Safe Injection Practices in Long Term Care

Susan M Cleveland BSN, RN, WCC, CDP Director of Nursing Services, ICP, Inc.
As a result of the White House Conference on Aging updating the infection prevention and control program, which included an antibiotic stewardship program with protocols monitoring antibiotic use. This no doubt has a direct impact on the Center for Medicare and Medicaid Services (CMS) Final Rule, especially Phase 2 and Phase 3 taking effect November 28, 2017 and November 28, 2019, respectively. A huge portion of infection prevention and control is adhering to safety and prevention policies, one of which is safe injection practice.
Investigations of HBV and HCV outbreaks among patients in ambulatory care facilities identified a need to define and reinforce safe injection practices. The primary breaches in infection control practice that contributed to these outbreaks were reinsertion of used needles into a multiple-dose vial or solution container and use of a single needle or syringe to administer intravenous medication to multiple patients. These and other outbreaks of viral hepatitis could have been prevented by adherence to basic principles of aseptic technique.
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. Among the deficiencies identified in outbreaks were a lack of oversight of personnel and failure to follow-up on reported breaches in infection control practices. 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.
Over the past few years there has been a lot of media attention surrounding disease outbreaks caused from unsafe injection practices. In response to this, the Centers for Disease Control and Prevention (CDC) and Safe Injection Practices Coalition (SIPC) have joined to educate healthcare providers and the public on safe injection practices.

What you can do:
It is important to remember that needles and syringes are single use devices. The following are other ways you can ensure safe injection practices:
  • Wash your hands before administering an injection.
  • Use a clean needle and syringe to draw up and administer medication.
  • Use a syringe to administer medication to only one person—this includes accessing the vial with a syringe that has already been used to administer medication to another patient.
  • Never use a common bag of saline or other IV fluid for more than one person, or by accessing the bag with a syringe that has already been used to flush another person’s IV line.
Learn more and share:
It takes a team infographic—from the AHRQ Safety Program for Ambulatory Surgery (funded by AHRQ, developed by APIC and HRET)
Injection safety tips—The Centers for Disease Control and Prevention
Safe injections—Speak up and stay alert—Infection Prevention and You
Single-dose or multi-dose vials—The One and Only Campaign
The One and Only Campaign
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