I'm the associate director for infection control at CDC.

The One and Only Campaign is aimed at raising awareness about safe injection

practices.

Every year millions of injections are administered in the United States.

Every one of them should be safe.

In these videos, we will discuss some of the misperceptions that healthcare

providers might have about safe injection practices.

Evelyn McKnight, AuD, President & Co-Founder HONOReform Foundation

My name is Evelyn McKnight.

In October of 2000 I was diagnosed with breast cancer

and underwent chemotherapy at my local oncology clinic in Fremont, Nebraska.

In less than a year, I experienced a recurrence of breast cancer.

Through the very thorough work-up for the second round of chemotherapy,

we found that I had become infected with Hepatitis C virus. My husband - a

family physician - and I were confounded.

I had no risk factors for Hepatitis C,

no drug abuse, no risky sexual behavior, no transfusions before

1992.

In total 99 patients contracted Hepatitis C at the oncology clinic.

I bet you're asking,

“how did this happen?”

The outbreak occurred because healthcare providers at the clinic did not

follow safe injection practices.

In the last 10 years,

more than 100,000 patients across the country

have been notified that they should be tested for Hepatitis B

Hepatitis C and HIV

due to the reuse of syringes and misuse of medication vials.

Our goal in the following videos is to discuss the basic evidence-based and

common sense precautions

that protect patients and prevent future outbreaks from occurring.

Dr. Gregory is starting his first day working in a pain management clinic.

He is discussing his first patient of the day with Helen, a nurse that has been

with the clinic for 10 years.

Good morning, Helen. How are you?

Fine, good morning.

I see our first patient is Miss Jones, she's here today for a steroid injection

to control her knee pain. Can you show me where we keep all the supplies?

Sure. Why don't you tell me what you need and I'll get the room set up for you?

I'll also draw up the medications. That's okay. I can draw them up myself during the

procedure. I'll just need a vial of lidocaine, a vial of kenalog,

a couple of needles, and one syringe. I already have the drape and skin prep.

One syringe? Aren't you giving two injections?

Yes, but after I inject the lidocaine, I'll just change the needle and draw up

the kenalog.

I'm sorry but I need to stop you right there.

First we use multidose vials of lidocaine and kenalog. Multidose vials must be

drawn up in our medication prep area and they can't enter the patient treatment

area unless we are dedicating them to that patient and discarding them at the end

of the procedure.

More importantly, reusing a syringe to access a medication vial is not

safe,

even if you change the needle.

Besides, changing the needle would only place you at an unnecessary risk

of a needle stick injury. Well I'll make sure not to aspirate to avoid any

contamination of the syringe. That won't prevent contamination.

As you give the injection, blood can travel up the needle into the syringe,

even if you don't aspirate. If you reuse that syringe with or without the

same needle you will contaminate the medication vial and place other patients

at risk of infection.

Thanks for explaining those issues. I would never want do something that

places patients at risk.

No problem.

We're glad to have you here on your rotation but

before you do any procedures you should review our infection protection policies

and procedures which incorporates CDC guidelines.

Some healthcare providers may have heard about the outbreaks due to syringe misuse

and assume they were all caused by reusing syringes or needles from

patient to patient.

In reality many were due to contamination of medication vials that were used

for multiple patients.

All healthcare providers must understand the risk or reusing syringes

or needles to access medication vials.

It is best not to take multidose vials into patient treatment areas

unless they will be dedicated to a single patient.

Multidose vials that are used for more than one patient should be prepared and kept

outside patient treatment areas.

Whenever possible multidose vials should be dedicated to a single patient

to provide an extra layer of protection.

Remember, injection safety is every providers responsibility.

A routine part of anesthesia practice is the administration of IV medications.

Let's observe as Laura,

a practitioner in training,

and Tony, an experienced anesthesia instructor, prepare for the first patient

of the day.

Good morning, Laura.

Good morning. Are you ready for the first case? Yes, I am.

I see you are using a 10cc syringe for the Propofol. What

are you planning on doing with the leftover propofol in the vial?

Since I only need 10ccs for this case, I'll keep in the cart for the next patient. No,

it's not appropriate to use a single-use medication vial for multiple patients.

It's important that we adhere to the manufacturers labeling for medication and propofol

is labeled as single-use. Any medication not used for this patient

should be discarded at the end of the case.

Okay, but I have another question for you.

Is it okay to a continue using a medication from this same syringe for the same patient. Yes,

we can titrate dosage from a filled syringe for individual patient

provided the syringes handled aseptically and discarded at the end of the

case.

Is it okay to use the same syringe to draw up more propofol if the patient needs

it? No,

once used syringes are considered contaminated and should not be used to

draw up more medication. Even for the same patient.

