CDC - Safe Injection Practices

[101N]

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http://www.cdc.gov/injectionsafety/IP07_standardPrecaution.html


Safe Injection Practices to Prevent Transmission of Infections to Patients

Download the complete 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [PDF - 3.80 MB]


III.A.1.b. Safe Injection Practices The investigation of four large outbreaks of HBV and HCV among patients in ambulatory care facilities in the United States identified a need to define and reinforce safe injection practices 453. The four outbreaks occurred in a private medical practice, a pain clinic, an endoscopy clinic, and a hematology/oncology clinic. The primary breaches in infection control practice that contributed to these outbreaks were 1) reinsertion of used needles into a multiple-dose vial or solution container (e.g., saline bag) and 2) use of a single needle/syringe to administer intravenous medication to multiple patients. In one of these outbreaks, preparation of medications in the same workspace where used needle/syringes were dismantled also may have been a contributing factor. These and other outbreaks of viral hepatitis could have been prevented by adherence to basic principles of aseptic technique for the preparation and administration of parenteral medications 453, 454. These include the use of a sterile, single-use, disposable needle and syringe for each injection given and prevention of contamination of injection equipment and medication.
Whenever possible, use of single-dose vials is preferred over multiple-dose vials, especially when medications will be administered to multiple patients. Outbreaks related to unsafe injection practices indicate that some healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic technique. A survey of US healthcare workers who provide medication through injection found that 1% to 3% reused the same needle and/or syringe on multiple patients 905. Among the deficiencies identified in recent outbreaks were a lack of oversight of personnel and failure to follow-up on reported breaches in infection control practices in ambulatory settings. Therefore, to ensure that all healthcare workers understand and adhere to recommended practices, principles of infection control and aseptic technique need to be reinforced in training programs and incorporated into institutional polices that are monitored for adherence 454.
III.A.1.c. Infection Control Practices for Special Lumbar Puncture Procedues In 2004, CDC investigated eight cases of post-myelography meningitis that either were reported to CDC or identified through a survey of the Emerging Infections Network of the Infectious Disease Society of America. Blood and/or cerebrospinal fluid of all eight cases yielded streptococcal species consistent with oropharyngeal flora and there were changes in the CSF indices and clinical status indicative of bacterial meningitis. Equipment and products used during these procedures (e.g., contrast media) were excluded as probable sources of contamination. Procedural details available for seven cases determined that antiseptic skin preparations and sterile gloves had been used. However, none of the clinicians wore a face mask, giving rise to the speculation that droplet transmission of oralpharyngeal flora was the most likely explanation for these infections. Bacterial meningitis following myelogram and other spinal procedures (e.g., lumbar puncture, spinal and epidural anesthesia, intrathecal chemotherapy) has been reported previously 906-915. As a result, the question of whether face masks should be worn to prevent droplet spread of oral flora during spinal procedures (e.g., myelogram, lumbar puncture, spinal anesthesia) has been debated 916, 917. Face masks are effective in limiting the dispersal of oropharyngeal droplets 918 and are recommended for the placement of central venous catheters 919. In October 2005, the Healthcare Infection Control Practices Advisory Committee (HICPAC) reviewed the evidence and concluded that there is sufficient experience to warrant the additional protection of a face mask for the individual placing a catheter or injecting material into the spinal or epidural space.
Recommendations

IV.H. Safe injection practices The following recommendations apply to the use of needles, cannulas that replace needles, and, where applicable intravenous delivery systems
IV.H.1. Use aseptic technique to avoid contamination of sterile injection equipment 1002, 1003. Category IA
IV.H.2. Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient 453, 919, 1004, 1005. Category IA
IV.H.3. Use fluid infusion and administration sets (i.e., intravenous bags, tubing and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set 453. Category IB
IV.H.4. Use single-dose vials for parenteral medications whenever possible 453. Category IA
IV.H.5. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use 369 453, 1005. Category IA
IV.H.6. If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile 453, 1002. Category IA
IV.H.7. Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable 453, 1003. Category IA
IV.H.8. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients 453, 1006. Category IB
IV.I. Infection control practices for special lumbar puncture procedures Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anesthesia 906 907-909 910, 911 912-914, 918 1007. Category IB

 

[101N]

https://www.cms.gov/manuals/downloads/som107ap_l_ambulatory.pdf

§416.48(a) Standard:

