Question

After listening to this podcast, list and discuss the safe injection practices you should follow to prevent causing harm.

Protecting Patients from Unsafe Injections:
What Every Provider Needs to Know
[Announcer] This program is presented by the Centers for Disease Control and Prevention.
[Joyanna Wendt] Hello. I’m Dr. Joyanna Wendt, a Medical Officer at the Centers for Disease
Control and Prevention, or CDC, and today we’re talking about injection safety. I know some of
you are thinking, “That’s so basic. Of course I give injections safely.” You might be surprised to
hear that year after year, CDC investigates situations where providers thought they were doing
everything right, but in fact, were making basic mistakes and putting their patients at risk for
infection.
Joining me today to discuss this critical issue is Janice Izlar. Janice has been a certified registered
nurse anesthetist for more than three decades and has recently started her tenure as the president
of the American Association of Nurse Anesthetists. Welcome, Janice.
[Janice Izlar] Thank you for having me, Joyanna.
[Joyanna Wendt] To start, tell us a little bit about yourself, and you and your organization
advocate for injection safety.
[Janice Izlar] The American Association of Nurse Anesthetists advocates on behalf of our
profession, but more importantly, we advocate for the safety of patients. We have taken a very
active role in helping educate our members about safe injection practices. I’ve always felt that
injection safety needed to be clearly communicated since it’s such an important issue. In fact, I
felt so strongly that I did my doctorate on how the AANA can best communicate with our
members on injection safety. I’m proud that the AANA is a part of the Safe Injection Practices
Coalition, which worked with the CDC to create the One & Only Campaign. Together, we’re
spreading the message of one needle, one syringe, only one time.
[Joyanna Wendt] One needle, one syringe, only one time – that sounds like pretty basic stuff.
Some of our listeners may be thinking, ”Aren’t all medical providers familiar with safe injection
practices?”
[Janice Izlar] Safe injection practices have been part of standard precautions for years and most
providers take steps to safely prepare and administer injections – whether sedatives, anesthetics,
vaccines, or other injectable medications. But we know that some do not.
The issue isn’t just related to nurses. I’ve given lectures about safe injection practices to nurses,
doctors, technicians, and administrators from California to Maine and it shocks me how often I
hear, from trained professionals, that they had not understood the dangers of certain injection
practices. Just one mistake or missed protocol can put many patients at risk.
[Joyanna Wendt] How does this happen and how big a problem is it?[Janice Izlar] To save time or stretch supplies, some providers take shortcuts, like re-using
syringes or using single-dose vials for more than one patient. There’s a myth that changing a
needle makes a syringe safe for re-use. The reality is that once they are used, both the needle and
the syringe are contaminated and must be discarded. During the past 10 years in the United
States, syringe reuse and the misuse of medication vials have resulted in dozens of outbreaks.
Since 2001, more than one hundred and thirty thousand patients have needed to get tested for
bloodborne pathogens, such as Hepatitis B, Hepatitis C, and HIV because of potential exposure
related to unsafe injection practices. These exposures are completely preventable.
[Joyanna Wendt] What are some other rules that every provider needs to know?
[Janice Izlar] Medications packaged in containers labeled as single-dose or single-use should not
be used for multiple patients. Also, there’s a common belief that syringes can be reused as long
as an injection is administered through an intervening length of IV tubing. That is not correct.
Everything from the medication bag to the patient's IV catheter is a single interconnected unit.
Distance from the patient, gravity, or even infusion pressure do not ensure that small amounts of
blood won't contaminate the syringe when it is connected to the IV tubing. Syringes should never
be reused for more than one patient or to access medication vials.
[Joyanna Wendt] We’ve heard from health professionals that one reason they might break safety
rules and use a single-dose vial for more than one patient is that a medication isn’t available in a
small enough vial. They don’t want to waste medication that might be in short supply. How
would you reply to those who argue that it’s more cost-effective to use the vial for multiple
patients?
[Janice Izlar] Saving money by using medication in single-dose vials for multiple patients is
simply not worth the risk to patient safety. It’s also not worth the liability risk to your hospital or
clinic. You may be saving a couple of dollars, but you could cost the facility millions or even
cause it to be closed. If you need to split or customize doses, it must be done with full adherence
to United States Pharmacopeia, or USP, 797 standards, including use of a laminar flow hood and
other precautions. Many clinicians work with high-quality compounding pharmacies or
pharmaceutical compounding companies to assist with repackaging. If you do this, it’s important
to be sure that the pharmacy or outsourcing company follows USP 797 standards.
The bottom line is, a single-dose vial should only be used for one patient and one procedure. Any
remaining contents should be discarded. Even medication that comes in multi-use vials should be
dedicated to a single patient whenever possible. If multi-use vials are used for more than one
patient, they should not be kept in the immediate patient treatment area. You must use a new
syringe and needle for each withdrawal, with appropriate disinfecting technique for the vial prior
to each entry, and discard the vial and any remaining contents within 28 days, unless the
manufacturer specifies a different time period.
[Joyanna Wendt] IV bags are single-use items. Can they be used to supply multiple patients?
[Janice Izlar] No. IV bags should not be used for more than one patient. Outbreaks have
occurred when providers flushed IV lines and catheters with saline solution taken from acommon-use saline bag.
[Joyanna Wendt] So to recap, there are three main things every provider should know:
1. Needles and syringes should not be used for more than one patient or re-used to draw up
additional medication.
2. Don’t administer medications from a single-dose vial or IV bag to more than one patient.
And
3. Limit the use of multi-dose vials and dedicate them to a single patient, whenever
possible.
[Janice Izlar] That’s right.
[Joyanna Wendt] Any final words of advice for our listeners?
[Janice Izlar] Injections are an important part of the work we do and injection safety is critical.
For most of us, it’s second nature. You may be doing everything right, but your colleagues might
not be, and that puts everyone at risk. So stay alert. If you see a colleague who isn’t following
safe injection practices, speak up. Talk to him or her or talk to their supervisor. It might be a little
uncomfortable, but you could be saving someone’s life, and that’s much more important.
[Joyanna Wendt] Thank you so much, Janice, for joining us.
[Janice Izlar] Thank you for having me.
[Joyanna Wendt] For more information about safe injection practices, including a checklist,
toolkits, and brochures that can be shared with staff and patients, go to the One & Only
Campaign website at oneandonlycampaign.org.
[Announcer] For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO.

Answer 1

Answer.

A safe injection is one that,does not harm the patient,does not expose the provider to any avoidable risk and does not result in waste that is dangerous for the community,so safe injection practice involves administration of rational injection by a well trained qualified person.

Three main things every provider to follow for safe injection practices are

1. Needles and syringes should not be used for more than one patient or re used to draw up additional medication.
2. Dont administer medication From a single dose vial or iv bag to more than one patient.
3. Limit the use of multi dose vialsand dedicate them to a single patient when ever possible.