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  • Hello I'm Doctor Mike Bell.

  • I'm the associate director for infection control at CDC.

  • The One and Only Campaign is aimed at raising awareness about safe injection

  • practices.

  • Every year millions of injections are administered in the United States.

  • Every one of them should be safe.

  • In these videos, we will discuss some of the misperceptions that healthcare

  • providers might have about safe injection practices.

  • Evelyn McKnight, AuD, President & Co-Founder HONOReform Foundation

  • My name is Evelyn McKnight.

  • In October of 2000 I was diagnosed with breast cancer

  • and underwent chemotherapy at my local oncology clinic in Fremont, Nebraska.

  • In less than a year, I experienced a recurrence of breast cancer.

  • Through the very thorough work-up for the second round of chemotherapy,

  • we found that I had become infected with Hepatitis C virus. My husband - a

  • family physician - and I were confounded.

  • I had no risk factors for Hepatitis C,

  • no drug abuse, no risky sexual behavior, no transfusions before

  • 1992.

  • In total 99 patients contracted Hepatitis C at the oncology clinic.

  • I bet you're asking,

  • how did this happen?”

  • The outbreak occurred because healthcare providers at the clinic did not

  • follow safe injection practices.

  • In the last 10 years,

  • more than 100,000 patients across the country

  • have been notified that they should be tested for Hepatitis B

  • Hepatitis C and HIV

  • due to the reuse of syringes and misuse of medication vials.

  • Our goal in the following videos is to discuss the basic evidence-based and

  • common sense precautions

  • that protect patients and prevent future outbreaks from occurring.

  • Dr. Gregory is starting his first day working in a pain management clinic.

  • He is discussing his first patient of the day with Helen, a nurse that has been

  • with the clinic for 10 years.

  • Good morning, Helen. How are you?

  • Fine, good morning.

  • I see our first patient is Miss Jones, she's here today for a steroid injection

  • to control her knee pain. Can you show me where we keep all the supplies?

  • Sure. Why don't you tell me what you need and I'll get the room set up for you?

  • I'll also draw up the medications. That's okay. I can draw them up myself during the

  • procedure. I'll just need a vial of lidocaine, a vial of kenalog,

  • a couple of needles, and one syringe. I already have the drape and skin prep.

  • One syringe? Aren't you giving two injections?

  • Yes, but after I inject the lidocaine, I'll just change the needle and draw up

  • the kenalog.

  • I'm sorry but I need to stop you right there.

  • First we use multidose vials of lidocaine and kenalog. Multidose vials must be

  • drawn up in our medication prep area and they can't enter the patient treatment

  • area unless we are dedicating them to that patient and discarding them at the end

  • of the procedure.

  • More importantly, reusing a syringe to access a medication vial is not

  • safe,

  • even if you change the needle.

  • Besides, changing the needle would only place you at an unnecessary risk

  • of a needle stick injury. Well I'll make sure not to aspirate to avoid any

  • contamination of the syringe. That won't prevent contamination.

  • As you give the injection, blood can travel up the needle into the syringe,

  • even if you don't aspirate. If you reuse that syringe with or without the

  • same needle you will contaminate the medication vial and place other patients

  • at risk of infection.

  • Thanks for explaining those issues. I would never want do something that

  • places patients at risk.

  • No problem.

  • We're glad to have you here on your rotation but

  • before you do any procedures you should review our infection protection policies

  • and procedures which incorporates CDC guidelines.

  • Some healthcare providers may have heard about the outbreaks due to syringe misuse

  • and assume they were all caused by reusing syringes or needles from

  • patient to patient.

  • In reality many were due to contamination of medication vials that were used

  • for multiple patients.

  • All healthcare providers must understand the risk or reusing syringes

  • or needles to access medication vials.

  • It is best not to take multidose vials into patient treatment areas

  • unless they will be dedicated to a single patient.

  • Multidose vials that are used for more than one patient should be prepared and kept

  • outside patient treatment areas.

  • Whenever possible multidose vials should be dedicated to a single patient

  • to provide an extra layer of protection.

  • Remember, injection safety is every providers responsibility.

  • A routine part of anesthesia practice is the administration of IV medications.

  • Let's observe as Laura,

  • a practitioner in training,

  • and Tony, an experienced anesthesia instructor, prepare for the first patient

  • of the day.

  • Good morning, Laura.

  • Good morning. Are you ready for the first case? Yes, I am.

  • I see you are using a 10cc syringe for the Propofol. What

  • are you planning on doing with the leftover propofol in the vial?

  • Since I only need 10ccs for this case, I'll keep in the cart for the next patient. No,

  • it's not appropriate to use a single-use medication vial for multiple patients.

  • It's important that we adhere to the manufacturers labeling for medication and propofol

  • is labeled as single-use. Any medication not used for this patient

  • should be discarded at the end of the case.

  • Okay, but I have another question for you.

  • Is it okay to a continue using a medication from this same syringe for the same patient. Yes,

  • we can titrate dosage from a filled syringe for individual patient

  • provided the syringes handled aseptically and discarded at the end of the

  • case.

  • Is it okay to use the same syringe to draw up more propofol if the patient needs

  • it? No,

  • once used syringes are considered contaminated and should not be used to

  • draw up more medication. Even for the same patient.

  • I understand that syringes and needles are single-use items and can't be used for

  • more than one patient, but if I'm going to throw the vial out at the end of the case

  • anyway why can't I reuse the needle and syringe to draw up more medication? It's all for the

  • same patient.

