Hello I'm Doctor Mike Bell.
I'm the associate director for infection control at CDC.
The One and Only Campaign is aimed at raising awareness about safe injection
practices.
Every year millions of injections are administered in the United States.
Every one of them should be safe.
In these videos, we will discuss some of the misperceptions that healthcare
providers might have about safe injection practices.
Evelyn McKnight, AuD, President & Co-Founder HONOReform Foundation
My name is Evelyn McKnight.
In October of 2000 I was diagnosed with breast cancer
and underwent chemotherapy at my local oncology clinic in Fremont, Nebraska.
In less than a year, I experienced a recurrence of breast cancer.
Through the very thorough work-up for the second round of chemotherapy,
we found that I had become infected with Hepatitis C virus. My husband - a
family physician - and I were confounded.
I had no risk factors for Hepatitis C,
no drug abuse, no risky sexual behavior, no transfusions before
1992.
In total 99 patients contracted Hepatitis C at the oncology clinic.
I bet you're asking,
“how did this happen?”
The outbreak occurred because healthcare providers at the clinic did not
follow safe injection practices.
In the last 10 years,
more than 100,000 patients across the country
have been notified that they should be tested for Hepatitis B
Hepatitis C and HIV
due to the reuse of syringes and misuse of medication vials.
Our goal in the following videos is to discuss the basic evidence-based and
common sense precautions
that protect patients and prevent future outbreaks from occurring.
Dr. Gregory is starting his first day working in a pain management clinic.
He is discussing his first patient of the day with Helen, a nurse that has been
with the clinic for 10 years.
Good morning, Helen. How are you?
Fine, good morning.
I see our first patient is Miss Jones, she's here today for a steroid injection
to control her knee pain. Can you show me where we keep all the supplies?
Sure. Why don't you tell me what you need and I'll get the room set up for you?
I'll also draw up the medications. That's okay. I can draw them up myself during the
procedure. I'll just need a vial of lidocaine, a vial of kenalog,
a couple of needles, and one syringe. I already have the drape and skin prep.
One syringe? Aren't you giving two injections?
Yes, but after I inject the lidocaine, I'll just change the needle and draw up
the kenalog.
I'm sorry but I need to stop you right there.
First we use multidose vials of lidocaine and kenalog. Multidose vials must be
drawn up in our medication prep area and they can't enter the patient treatment
area unless we are dedicating them to that patient and discarding them at the end
of the procedure.
More importantly, reusing a syringe to access a medication vial is not
safe,
even if you change the needle.
Besides, changing the needle would only place you at an unnecessary risk
of a needle stick injury. Well I'll make sure not to aspirate to avoid any
contamination of the syringe. That won't prevent contamination.
As you give the injection, blood can travel up the needle into the syringe,
even if you don't aspirate. If you reuse that syringe with or without the
same needle you will contaminate the medication vial and place other patients
at risk of infection.
Thanks for explaining those issues. I would never want do something that
places patients at risk.
No problem.
We're glad to have you here on your rotation but
before you do any procedures you should review our infection protection policies
and procedures which incorporates CDC guidelines.
Some healthcare providers may have heard about the outbreaks due to syringe misuse
and assume they were all caused by reusing syringes or needles from
patient to patient.
In reality many were due to contamination of medication vials that were used
for multiple patients.
All healthcare providers must understand the risk or reusing syringes
or needles to access medication vials.
It is best not to take multidose vials into patient treatment areas
unless they will be dedicated to a single patient.
Multidose vials that are used for more than one patient should be prepared and kept
outside patient treatment areas.
Whenever possible multidose vials should be dedicated to a single patient
to provide an extra layer of protection.
Remember, injection safety is every providers responsibility.
A routine part of anesthesia practice is the administration of IV medications.
Let's observe as Laura,
a practitioner in training,
and Tony, an experienced anesthesia instructor, prepare for the first patient
of the day.
Good morning, Laura.
Good morning. Are you ready for the first case? Yes, I am.
I see you are using a 10cc syringe for the Propofol. What
are you planning on doing with the leftover propofol in the vial?
Since I only need 10ccs for this case, I'll keep in the cart for the next patient. No,
it's not appropriate to use a single-use medication vial for multiple patients.
It's important that we adhere to the manufacturers labeling for medication and propofol
is labeled as single-use. Any medication not used for this patient
should be discarded at the end of the case.
Okay, but I have another question for you.
Is it okay to a continue using a medication from this same syringe for the same patient. Yes,
we can titrate dosage from a filled syringe for individual patient
provided the syringes handled aseptically and discarded at the end of the
case.
Is it okay to use the same syringe to draw up more propofol if the patient needs
it? No,
once used syringes are considered contaminated and should not be used to
draw up more medication. Even for the same patient.
