Healthcare News & Insights

Misuse of vials: Joint Commission’s recommendations to prevent infections

477442725 (1)In spite of the numerous infection control practices the healthcare industry has implemented, there have been at least 49 outbreaks due to the mishandling of injectable medical products, according to the Centers for Disease Control and Prevention (CDC). And that statistic is very likely on the low side. 

Reason: It’s difficult to trace the misuse of vials to infections, because the impact of misusing a vial is often not seen immediately. Therefore, adverse events related to unsafe injection practices and lapses in infection control practices are under-reported.

Measuring the true frequency of these infections remains a major challenge for the healthcare industry, noted The Joint Commission in its recent Sentinel Alert Event.

Inpatient and outpatient settings

Adverse events caused by this misuse of injectables have occurred in both inpatient and outpatient settings, according to the CDC.

Those misuses of vials primarily involve the reuse of single-dose vials, which are intended to be used once for a single patient. Single-dose vials typically lack preservatives, and because of this using these vials more than once carries a huge risk for bacterial contamination, growth and infection.

A survey of 5,446 healthcare practitioners found the following lapses in basic infection control practices relating to vial use:

  • 6% admitted to sometimes or always using single-dose/single-use vials for multiple patients
  • 15% reported using the same syringe to reenter multiple-dose vials numerous times for the same patients, and of that 15%, 6.5% admitted saving vials for use on another patient, and
  • of the 51 professionals who reported reusing a syringe to obtain an additional dose from a multiple-dose vial and then leaving it for use on another patients, about half (52%) were from the hospital setting.

Another study by the CDC and the Centers for Medicare & Medicaid Services (CMS), which was published in the Journal of the American Medical Association (JAMA), found two-thirds of inspected CMS-certified ambulatory surgical centers had lapses in basic infection control practices. In fact, 28% of these facilities used single-dose vials for multiple patients.

These types of misuse in both in- and outpatient settings have exposed patients to hepatitis B and C viruses, meningitis, and other types of infections.

While these healthcare practitioners may have been focused on trying to prevent waste and save costs, the Joint Commission noted that any costs savings experiences can be wiped out by one single infection.

The Joint Commission guidance

To help prevent the misue of vials and thereby prevent the spread of infection, the Joint Commission has provided the following recommendation and strategies:

Single-dose/single-use vials

  • Use a single-dose/single-use vial for a single patient during the course of a single procedure. Discard the vial after this single use. Used vials should never be returned to stock on clinical units, drug carts, anesthesia carts, etc.
  • If a single-dose/single-use vial must be entered more than once during a single procedure for a single patient to achieve safe and accurate titration of dosage, use a new needle and new syringe for each entry.
  • Do not combine or pool leftover contents of these vials. Never store used vials for later use.
  • Unopened single-dose/single-use vials may be repackaged into multiple single-dose/single-use containers (e.g. syringes), which should be properly labeled, including the expiration date and a beyond-use date (which is different from the manufacturer assigned expiration date).

Multiple-dose vials

  • Only vials clearly labeled by the manufacturer for multiple dose use can be used more than once.
  • Limit the use of these vials to only a single patient, whenever possible, to reduce the risk of contamination.
  • When multiple-dose vials are used more than once, use a new needle and new syringe for each entry. And do not leave needles in vial entry diaphragms between uses.
  • Disinfect the vial’s rubber septum before piercing by wiping with a sterile 70% isopropyl alcohol, ethyl/ethanol alcohol, iodophor or other approved antiseptic swab. Allow septum to dry before inserting a needle.
  • Once a multiple-dose vial is punctured, it should be assigned a “beyond-use date” (28 days for antimicrobial preservatives unless otherwise specified by the manufacturer).
  • Store these vials outside the immediate patient treatment area.

All vials

  • Discard any vial if its sterility has been compromised or is questionable, even if the vial is unopened.
  • Select the smallest vial necessary when making purchasing and treatment decisions.
  • Encourage manufacturers to produce vials in appropriate sizes to reduce waste.

For additional information, check out the CDC’s One & Only Campaign.

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