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Best practices for the safe administration of injectable medications

Originally published in the November/December 2014 issue of Dispatch

The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures has occurred frequently due to unsafe injection practices. For example, it was recently reported that between 2011 and 2013, eleven patients contracted hepatitis C during separate outbreaks at three Toronto colonoscopy clinics. The improper use of multidose medication vials was implicated in these outbreaks.

Public Health Ontario has published a best practice document on Infection Prevention and Control for Clinical Office Practice that describes best practices for the safe administration of injectable medications. As this document describes, the following practices should be adhered to when preparing and administering injectable medications.

ASEPTIC TECHNIQUE

  • Perform hand hygiene prior to accessing supplies, handling vials and IV solutions, and preparing or administering medications.
  • Use aseptic technique in all aspects of parenteral medication administration, medication vial use, injections and glucose monitoring procedures. Limit access to select trained individuals, if possible.
  • Never administer medication from the same syringe to more than one patient, even if the needle is changed between patients.
  • Never store needles and syringes unwrapped as sterility cannot be assured.
  • Do not set up administration sets ahead of time. Once set up, an administration set should be covered.
  • Do not use intravenous solution bags as a common source of supply for multiple patients.

SINGLE DOSE VIALS

Single dose vials, intended for single patient use, typically lack preservatives. The use of these vials for multiple patients carries substantial risk for bacterial contamination and infection.

  • Do not reuse single dose vials. Enter the vial once and then immediately discard it.
  • Always use a sterile syringe and needle/cannula when entering a vial. Never enter a vial with a syringe or needle/cannula that has been used on a patient.
  • Never combine or pool the leftover contents of single dose vials.

MULTIDOSE VIALS

The use of multidose vials should be avoided whenever possible. If they are used:

  • NEVER re-enter a vial with a used needle OR used syringe.
  • Once medication is drawn up, the needle should be IMMEDIATELY withdrawn from the vial. A needle should NEVER be left in a vial to be attached to a new syringe.
  • Use multidose vial for a single patient whenever possible and mark the vial with the patient’s name.
  • Mark the multidose vial with the date it was first used and ensure that it is discarded at the appropriate time.
  • Adhere to aseptic technique when accessing multidose vials. Multidose vials should be accessed on a surface that is clean and where no dirty, used or potentially contaminated equipment is placed or stored. Scrub the access diaphragm of vials using friction and 70% alcohol. Allow to dry before inserting a new needle and new syringe into the vial.
  • Discard the multidose vial immediately if sterility is questioned or compromised or if the vial is not marked with the patient’s name and original entry date.
  • Review the product leaflet for recommended duration of use after entry of the multidose vial. Discard opened multidose vials according to the manufacturer’s instructions or within 28 days,30 whichever is shorter.