Injection Safety

Nevada Sentinel Events Registry

Nevada Center for Patient Safety

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A principal responsibility for organized medicine is to provide practicing physicians with tools to assist them in their practices. The NSMA is developing supporting materials to help members talk to their patients and their patients’ families about their concerns as a result of this crisis. Even if patients don’t bring the subject up, NSMA is encouraging every physician to say, “Please Ask Me” about the news stories regarding infection control.

The Nevada State Health Division has encouraged patients to ask several questions prior to a surgical procedure (http://health.nv.gov/docs/030308PressRelease.pdf):

• Can you assure me that I am safe in your facility from the transmission of communicable diseases?
• How does the staff at this facility conduct sterilization of diagnostic equipment after each patient use?
• Are single or multiple dose vials used at the facility? Are label instructions followed specifically?
• Are syringes and needles disposed of after each use?
• Has your facility ever received a complaint of the spread of an infectious disease to another patient as a result of staff practices?

NSMA encourages physicians to invite patients (and their families) to ask these or similar questions on the subjects that bother them based on the coverage of the issues and the releases from government agencies. Physicians are encouraged first make sure that they have reviewed the policies & practices. If the practice is in a licensed facility, physicians are encouraged to make sure that they have talked with the risk management department to clarify the facility’s position regarding disclosure and release of information including policies, plans and infection rates.

NSMA recommends that every physician should consider and adopt as appropriate in his/her practice the Centers for Disease Control and Prevention standards for preventing viral hepatitis transmission in ambulatory care settings (http://www.cdc.gov/ncidod/diseases/hepatitis/spotlights/ambulatory.htm). 

“Injection safety” standards are presented at: http://www.cdc.gov/ncidod/diseases/hepatitis/spotlights/ambulatory.pdf). The key standards, which addresses the concerns raised in response to the Las Vegas hepatitis C outbreak, are:

• Use a sterile, single-use, disposable needle and syringe for each injection and discard intact in an appropriate sharps container after use.
• Use single-dose medication vials, pre-filled syringes, and ampules when possible. Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use.
• If multiple-dose vials are used, restrict them to a centralized medication area or for single patient use. Never re-enter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient. Store vials in accordance with manufacturer’s recommendations and discard if sterility is compromised.
• Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.
• Use aseptic technique to avoid contamination of sterile injection equipment and medications.

The Association for Professionals in Infection Control & Epidemiology (APIC) advises (http://apic.informz.net/apic/archives/archive_272235.html) the following points to share with patients:

• The infection prevention & control professionals at our facility have designed a coordinated infection prevention & control program to protect everyone who comes into our facility, including patients, healthcare workers & the public. 
• Our program incorporates evidence-based practices from leading authorities in infection prevention including the CDC. In addition, we comply with regulations from government agencies such as the state & local health departments, OSHA & the Centers for Medicare & Medicaid Services, as well as accrediting bodies, such as The Joint Commission. 
• The essential elements of an infection prevention & control program include:
  • Rigorous hand hygiene practices – that ensures healthcare providers clean their hands before & after giving patient care
  • Monitoring the cleaning, disinfection and sterilization of instruments and equipment used for patient care 
  • An Exposure Control Plan that serves to minimize exposure to bloodborne pathogens such as Hepatitis B, C and HIV by patients and healthcare personnel
    • As part of that plan, there are measures to prevent the re-use of items that are designed to be used only once then disposed of, such as needles and syringes 
    • Additionally, in order to ensure patient safety, our staff is trained to identify a breach in infection control practice and intervene if such practices are identified.

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