by Marilee Johnson, MBA, MT (ASCP), Campaign Coordinator, NC One
& Only Campaign, NC Division of Public Health
The information is clearly written on the label: Single-dose
or multi-dose. However, surveys have
found that 6% percent of US clinicians admit to using single-dose vials for
more than one patient.1 In a
recent assessment of infection prevention practices in ambulatory surgical
centers, 28% percent of centers were found to reuse single-dose vials for more
than one patient.2 When you, as a healthcare worker, reuse a vial intended
for only one patient, a person’s life and well-being are at stake.
It’s also important to remember that the preservatives in
multi-dose vials have no effect on viruses and do not protect against
contamination when healthcare personnel fail to follow safe injection
practices. For this reason, even vials labeled as “multi-dose” should be
dedicated to a single patient whenever possible. If multi-dose vials must be used for more than
one patient, they should never be kept or accessed in the immediate patient
treatment area.3
Since 2001, at least 50 outbreaks involving unsafe
injection practices have been reported to CDC, with 90% of these occurring in
outpatient facilities.4 Misuse of multi-dose vials – including
accessing a medication vial with a syringe that has already been used to administer
medication to a patient – is one of the leading culprits.
If you do not believe that someone in your facility could
harm your patients by misusing a multi-dose vial, I challenge you to read on.
In 2007, Johnny Robertson of Red Springs, NC, elected to
have a preventative health care checkup. After all, he was turning 50 years old
and it was time to have some preventative health screening. His primary care provider recommended a few
procedures, including a colonoscopy and a cardiac perfusion study. Johnny followed this advice, scheduled the
procedures and found the results were all good.
All was well and Johnny continued to donate blood regularly, as he had
done for years. However, when he donated
blood this time (in 2007), he received an official letter from the Red Cross
stating that he was infected with hepatitis C. Johnny was shocked because he
did not have any known risk factors associated with hepatitis C. He kept digging to see how he could have
possibly gotten this awful disease.
Ultimately, an epidemiologic investigation conducted by
the North Carolina Division of Public Health determined that Johnny had
acquired hepatitis C during the cardiac perfusion study performed at his
cardiologist’s office.5 The results from the investigation suggested
that a staff member routinely reused syringes to access multi-dose vials of
saline, thereby contaminating the vials with patient blood. When saline from one of these vials was
injected into Johnny’s IV, he was exposed to hepatitis C from a previous
patient. In total, 5 patients at this cardiology
practice contracted hepatitis C on two different dates.
Johnny Robertson is an active Rotarian and he is
committed to that organization’s motto of “Service above Self”. Therefore, he has
chosen to become a member of the NC One & Only Campaign and to help spread
the message and serve as a patient advocate.
If you are still reading this article (which I hope you
are), I encourage you to read more patient stories, like Johnny’s at http://www.honoreform.org/blog/. Evelyn McKnight, a hepatitis C survivor from an
outbreak at an oncology clinic in Fremont, Nebraska, started the non-profit
HONOReform to raise awareness of injection safety. Since 2001, over 150,000 patients have been
placed in direct risk of contracting hepatitis C, hepatitis B and HIV through
known outbreaks. Dr. McKnight, like many other victims of outbreaks associated
with unsafe injection practices, wants to end the harm being done to patients.
What can you, the Infection Preventionist, do to prevent
unsafe injection practices from occurring at your facility? First, remember, at
the end of the day we are all patients. Imagine you were the one who got
hepatitis from a medical procedure. Your life would change forever. There is
too much at stake to not educate yourself and those around you. Safe injection
practices are not to be taken for granted.
Next, go to the One
& Only Campaign website and download the new interactive tool: http://bit.ly/1eXsMKL. Share this information with staff at your
facility. Include the One Needle, One Syringe, Only One Time message
in all new employee orientation trainings as well as yearly required
trainings. Reach out to clinics that
might not know about or have access to these training materials.
Finally, as a provider of health care, encourage your
patients to ask questions about safe injection practices:
Did you wash your hands?
Did you use a clean needle and
syringe to draw up this medication?
Is this medication from a
single-dose vial? Have you used this vial of medication on another person?
Remember at the end of the day,
we are all patients.
 |
| Click on the picture for a new One and Only Campaign interactive tool! |
References:
1 Pugliese G, Gosnell C, Bartley JM, Robinson S.
Injection Practices among Clinicians in United States Health Care Settings. Am
J Infect Control 2010;38(10) :789–798.
2 Schaefer MK, Jhung M, Dahl M et al. Infection
Control Assessment of Ambulatory Surgical Centers. JAMA 2010;
303(22):2273–2279.
3 CDC. Questions about Multi-dose vials.
Available at http://www.cdc.gov/injectionsafety/providers/provider_faqs_multivials.html
(accessed November 13, 2013).
4 CDC Grand Rounds: Preventing Unsafe Injection
Practices in the U.S. Health-Care System. Morb & Mort Weekly Rep
2013;62(21):423-425. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6221a3.htm.
5 Moore Z, Schaefer MK, Hoffmann K et al. Transmission of Hepatitis C Virus during
Myocardial Perfusion Imaging in an Outpatient Clinic. Am J Cardiol 2011;108:126–132.
