When receiving an injection, protection from infections, including bloodborne pathogens,
is a basic requirement and expectation anywhere healthcare is provided.
For employees, the Needlestick Safety and Prevention Act requires appropriate, commercially
available, and effective safer medical devices designed to eliminate or minimize occupational
exposure.
Whenever unsafe injection practices occur, it indicates that healthcare personnel are
unaware of, do not understand, or do not adhere to basic principles of infection control and
aseptic technique.
Unfortunately, there have been thousands of reported potential infections each year in
the United States from unsafe injection practices.
Infections can range from bacterial, fungul, and viral including HIV, hepatitis B and hepatitis
C.
The most common unsafe injection practices are:
reinsertion of used needles into a multiple-dose vial or solution container (like a bag of
normal saline) and the use of a single needle or syringe
to administer intravenous medication to multiple patients.
Safe injection practices are integral to Standard Precautions, and include the following key
ideas: Needles and other sharps must be discarded
in leak-proof, rigid, puncture resistance containers
Sharps with Engineered Sharps Injury Protections are defined as "a non-needle sharp or a needle
device used for withdrawing blood or body fluids, accessing a vein or artery, or administering
medications or other fluids, with a built-in safety feature or mechanism that effectively
reduces the risk of an exposure incident."
So, an angiocath for example, as you can see it has this button here, that once we've inserted
the actual catheter into the vein, we can actually withdraw the needle, while the catheter
stays in the vein, and now we have a very protective covering over this needle, so we
can dispose that in the sharps container, and we don't run the risk of getting poked.
Make sure not to bend, shear, break or recap needles.
If you must recap, use a one-handed method.
For example, this is most often used when we are going to be drawing up medication.
We need to obviously put the air into the vial to get the medication out.
After we've withdrawn the appropriate amount of medication, now we're probably going to
set this on a tray, or get ready for the actual injection in the room.
This is where a one-handed needle recapping is gonna come in handy, and we can mark that,
and leave that on the tray safely.
Make sure to use aseptic technique to avoid contamination of sterile injection equipment.
This means washing our hands, using clean gloves; using alchol wipe to clean injection
portals, vials, and skin where a needle will be inserted.
So for example, in a real situation, maybe we have our gloves on after we've washed our
hands, depending on your protocols, your local protocols, we can clean the top of that vial
with the alcohol wipe, before we actually draw up the medication.
Again, having gloves available is always a good idea.
Having multiple available in case one gets contaminated is important.
And then changing gloves in-between patients, and in-between the different types of tasks
that you're doing.
And example a needle that's still capped, you can see this here, it's not done yet,
so you know, if we're changing needles, you're going from the actual drawing up, to the actual
injection needle.
Again, this is all gonna be done with aseptic and clean technique.
Do not administer medications from a syringe to multiple patients, even if the needle of
the syringe is changed.
Needles and syringes are sterile, single-use items; they should not be reused for another
patient nor to access a medication or a solution that might be used for a subsequent patient.
A good rule of thumb to remember is "One Needle, One Syringe, One Time only"
Use fluid infusion and administration sets (IV intravenous bags, tubing and connectors)
for one patient only and dispose of those appropriately after use.
Consider a syringe or needle / cannula contaminated once it has been used to enter or connect
to a patient's intravenous infusion bag or either that, or the administration set as
well.
Use single-dose vials for medications should always be used whenever possible.
Do not administer medications from single-dose vials or ampules to multiple patients or combine
leftover contents for later use.
Whenever possible, use a single-dose vial.
It's preferred over multiple-dose vials, especially when medications will be administered to multiple
patients.
If it is a multidose vial and you have to use it, both the needle and syringe used to
access the multidose vial must be sterile.
Do not keep multidose vials in the immediate patient treatment area and store in accordance
with the manufacturer's recommendations; discard if the sterility is compromised or questionable.
Do not use bags or bottles of intravenous solution as a common source of supply for
multiple patients.
And for spinal lumbar puncture procedures, wear a surgical masks when placing a catheter
or injecting material into the spinal canal or subdural space (for example: during myelograms,
lumbar puncture and spinal or epidural anesthesia.)
Remember, OSHA requires that Exposure Control Plans reflect how employers implement new
developments in control technology.
It also requires employers to solicit input from employees responsible for direct patient
care in the identification, evaluation, and selection of engineering and work practice
controls; and it also requires certain employers to establish and maintain a sharps injury
log of percutaneous injuries from contaminated sharps.
The sharps injury log must include the specified minimum information regarding the device that
was involved (if you know what it was), the location of the incident, and the description
of the events that resulted in the injury.
The level of detail presented should be sufficient to allow ready identification of the device,
the location, and circumstances surrounding an exposure incident so that the intended
evaluation of risk and device effectiveness can be accomplished.
Employers are required to record sharps injuries involving contaminated objects on the OSHA
300 Log of the Work-Related Injuries and Illnesses and the OSHA 301 Injury and Illness Incident
Report.
So be sure that if you're stuck by a needle or other sharp, or get blood or other potentially
infectious materials in your eyes, nose, mouth, or broken skin, immediately flood the exposed
area with water and clean any wound with soap and water or a skin disinfectant if at all
available.
Report this immediately to your employer and seek immediate medical attention.
Now let me demonstrate the basic aseptic technique in preparing an injection:
Keep the area free of clutter so all surfaces can be easily cleaned and disinfected, be
sure to wash your hands appropriately.
Remember, gloves are not usually needed when giving injections.
However, if excessive bleeding is expected or other bloodborne pathogen risks exist,
wear gloves; for example, the healthcare worker has dry cracked skin on his hands.
When you attach needle to a syringe to draw up medication, remember to discard the needle
if it touches a hand, a surface or any other non-sterile object.
Just throw it away.
And then use another clean, sterile needle.
Check the medication and the corresponding patient's name dosage and make sure to have
the right medication, the right dose, the right route, and the right person before giving
any medication.
Swab the top of the vial with an individual alcohol pad.
Just a sidenote here: if you're using a glass ampule, don't use your bare fingers.
Use a gauze pad to break it open.
And remember to use a filtered needle when you draw up from a glass ampule like that.
You'll change the needle to actually administer the medication after you've drawn up to a
non-filtered needle when you deliver the medication.
I've I'm gonig to be drawing up three or four, let's say four CC's of medication, I'm actually
going to insert that amount of air into the vial.
This gives me enough pressure to be able to actually withdraw the appropriate amount of
medication.
Remember to use the one hand recapping technique and then use the new sterile needle on the
actual syringe to deliver the medication.
Remember, never reenter a multi-dose vial with the same needle and syringe.
Always use a new sterile needle and a new syringe.