A common error in healthcare facilities is the use of single-use vials of medications as multi-use vials. Healthcare workers must take the time to identify and become familiar with which vials of medicine are for single-use and which are multi-use to prevent using a single-use vial on multiple patients. The manufacturer labels the medicines as single-use or multi-use. Manufacturers’ instructions for use should always be followed.
Single (dose) use vials are to be used on only one patient and discarded after that patient or procedure. The best practice standard is that single dose medications are encouraged to be used whenever possible to reduce the likelihood of contamination. Single-use vials do not typically contain antimicrobial preservatives and therefore can only be used once. They should not be left lying around after a patient to possibly be mistaken for multi-use vials. Single-use vials should never be used more than once.
Multi-dose vials typically contain an antimicrobial preservative to help prevent the growth of bacteria therefore making them safe to be used on multiple patients. The preservative has no effect on viruses and does not protect against contamination when healthcare personnel fail to follow safe injection practices and aseptic technique. When using multi-dose medications, aseptic techniques should be strictly followed, including proper hand hygiene.
Once a multi-dose vial has been opened or accessed, the vial should be dated and discarded within 28 days unless the manufacturer specifies a different date for the opened vial. If a vial has not been accessed and is unopened, it should be discarded according to the expiration date on the manufacturer’s label. The manufacturer’s expiration date refers to the shelf life of the medicine.
Both multi-dose and single-dose medications should be drawn up in a dedicated clean area away from possible contamination. The area should be away from a sink or other water sources to avoid contamination. The area should also be away from any area that is contaminated with blood or other body fluids, such as equipment. The area should be cleaned and disinfected on a regular basis and anytime it is visibly soiled.
The medication vials should be accessed in an aseptic manner. The rubber septum of the vial should be cleaned with alcohol before it is pierced. A new needle and new syringe should be used each time a vial is accessed. Hand hygiene should always be performed when handling medicines, needles, and syringes.
From an infection control perspective, medications should be prepared as close as possible to the time it is administered to the patient. It is a safer practice to administer the medicine as soon as possible to prevent contamination of the medicine. The medicine may become physically or chemically unstable if drawn too far in advance. There is also a risk of contamination of the syringe and needle to air and dust if drawn in advance and stored in a drawer. Pre-filled syringes would be a better, safer practice to administer medicines rather than pre-drawing from a medicine vial.
Following these simple instructions will prevent error in utilizing vials of medicines and in pre-drawing medicines, therefore, keeping your patients safe. Whenever possible, use single-dose vials to minimize potential cross contamination and double-check the label prior to drawing up your medication. If you have any questions or would like further information, don’t hesitate to contact TMC. We are here to help create a safer, more compliant environment for you, your staff, and your patients!