse of a syringe to enter a multi-dose vial. Of this group, 6.5 percent, reported saving vials for use on another patient, representing approximately 1 percent of all respondents.

Safe injection guidelines from the Centers for Disease Control and Prevention (CDC) recommend that single-dose vials not be used for multiple patients. The guidelines also recommend syringes and needles to be used only once and not reused for another patient or to access a medication or solution that might be used for a subsequent patient.

According to participants at the Safer Designs for Safer Injections: Innovations in Process, Products and Practices meeting, ensuring safe injection practices in all healthcare settings will require a focus on monitoring current practices with increased oversight and enforcement; education and empowerment of clinicians and patients; and redesign of devices, products and processes to reduce risk.

"Preventing the spread of infection among patients and healthcare providers is a basic expectation," says Sara Hart Weir, MS, of the Safe Injection Practices Coalition. "Although significant progress has been made, we need to make every injection a safe injection. This will require a multifaceted, collaborative effort among all stakeholder groups."

Specific recommendations suggested by participants include:


- Educate patients to explain safe injections and how to ensure theyre receiving safe care during injections.

- Continue to educate clinicians and broadly disseminate best practice guidelines based on evidence-based safe practices for infection prevention and control.

- Develop resources to help implement best practices.

- Correct or refute mistaken information on safe injection practices.

- Assess the obstacles to use of current safety technologies and educate clinicians on appropriate use.

- Dispel myths and misperceptions about what is safe practice and discourage inappropriate reuse in the interest of conserving costs.

Clinical best practices

- Carefully and regularly review infection prevention and control protocols.

- Ensure safe practices are understood and followed by all clinical staff.

- Create a safety culture whereby every provider is empowered to stop any colleague from engaging in unsafe practices.

- Work with pharmacy partners and others so that medications are supplied in a form that is ready to deliver, minimizing the need for manipulation and opportunities for contamination and disease transmission.

- Work to develop curricula in nursing, medical, and other healthcare professional training and vocational programs on safe injection practices.

- Request safe design information from manufacturers as part of the clinical evaluation and purchasing process.

Research and surveillance

- Conduct studies to evaluate safer practices and safety signals.

- Continue to research clinical practice to ensure progress is being made.

- Improve surveillance of healthcare-associated infections at the state, national and institutional levels so the impact of prevention efforts can be documented and shared.

- Develop calculators and value analysis methodologies that assess the total cost of products, balanced with quality and outcomes implications.

Product design

- Redesign injection devices to make compliance with safety best practices easy and error proof.

- Develop consistent and clear labeling of injection-related products, including medication vials, containers and devices to encourage intended usage.

- Consider options for packaging, such as right-sized syringes or vials for specific clinical application.

- Create clear, consistent and understandable labeling requirements.


- Collaborate across governmental agencies and among stakeholders to identify solutions to prevent unsafe practices.

- Collaborate between providers and manufacturers to design products that support easy compliance with safe injection practices.

"Premier and its member are committed to preventing infections and improving the overall safety of healthcare," says Gina Pugliese, RN, vice president of the Premier Safety Institute. "Through the power of collaboration, Premier can pull together public and private stakeholders, along with healthcare providers, in order to develop solutions for some of our most pressing safety challenges. Premier will continue to publicly promote these solutions through our Safety Institute website, educational programs, newsletters and other forums."

Founded in June 2008, the Safe Injection Practices Coalition is composed of patient advocacy organizations, foundations, provider associations, industry partners and the CDC, united to halt unsafe injection practices. The coalition focuses its efforts on advancing and promoting safe injection practices by informing and educating healthcare professionals and the public, especially in outpatient settings. Issues of particular concern include the reuse of syringes and misuse of single-use and multi-dose vials. In addition to creating and distributing the safe injection practices video for healthcare providers, the coalition has launched pilot campaigns promoting safe injection practices in Nevada and New York, two states in which disease outbreaks have occurred.

Coalition partners include the following organizations: Accreditation Association for Ambulatory Health Care, Ambulatory Surgery Foundation, American Association of Nurse Anesthetists, Association for Professionals in Infection Control and Epidemiology Inc., BD (Becton, Dickinson and Company), Centers for Disease Control and Prevention, CDC Foundation, Covidien, Hospira, HONOReform Foundation, National Association of County & City Health Officials, Nebraska Medical Association, Nevada State Medical Association and the Premier healthcare alliance.