Administration of Drugs
Drugs must be prepared and administered according to established policies and
acceptable standards of practice
Interpretive Guidelines: §416.48(a)
Drugs and biologicals used within the ASC must be administered to patients in
accordance with formal policies the ASC has adopted, and those policies and the ASC’s
actual practices must conform to acceptable standards of practice for medication
administration.“Accepted professional practice” and “acceptable standards of practice” mean that
drugs and biologicals are handled and provided in the ASC in accordance with
applicable State and Federal laws as well as with standards established by organizations
with nationally recognized expertise in the clinical use of drugs and biologicals. This
would include organizations such as the National Association of Boards of Pharmacy,
the Institute for Safe Medication Practices, the American Society of Health-System
Pharmacists, etc.
The ASC must have policies and procedures designed to promote medication
administration consistent with acceptable standards of practice. The policies and
procedures should address issues including, but not limited to:
• A physician or other qualified member of the medical staff acting within their
scope of practice must issue an order for all drugs or biologicals administered
in the ASC. The administration of the drugs or biologicals must be by, or under
the supervision of, nursing or other personnel in accordance with applicable
laws, standards of practice and the ASC’s policies.
• Following the manufacturer’s label, including storing drugs and biologicals as
directed; disposing of expired medications in a timely manner; using single-dose
vials of medication for one ASC patient only; etc.
• Avoiding preparation of medications too far in advance of their use. For
example, while it may appear efficient to pre-draw the evening before all
medications that will be used for surgeries scheduled the following day, this
practice may, depending on the particular drug or biological, promote loss of
integrity, stability or security of the medication.
• Any pre-filled syringes must be initialed by the person who draws it, dated and
timed to indicate when they were drawn, and labeled as to both content and
expiration date.
• Employing standard infection control practices when using injectable
medications.
There must be records of receipt and disposition of all drugs listed in Schedules II, III,
IV, and V of the Comprehensive Drug Abuse Prevention and Control Act of 1970, if the
ASC uses any such scheduled drugs. The ASC’s policies and procedures should also
address the following:
• Accountability procedures to ensure control of the distribution, use, and
disposition of all scheduled drugs.
• Records of the receipt and disposition of all scheduled drugs must be current and
must be accurate.• Records to trace the movement of scheduled drugs throughout the ASC.
• The licensed health care professional who has been designated responsible for
the ASC’s pharmaceutical services is responsible for determining that all drug
records are in order and that an account of all scheduled drugs is maintained
and reconciled.
• The record system, delineated in policies and procedures, tracks movement of all
scheduled drugs from the point of entry into the ASC to the point of departure,
either through administration to the patient, destruction, or return to the
manufacturer. This system provides documentation on scheduled drugs in a
readily retrievable manner to facilitate reconciliation of the receipt and
disposition of all scheduled drugs.
• All drug records are in order and an account of all scheduled drugs is
maintained and any discrepancies in count are reconciled promptly.
• The ASC’s system is capable of readily identifying loss or diversion of all
controlled substances in such a manner as to minimize the time frame between
the actual loss or diversion to the time of detection and determination of the
extent of loss or diversion?

 

[PMR 4 MSK]

III.A.1.c. Infection Control Practices for Special Lumbar Puncture Procedues In 2004, CDC investigated eight cases of post-myelography meningitis that either were reported to CDC or identified through a survey of the Emerging Infections Network of the Infectious Disease Society of America. Blood and/or cerebrospinal fluid of all eight cases yielded streptococcal species consistent with oropharyngeal flora and there were changes in the CSF indices and clinical status indicative of bacterial meningitis. Equipment and products used during these procedures (e.g., contrast media) were excluded as probable sources of contamination. Procedural details available for seven cases determined that antiseptic skin preparations and sterile gloves had been used. However, none of the clinicians wore a face mask, giving rise to the speculation that droplet transmission of oralpharyngeal flora was the most likely explanation for these infections. Bacterial meningitis following myelogram and other spinal procedures (e.g., lumbar puncture, spinal and epidural anesthesia, intrathecal chemotherapy) has been reported previously 906-915. As a result, the question of whether face masks should be worn to prevent droplet spread of oral flora during spinal procedures (e.g., myelogram, lumbar puncture, spinal anesthesia) has been debated 916, 917. Face masks are effective in limiting the dispersal of oropharyngeal droplets 918 and are recommended for the placement of central venous catheters 919. In October 2005, the Healthcare Infection Control Practices Advisory Committee (HICPAC) reviewed the evidence and concluded that there is sufficient experience to warrant the additional protection of a face mask for the individual placing a catheter or injecting material into the spinal or epidural space.
Recommendations

IV.I. Infection control practices for special lumbar puncture procedures Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space (i.e., during myelograms, lumbar puncture and spinal or epidural anesthesia 906 907-909 910, 911 912-914, 918 1007. Category IB

I guess since the lawyers have access to this information as well, we all should be wearing masks.

 

[101N]

I guess since the lawyers have access to this information as well, we all should be wearing masks.

These rules - masks & labels - are being rolled out in hospitals and ASCs out across the US. There is usually little discussion with us - the people who perform the injections.

 

[Gauss]

I dislike wearing masks but it's not that big of a deal. The labeling part annoys the crap out of me

 

[101N]

I dislike wearing masks but it's not that big of a deal. The labeling part annoys the crap out of me

Agreed. Wait till they hit ya with the single dose vial requirements, for Omnipaque. Lovely🙁