Reusing Single-Dose Vials.
Reusing Single-Dose Vials.
Reusing Single-Dose Vials.
http://www.medscape.com/viewarticle/768187_3
Posted: 08/02/2012
Reusing Healthcare
The Single-Use/Single-Dose Vial
Reusing Healthcare
The problem of reuse of single-use medical items and devices is not new. Almost as
soon as healthcare began adopting single-use and disposable items in the 1970s for
purposes of infection control, the reuse of such items began as a cost-saving measure.
Despite infection control guidance to the contrary, in 2008, 20%-30% of US hospitals
reported that they reused at least 1 type of single-use device.[1]
Evidence suggests that reuse practices extend to sterile vials of injectable drugs intended
for one-time use. For example, some nurses and other healthcare providers admit to
practices such as re-entering single-dose/single-use sterile vials after the initial access,
either for the same or different patients, or inappropriately diluting contents of single-
dose vials. A 2012 online survey[2] of 5446 healthcare practitioners found that 6% of
respondents sometimes or always used single-dose/single-use vials for multiple patients,
15% used the same syringe to re-enter multidose vials, and 9% sometimes or always
used a common bag or bottle of intravenous solution as a source of flushes and drug
diluents for multiple patients. Comments made by respondents suggest that healthcare
practitioners have many misconceptions about injection safety with single-use vials.
Vials intended for single use are labeled "single use/single dose" for a very good reason.
These vials contain no preservative or antimicrobial to prevent bacterial contamination.
Because such contamination is not visible to the human eye, it must be assumed that
once the stopper is penetrated or the ampule is broken, contamination may have
occurred despite our best intentions, posing a risk for serious infection to the patient
who next receives contents withdrawn from the vial.
If a healthcare provider breaks infection control technique when preparing and giving a
sterile injection (forgets to wash hands, fails to prepare the skin, accidentally touches
the needle, etc.) the risk of introducing infection to that patient rises. This risk has
always been present and probably happens more than we realize. Still, we hope that
when this happens, only that patient will suffer the consequences of our lapse in proper
technique. When a healthcare provider inadvertently contaminates a single-use vial and
reuses that vial for more than 1 patient, it is not only a single infection that can follow,
but an outbreak.
What did these healthcare professionals do, or not do, that transmitted MRSA to these
patients? Although the primary lapse in injection safety technique was determined to be
the use of a single-dose vial for multiple patients, the investigation also found that staff
were not wearing facemasks during spinal injection procedures.
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