I understand that syringes and needles are single-use items and can't be used for

more than one patient, but if I'm going to throw the vial out at the end of the case

anyway why can't I reuse the needle and syringe to draw up more medication? It's all for the

same patient.

Using a new needle and a new syringe every time we enter the medication vial

adds an extra layer of safety in case, for some reason, the vial is not discarded

like it should be.

To protect patients and ensure that medications are sterile,

single-dose and single-use vials should not be used for more than one patient.

Always use a new sterile needle and a new sterile syringe to access

medications.

Remember that injection safety

is every provider's responsibility.

The next scene occurs in an oncology clinic where an experienced oncology nurse practitioner,

Claire,

is orienting a new registered nurse, Christine.

Claire and Christine had been reviewing the clinic's protocol for catheter

flushing.

Let's listen to the discussion.

I have a question about the policy on line flushing -

it said to use a pre-filled syringe of normal saline

and at the clinic where I last worked

we drew saline from a liter bag that was hung over the sink in the medication

room. No, that can cause the saline bag to be contaminated

and lead to infection in large numbers of patients.

Saline bags are labeled as single-use and should only be

used for one person.

Pre-filled syringes either from a manufacturer or prepared in a pharmacy

can prevent the transmission of bloodborne and other pathogens.

But I thought changing the needle prevented contamination.

During the flushing process, you have to aspirate blood to be sure that the line is

patient right.

Yes.

Traces of blood, which can't be seen by the naked eye,

can coat the inside of the needle and syringe.

If that syringe is then used to then access the bag of saline,

blood with viruses and other pathogens

can wind up in the bag.

That contaminated bag places any other patients that receive saline from that

bag at risk for infection.

Changing the needle won't prevent this from happening

and can put you at risk for a needle stick injury.

Remember

even if you don't aspirate you can still get backflow of blood into the syringe.

Using pre-filled syringes adds a layer of safety for patients undergoing this

procedure.

We follow the One-One-One rule here -

one needle, one syringe,

one time.

We never reuse needles or syringes.

They're used for only one patient and only one time.

We also dispose of used equipment right away to prevent injuries or

reuse.

Thank you for that clarification.

Why sure. I'm glad you came in.

Remember, saline bags are single-use and should not be used as a common supply for

multiple patients.

Always use a new sterile needle and a new sterile syringe to access medications.

Changing the needle does not prevent contamination

and remember,

injection safety is every provider's responsibility.

In this short video, we will review some key points of safe injection practices.

Safe injection practices ensure the safety of patients healthcare personnel

and others.

As defined by the World Health Organization, a safe injection does not

harm the recipient,

does not expose the provider to avoidable risks,

and does not result in waste that is dangerous for the community.

There have been numerous outbreaks of bloodborne and other pathogens

reported in the United States due to lapses in safe injection practices.

Here are some examples of dangerousness misperceptions that healthcare providers

might have regarding safety injection practices.

One myth is that contamination of injection devices is limited to the

needle

and that removing the needle makes the syringe safe for reuse.

The truth is that once they are used both the needle and the syringe are

contaminated and must be discarded.

A new sterile syringe and a new sterile needle should always be used for each

patient and to access medication vials.

Another myth is that IV tubing or valves can prevent backflow and contamination

of injection devices.

The truth is that everything from the medication bag to the patient's IV

catheter is a single interconnected unit.

Distance from the patient, gravity, or even positive infusion pressure do not

ensure that small amounts of blood won't contaminate the supply.

Another myth is that if you don't see blood in the IV tubing or injection

equipment there isn't a risk of cross-contamination.

The truth is the pathogens including Hepatitis C and B viruses and HIV

can be present in sufficient quantities to produce infection

without any visible blood.

And finally, the last myth is that single use vials with large volumes that

appear to contain multiple doses

can be used for more than one patient.

The truth is that

single-use vials should not be used for more than one patient

regardless of the vial size.

The following practices will help safeguard patients from transmission of

bloodborne and other pathogens.

Needles and syringes are single-use devices.

They should not be used for more than one patient or reused to access medication

vials.

Once they are used the syringe and needle are both contaminated and must be discarded.

Do not administer medications from single-does vials,

Ampoules, pre-filled syringes

or intravenous bags to multiple patients

and never combine leftover contents for later use.

In general,

limit the use of multidose vials whenever possible.

As you've heard, single-does vials should only be used for a single patient.

In addition,

if multidose vials are used they should be dedicated to single patient whenever

possible.

This adds an extra layer of protection by minimizing the chance that a

contaminated vial

will be used on another patient.

Injection safety is every provider's responsibility.

Every injection should be safe.

Anyone should be able to stop a procedure if they think it isn't safe.

Please go to the website on your screen for more information and thank you

for doing your part for making every injection safe.