  • Using a new needle and a new syringe every time we enter the medication vial

  • adds an extra layer of safety in case, for some reason, the vial is not discarded

  • like it should be.

  • To protect patients and ensure that medications are sterile,

  • single-dose and single-use vials should not be used for more than one patient.

  • Always use a new sterile needle and a new sterile syringe to access

  • medications.

  • Remember that injection safety

  • is every provider's responsibility.

  • The next scene occurs in an oncology clinic where an experienced oncology nurse practitioner,

  • Claire,

  • is orienting a new registered nurse, Christine.

  • Claire and Christine had been reviewing the clinic's protocol for catheter

  • flushing.

  • Let's listen to the discussion.

  • I have a question about the policy on line flushing -

  • it said to use a pre-filled syringe of normal saline

  • and at the clinic where I last worked

  • we drew saline from a liter bag that was hung over the sink in the medication

  • room. No, that can cause the saline bag to be contaminated

  • and lead to infection in large numbers of patients.

  • Saline bags are labeled as single-use and should only be

  • used for one person.

  • Pre-filled syringes either from a manufacturer or prepared in a pharmacy

  • can prevent the transmission of bloodborne and other pathogens.

  • But I thought changing the needle prevented contamination.

  • During the flushing process, you have to aspirate blood to be sure that the line is

  • patient right.

  • Yes.

  • Traces of blood, which can't be seen by the naked eye,

  • can coat the inside of the needle and syringe.

  • If that syringe is then used to then access the bag of saline,

  • blood with viruses and other pathogens

  • can wind up in the bag.

  • That contaminated bag places any other patients that receive saline from that

  • bag at risk for infection.

  • Changing the needle won't prevent this from happening

  • and can put you at risk for a needle stick injury.

  • Remember

  • even if you don't aspirate you can still get backflow of blood into the syringe.

  • Using pre-filled syringes adds a layer of safety for patients undergoing this

  • procedure.

  • We follow the One-One-One rule here -

  • one needle, one syringe,

  • one time.

  • We never reuse needles or syringes.

  • They're used for only one patient and only one time.

  • We also dispose of used equipment right away to prevent injuries or

  • reuse.

  • Thank you for that clarification.

  • Why sure. I'm glad you came in.

  • Remember, saline bags are single-use and should not be used as a common supply for

  • multiple patients.

  • Always use a new sterile needle and a new sterile syringe to access medications.

  • Changing the needle does not prevent contamination

  • and remember,

  • injection safety is every provider's responsibility.

  • In this short video, we will review some key points of safe injection practices.

  • Safe injection practices ensure the safety of patients healthcare personnel

  • and others.

  • As defined by the World Health Organization, a safe injection does not

  • harm the recipient,

  • does not expose the provider to avoidable risks,

  • and does not result in waste that is dangerous for the community.

  • There have been numerous outbreaks of bloodborne and other pathogens

  • reported in the United States due to lapses in safe injection practices.

  • Here are some examples of dangerousness misperceptions that healthcare providers

  • might have regarding safety injection practices.

  • One myth is that contamination of injection devices is limited to the

  • needle

  • and that removing the needle makes the syringe safe for reuse.

  • The truth is that once they are used both the needle and the syringe are

  • contaminated and must be discarded.

  • A new sterile syringe and a new sterile needle should always be used for each

  • patient and to access medication vials.

  • Another myth is that IV tubing or valves can prevent backflow and contamination

  • of injection devices.

  • The truth is that everything from the medication bag to the patient's IV

  • catheter is a single interconnected unit.

  • Distance from the patient, gravity, or even positive infusion pressure do not

  • ensure that small amounts of blood won't contaminate the supply.

  • Another myth is that if you don't see blood in the IV tubing or injection

  • equipment there isn't a risk of cross-contamination.

  • The truth is the pathogens including Hepatitis C and B viruses and HIV

  • can be present in sufficient quantities to produce infection

  • without any visible blood.

  • And finally, the last myth is that single use vials with large volumes that

  • appear to contain multiple doses

  • can be used for more than one patient.

  • The truth is that

  • single-use vials should not be used for more than one patient

  • regardless of the vial size.

  • The following practices will help safeguard patients from transmission of

  • bloodborne and other pathogens.

  • Needles and syringes are single-use devices.

  • They should not be used for more than one patient or reused to access medication

  • vials.

  • Once they are used the syringe and needle are both contaminated and must be discarded.

  • Do not administer medications from single-does vials,

  • Ampoules, pre-filled syringes

  • or intravenous bags to multiple patients

  • and never combine leftover contents for later use.

  • In general,

  • limit the use of multidose vials whenever possible.

  • As you've heard, single-does vials should only be used for a single patient.

  • In addition,

  • if multidose vials are used they should be dedicated to single patient whenever

  • possible.

  • This adds an extra layer of protection by minimizing the chance that a

  • contaminated vial

  • will be used on another patient.

  • Injection safety is every provider's responsibility.

  • Every injection should be safe.

  • Anyone should be able to stop a procedure if they think it isn't safe.

  • Please go to the website on your screen for more information and thank you

  • for doing your part for making every injection safe.

Hello I'm Doctor Mike Bell.

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B2 syringe patient injection needle medication vial

Injection Safety Video

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    kuoyumei posted on 2014/06/04
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