Safe and effective injection practices are a cornerstone of any facility's infection prevention processes.
"We want to do no harm. We don't expose the patient or provider to any avoidable risk and we want to ensure that the practice does not produce dangerous waste. Injection safety has to be a part of the facility's standard precautions," said Barbara J. Connell, vice president of clinical services at Medline, in a webinar Medline hosted on June 16.
The CDC released its "Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in the Healthcare Settings" in 1996, but the agency has since updated the document to accommodate for numerous changes in healthcare delivery. For instance, care is provided in a number of different healthcare settings, not just in the acute-care setting, according to Ms. Connell. Outpatient settings and home health care settings are growing in popularity as the healthcare industry becomes more patient-focused.
Additionally, the evidence for unsafe injection-related outbreaks is growing. In 2008, a group of endoscopy clinics in Nevada exposed 50,000 people to hepatitis C. The clinics used the same syringe for numerous patients as well as single-dose vials of medication. In another case, a hospital in Oklahoma transmitted hepatitis C to 69 patients and hepatitis B to 31 patients because a provider reused needles.
Ms. Connell noted the top four unsafe injection practices that caused the aforementioned infection outbreaks. They are:
• Syringe reuse between patients during medication administration
• Contamination of medication vials or IV bags
• Failure to follow basic inject safety practices when preparing and administering parenteral medications to multiple patients
• Inappropriate use and maintenance of finger stick devices and glucometer
In its April 2016 edition, the American Journal of Infection Control published a 2014 study on trained medical students observing hand hygiene and injection practices in ambulatory surgery centers and outpatient settings. Of the 163 injection observations the students made during the study, providers only disinfected the rubber septums on medication vials with alcohol 78 percent or 79 percent of the time before being pierced with a needle.
Not having a clean septum is one problem. Another is a common misconception among providers is reusing syringes is safe, said Ms. Connell. However, a provider using a clean syringe on an infected patient can contaminate the syringe, allowing the infection to pass on from patient to patient, even if providers change the needle.
Here are six safe injection practices Ms. Connell highlighted to limit infection transmission:
1. Use aseptic techniques. Aseptic techniques include handling, preparing and storing medications and all associated supplies for infections and infusions in a manner that prevents microbial contamination. "[Following aseptic techniques] can sometimes be difficult, and it has to be a thoughtful process," said Ms. Connell.
2. Follow medication preparation guidelines. Make sure medications in your facility are prepared in a clean area, free from contamination. The medication preparation area should not include any item that has come into contact with blood or bodily fluids and is clean and dry, notes Ms. Connell. Medications should also be stored to as to limit the risk of tampering.
"Also, make sure trained staff members are prepping the medications," she says. "Verify the staff members' competency and monitor their compliance with with aseptic techniques."
Finally, use single-dose vials whenever possible, added Ms. Connell. And if you must use a multi-dose vial, designate the vial to a single person when possible. Both the needle and syringe must be sterile when used to access any vial.
3. Maintain sterility of the vials. Perform proper hand hygiene before you start to prepare and use the medications. Use new sterile needles and syringes and disinfect all vial tops as well as IV hubs/ports. Also, providers need to discard all medications by their expiration date.
"And never store or transport vials in clothing," she added. "Your clothing could be contaminated."
As for multi-dose vials, they should never be kept in the patient's immediate area. If the vial does enter the patient area, providers should use that vial on only that patient.
4. Inspect the vial before the procedure. Carefully examine the vial for any visible contamination. Also, check and see if it is a single-dose or multi-dose vial. If it is a multi-dose vial, double check the name of the patient and the expiration date.
"And remember, when in doubt, throw it out," said Ms. Connell.
5. Put postoperative disposal processes into place. Appropriately discard all used needles, syringes and single-dose vials after a procedure. Store multi-dose vials appropriately, but remember to discard the vials by their expiration date, when doses are drawn in a patient area and any time vial sterility is in question.
6. Make injection safety a part of your infection control program. Have a dedicated person responsible for infection control in your facility and include safe injection practices in your facility's risk assessment and infection control program. Don't forget to include point-of-care devices as part of the program. Ensure your facility's infection control policy reflects the latest recommendations and guidelines. Also, periodically educate and train staff members and conduct competency testing.
To download the presentation as PDF, click here.
To view the webinar on YouTube, click here.