I understand that syringes and needles are single-use items and can't be used for
more than one patient, but if I'm going to throw the vial out at the end of the case
anyway why can't I reuse the needle and syringe to draw up more medication? It's all for the
same patient.
Using a new needle and a new syringe every time we enter the medication vial
adds an extra layer of safety in case, for some reason, the vial is not discarded
like it should be.
To protect patients and ensure that medications are sterile,
single-dose and single-use vials should not be used for more than one patient.
Always use a new sterile needle and a new sterile syringe to access
medications.
Remember that injection safety
is every provider's responsibility.
The next scene occurs in an oncology clinic where an experienced oncology nurse practitioner,
Claire,
is orienting a new registered nurse, Christine.
Claire and Christine had been reviewing the clinic's protocol for catheter
flushing.
Let's listen to the discussion.
I have a question about the policy on line flushing -
it said to use a pre-filled syringe of normal saline
and at the clinic where I last worked
we drew saline from a liter bag that was hung over the sink in the medication
room. No, that can cause the saline bag to be contaminated
and lead to infection in large numbers of patients.
Saline bags are labeled as single-use and should only be
used for one person.
Pre-filled syringes either from a manufacturer or prepared in a pharmacy
can prevent the transmission of bloodborne and other pathogens.
But I thought changing the needle prevented contamination.
During the flushing process, you have to aspirate blood to be sure that the line is
patient right.
Yes.
Traces of blood, which can't be seen by the naked eye,
can coat the inside of the needle and syringe.
If that syringe is then used to then access the bag of saline,
blood with viruses and other pathogens
can wind up in the bag.
That contaminated bag places any other patients that receive saline from that
bag at risk for infection.
Changing the needle won't prevent this from happening
and can put you at risk for a needle stick injury.
Remember
even if you don't aspirate you can still get backflow of blood into the syringe.
Using pre-filled syringes adds a layer of safety for patients undergoing this
procedure.
We follow the One-One-One rule here -
one needle, one syringe,
one time.
We never reuse needles or syringes.
They're used for only one patient and only one time.
We also dispose of used equipment right away to prevent injuries or
reuse.
Thank you for that clarification.
Why sure. I'm glad you came in.
Remember, saline bags are single-use and should not be used as a common supply for
multiple patients.
Always use a new sterile needle and a new sterile syringe to access medications.
Changing the needle does not prevent contamination
and remember,
injection safety is every provider's responsibility.
In this short video, we will review some key points of safe injection practices.
Safe injection practices ensure the safety of patients healthcare personnel
and others.
As defined by the World Health Organization, a safe injection does not
harm the recipient,
does not expose the provider to avoidable risks,
and does not result in waste that is dangerous for the community.
There have been numerous outbreaks of bloodborne and other pathogens
reported in the United States due to lapses in safe injection practices.
Here are some examples of dangerousness misperceptions that healthcare providers
might have regarding safety injection practices.
One myth is that contamination of injection devices is limited to the
needle
and that removing the needle makes the syringe safe for reuse.
The truth is that once they are used both the needle and the syringe are
contaminated and must be discarded.
A new sterile syringe and a new sterile needle should always be used for each
patient and to access medication vials.
Another myth is that IV tubing or valves can prevent backflow and contamination
of injection devices.
The truth is that everything from the medication bag to the patient's IV
catheter is a single interconnected unit.
Distance from the patient, gravity, or even positive infusion pressure do not
ensure that small amounts of blood won't contaminate the supply.
Another myth is that if you don't see blood in the IV tubing or injection
equipment there isn't a risk of cross-contamination.
The truth is the pathogens including Hepatitis C and B viruses and HIV
can be present in sufficient quantities to produce infection
without any visible blood.
And finally, the last myth is that single use vials with large volumes that
appear to contain multiple doses
can be used for more than one patient.
The truth is that
single-use vials should not be used for more than one patient
regardless of the vial size.
The following practices will help safeguard patients from transmission of
bloodborne and other pathogens.
Needles and syringes are single-use devices.
They should not be used for more than one patient or reused to access medication
vials.
Once they are used the syringe and needle are both contaminated and must be discarded.
Do not administer medications from single-does vials,
Ampoules, pre-filled syringes
or intravenous bags to multiple patients
and never combine leftover contents for later use.
In general,
limit the use of multidose vials whenever possible.
As you've heard, single-does vials should only be used for a single patient.
In addition,
if multidose vials are used they should be dedicated to single patient whenever
possible.
This adds an extra layer of protection by minimizing the chance that a
contaminated vial
will be used on another patient.
Injection safety is every provider's responsibility.
Every injection should be safe.
Anyone should be able to stop a procedure if they think it isn't safe.
Please go to the website on your screen for more information and thank you
for doing your part for making every injection safe.