infection prevention
By Margaret M . Miller , BS , MT ( ASCP ) M , CIC , FAPIC , and Christina Michalek , BS , RPh , FASHP
In response to the HIV / AIDS epidemic in the early-mid 1980s , Universal
Precautions were created by the Centers for Disease Control and Prevention
( CDC ) and applied blood and body fluid precautions to all patients , regardless of infection status .
Safe Injection Practices in Ambulatory Care Settings
Injection safety is a set of practices followed to perform injections in a manner that is safe for patients , staff , and others . Injection safety also includes practices to prevent sharps injuries and contamination of medications .
The primary objective in injection safety is preventing transmission of hepatitis B virus ( HBV ), hepatitis C virus ( HCV ), and human immunodeficiency virus ( HIV ). In response to the HIV / AIDS epidemic in the early-mid 1980s , Universal Precautions were created by the Centers for Disease Control and Prevention ( CDC ) and applied blood and body fluid precautions to all patients , regardless of infection status . Universal Precautions guidelines recommended the use of personal protective equipment to protect mucous membranes , hand hygiene , and methods for safely handling needles and other sharp devices ; this concept became integral to the Occupational Safety and Health Administration ( OSHA )’ s 1991 regulation on occupational exposure to bloodborne pathogens in healthcare settings . In 1996 , the Healthcare Infection Control Practices Advisory Committee ( HICPAC ) Guideline for Isolation Precautions in Hospitals replaced Universal Precautions with Standard Precautions , which we continue to follow to this day .
OSHA ’ s Bloodborne Pathogens standard (
29 CFR 1910.1030 ) revision in 2001 specified in greater detail the engineering controls , such as non-needle devices and other safety features , which must be used to reduce or eliminate worker exposure . The standard places these requirements on employers whose workers can reasonably anticipate contact with blood or other potentially infectious materials .
Despite recommendations from HICPAC and OSHA , outbreaks and patient exposures to potentially infectious bodily fluids continue to be reported . The largest outbreak of HCV occurred at an outpatient endoscopy center where a cluster of patients developed acute HCV infection after their procedures . An investigation uncovered unsafe injection practices including reuse of patient syringes to access propofol vials . The single-dose vials ( SDVs ) were then reused for subsequent patients , transmitting potentially contaminated medication to those patients . More than 50,000 patients were notified of exposure and the need for HBV , HCV , and HIV testing . The final cost of the outbreak was estimated to be $ 16 million to $ 21 million . In the end , every exposure was preventable and would not have occurred if staff had adhered to established safe injection practices .
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Safe Injection Practices
Following safe injection practices and aseptic technique during the preparation and administration of medications is a priority . Always perform hand hygiene and work on a clean surface , preferably in a separate medication preparation area , not in a patient-care area . Other essential elements include :
Never administer medications from the same syringe to more than one patient , even if the needle is changed .
● Needles and syringes are sterile , single-use items
● Never enter a vial with a used syringe or needle
● Do not use bags of intravenous ( IV ) solution as a common source of supply for more than one patient
● Limit the use of multi-dose vials ( MDVs ) and dedicate them to a single patient whenever possible
● Always use facemasks when injecting material or inserting a catheter into the epidural or subdural space
● Prepare injectable medications as close as possible to the time of administration , rather than in advance
Procedures identified as prone to unsafe injection practices include :
● Administration of sedatives and anesthetics for surgical , diagnostic , and pain management
● Administration of IV medications for chemotherapy , cosmetic procedures , and alternative medicine therapies
● Use of saline solutions to flush IV lines and catheters
● Administration of joint injections
Medication Safety Recommendations for Ambulatory Care Settings
Employ safe practices for IV push medications :
● Do not further dilute IV push doses of medication unless recommended by the drug ’ s manufacturer or supported by evidence in peer-reviewed biomedical literature