Safe Injection Practices: Infection Control Guidelines

Safe injection practices are a core component of Standard precautions-the foundational infection prevention measures designed to protect both patients and healthcare personnel across all clinical settings. According to the Centers for Disease Control and Prevention (CDC) and The Safe Injection Practices and Coalition (SIPC), unsafe injection practices place patients at significant risk for devastating, completely preventable healthcare-associated infections (HAIs).  Safe injection practices prevent the transmission of bloodborne pathogens, such as HIV, Hepatitis B and Hepatitis C, and bacteria between patients and healthcare workers during procedures.  Over the last two decades, CDC has investigated dozens of serious outbreaks linked to deviations from injection safety protocols. Unsafe injection practices are any procedures that deviate from established safety protocols and put patients and healthcare workers at risk of infections.  When this happens, unfortunately outbreaks in healthcare settings can occur. Unsafe practices are preventable with education and training of healthcare workers.

Safe injection practices must be followed to prevent illness and even deaths to patients. Unfortunately, outbreaks have occurred in healthcare facilities when safe injection practices are not followed. Safe injection practices are critical for patient safety and for preventing infection. Some best practices to follow:

• Use aseptic technique when preparing and administering injections. Maintain sterility during the entire lifecycle of medication handling.
• Perform hand hygiene when preparing and administering injections.
• Avoid distractions or create a no-interruption zone. Healthcare professionals must prepare medications without interruptions in an orderly space to eliminate errors, miscalculations, and accidental cross-contamination.
• When preparing vaccines, prepare for one patient at a time.
• Never administer medications from the same syringe to multiple patients.
• Use a new syringe and needle for entry to medication vial. Every entry into a medication container must be performed using a new, sterile needle and syringe. Both must be immediately discarded into a puncture-resistant sharps container after a single use. A new syringe and needle must be use to re-enter a multi-dose vial.
• Do not administer medications from the same syringe to more than one patient. Do not change the needle and reuse the syringe.
• Do not reuse needles. Needles are single use items. One time and then they are discarded!
• Do not enter a medication vial, bag, or bottle with a syringe or needle that has been used on a patient.
• Never use medications intended for single use for more than one patient. This includes single-dose vials, ampoules, bags or bottles of intravenous solutions.  Single use means one time use only!
• Multi-dose vials should be dedicated to one patient when possible. Multi-dose vials that are reused should be kept and accessed in a designated clean area. Medication preparation must be away from patient treatment areas.
• Always follow the manufacturer’s directions, these are in the package inserts.
• Never combine or “pool” leftover medication contents of a syringe or single-use vials for later use.
• Prior to piercing any medication vial, scrub vial diaphragms with 70% alcohol and allow it to air-dry completely.

Let’s take a closer look at a few of these practices and explore what they mean for healthcare and how to achieve delivering safe injections each time.

Aseptic technique is a set of practices that is used to prevent the spread of infections. It is the framework used to properly handle, prepare and store injection supplies to ensure they remain entirely free of microbial contamination. There are a few principles to consider with aseptic techniques that must be followed to control the spread of pathogens of the surrounding workspace. These include:

• Hand hygiene- Recognized as the single most critical measure in reducing transmitting organisms to each other and to patients.  Hand hygiene with soap and water or an alcohol-based hand rub is the first line of defense in preventing the spread of infection. Hand hygiene must be done before handling injection supplies.
• Wearing appropriate personal protective equipment-gloves, masks, eyewear, gowns-as dictated by the specific procedure or exposure risk.
• Keep contaminated items away from the preparation area. If contamination occurs in the area, immediately stop, disinfect the area and obtain new supplies.
• Designate a clean area that is away from contaminated items and away from sinks and water sources. Clean areas must be kept sanitary and away from dust or water contamination of supplies.

A dangerous practice that occurs is inappropriate use of syringes. Inappropriate use of syringes can happen in different situations. The first situation is called indirect misuse or double dipping. This specific violation occurs when a healthcare provider utilizes a brand-new needle and syringe to draw medication from a multi-dose vial, administers the injection to a patient, and then changes only the needle to re-enter the same multi-dose vial for subsequent doses. Because the interior barrel of the syringe retains microscopic backflow forces from the patient, re-entering the share vial introduces bloodborne pathogens directly into the common medication source. Subsequent patients injected from that vial are then exposed to the contaminated solution.

The second inappropriate practice that can occur is called direct reuse. This occurs when a clinician utilizes the exact same syringe to deliver medication on multiple patients. Even if a fresh, sterile needle is attached for every separate patient, the syringe is not safe for reuse on another patient. The interior syringe body remains highly infectious. The CDC warns that changing the needle does not protect against contamination thus putting every patient at direct risk.  A new needle and new syringe must be obtained for each patient.

Pre-drawing medications are a commonly found practice in healthcare facilities.  However, this practice puts patient safety at risk.  Best practice would be to prepare medications as close to the time of administration as possible. This reduces the potential of contamination of the syringe, needle and medicine. Every provider has the responsibility to ensure safe injection practices. Drawing medications hours in advance and storing them in unverified spaces like drawers, closets or cabinets drastically elevates infection rick.

From an infection control perspective, medications should be prepared as close as possible to the time it is administered to the patient. Some sources state the injection should be used within 2 hours of drawing the medicine. Medications left sitting in plastic syringes for prolonged periods can undergo physical and chemical degradation, reducing therapeutic potency or generating hazardous byproducts.  There is also a risk of contamination of the syringe and needle to air currents, settling dust, and human handling. Pre-filled syringes would be a better, safer practice to administer medicines rather than pre-drawing from a vial , this would eliminate preparation errors and exposure windows.

Single use medication vials are for one use only. Once the vial is entered, if there is any left medication, this would be discarded. Single use vials do not contain preservatives that would render it safe for reuse. Healthcare workers must pay close attention to what is a single use vial versus multi-dose vials of medication. Multi-dose vials are labeled “Multi-Dose Vial” by the FDA and may be used on multiple patients, but it should be considered to use on only one patient when possible. Multi-dose vials contain antimicrobial preservatives to inhibit bacterial growth. Preservatives have no effect on bloodborne viruses like HIV or Hepatitis. If re-using multi-dose vials, they must be dated when opened and discarded after 28 days, unless the manufacturer states otherwise.  The expiration date on multi-dose vials is shelf life, not use life.

Healthcare facilities must establish comprehensive, facility-wide injection safety programs. Furthermore, job-specific training covering bloodborne pathogens and injection safety must be provided upon hire and repeated at least annually for all healthcare personnel. Following these safe injection practices will prevent the transmission of bloodborne pathogens; therefore, keeping your patients safe and free from infection.

Strengthen Your Safety and Compliance with an Infection Control Program

Keeping your practice compliant starts with the right training. From OSHA and HIPAA to infection control and safe injection practices, we offer on-site and online programs designed to fit your schedule and your team. Request a free quote today and take the first step toward a safer, more compliant practice that protects both employees and patients.