HEALTHCARE-ASSOCIATED INFECTIONS PROGRAM

Safe Injection Practices

Last Updated 2017

Basics of Infection Prevention

Healthcare-Associated Infections Program
Center for Health Care Quality
California Department of Public Health
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Objectives

• Describe how injection safety protects patients

• Discuss risk of unsafe injection practices
• Promote use of the Injection Safety Checklist
• Describe how injection safety protects health care workers
• Discuss a safety culture
• Describe methods to create a facility-wide injection
safety program to protect health care workers
• Review Safe Injection Practices (SIP) resources
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Hepatitis B and C Outbreaks Associated with

Unsafe Infection Practices
• CDC aware of 44 outbreaks of hepatitis B and C in non-
hospital settings in U.S., 2008-2015
• Outbreaks occurred due to injection safety breaches
• Reuse of syringes
• Contaminated medication vials used for more than one
patient
• Use of single-dose vials for more than one patient

CDC, 2015
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Hepatitis Outbreaks Associated with Unsafe

Infection Practices in California
• 6 outbreaks, 2008-2015
• 2678 persons notified and screened
• 27 cases of Hepatitis B or C identified
• Multiple settings
• 2 skilled nursing facilities
• 2 assisted living facilities
• 1 pain management clinic
• 1 outpatient dialysis clinic
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What are Safe Injection Practices?

• A set of measures to perform injections in an optimally
safe manner for patients, healthcare providers, and others
• Prevent transmission of infection from
• Provider to patient
• Patient to patient
• Patient to provider
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Safe Injection Practices are Part of Standard

Precautions
• Hand hygiene
• Use of personal protective equipment
• Safe injection practices
• Safe handling of potentially contaminated equipment or
surfaces in the patient environment
• Respiratory hygiene and cough etiquette
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Safe Injection = No Infection

Injection safety includes:
1. Safe production
• sterile medication
2. Safe preparation
• right dose, prepared in a clean area
3. Safe administration
• adherence to standard precautions
4. Safe disposal:
• minimize risks to patients and health care providers
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Aseptic Technique During the Preparation and

Administration of Injected Medications
• Perform hand hygiene
• Draw up medications in a designated clean medication area
• Area must not be adjacent to areas where potentially
contaminated items are placed
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Needles and Syringes: One Time Use ONLY

• Needles used for only one patient

• Syringes used for only one patient
• Includes manufactured prefilled
syringes
• Cartridge devices
• Insulin pens

CDC One and Only Campaign

http://www.oneandonlycampaign.org
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Injection Safety for Diabetic Patients

• Insulin pens containing more than one dose of insulin are
only meant for one person
• For glucose testing, clean the glucometer after every use
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Always Clean the Tops of Medication Vials

Before Entry
• Cleanse access diaphragms of medication vials using friction
with 70% alcohol
• Allow the alcohol to dry before inserting a device into the
vial
• Clean the tops of vials with alcohol even if they have lids or
caps
• Manufacturers guarantee sterility of medications and IV
solutions but not the outside of medication vials or
containers
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Single-Dose Vials: One Patient and Only Once

• Carefully read the vial • Single use medications
label to determine if it is should not be stores for
single-use future use
• Never enter a medication • Discard according to the
vial with a used syringe or manufacturer’s
needle expiration date
• If the vial says “single- • When in doubt, throw it
dose” and has already out!
been accessed, throw it
away
CDC Injection Safety
cdc.gov/injectionsafety
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Multi-Dose Vials
• Limit the use of multi-dose vials
• When possible, dedicate them to a single patient
• A multiple–dose vial is recognized by its FDA-approved label
• Discard multi-dose vials when the beyond-use date has
been reached
• Any time the sterility of the vial is in question, throw it out !

CDC Injection Safety

cdc.gov/injectionsafety
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Multi-Dose Vials -2
• Multi-dose vials used for more than one patient must be
kept in a centralized medication area
• Multi-dose vials should never enter the immediate patient
treatment area (e.g., patient rooms, operating rooms)
• Multi-dose vials should be dated by the health care worker
when first opened and discarded within 28 days
• Unless the manufacturer specifies a different expiration
date for an opened vial shorter than 28 days
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Use Bags of Intravenous Solutions for One

Patient Only
• Do not use bags of intravenous solution as a common source
of supply for more than one patient
• Everything from the medication bag to the patient's IV
catheter is a single interconnected unit
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The Injection
Safety Checklist
• Use to assess your
facility’s injection
safety practices
• Download and
share with all staff
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Sharps Safety
• Contaminated sharps devices can puncture or cut skin
• Approximately 385,000 needle sticks and other sharps-
related injuries occur in hospital-based health care
personnel each year
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Needle Sticks and Exposure to Blood or Other

Bodily Secretions
If you are stuck by a used needle or exposed to blood or
other bodily secretions:
• Wash the needle stick site or cut with soap and water
until clean
• Flush splashes to the nose, mouth, or skin with water
• Irrigate eyes with clean water, saline, or sterile irrigant
• Report the incident to your supervisor immediately
• Immediately seek medical evaluation per your facility's
policy
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Sharps Injuries in Healthcare

Injuries occur most frequently due to inappropriate sharps

disposal practices by healthcare workers. These include:
• Insufficient maintenance of sharps containers in every area
• Improper design of sharps disposal container
• Inappropriate placement of sharps disposal container
• Overfilling sharps disposal container
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Sharps Disposal Container Requirements

• Must be puncture-resistant, durable during installation and
transport, and of appropriate size and shape for the task
• Must be clearly visible
• Must be easy to access by being placed in an upright
position and easy to operate
• Must have ease of storage and assembly, require minimal
worker training requirements, be easy to operate, and have
a flexible design

CDC Injection Safety Workbook

https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
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Reduce the Risk of Blood Contact

Follow Cal-OSHA requirements and CDC guidelines
• Establish an exposure control plan
• Use labels and signs to communicate hazards
• Provide information and training to workers
• Make available hepatitis B vaccinations to all workers who
may have occupational exposures to blood or body fluids
• Identify and use engineering controls
• Implement the use of universal precautions
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CDC Recommendations for Improving Injection

Safety at Healthcare Facilities
• Designate someone to provide ongoing oversight for infection
control issues
• Develop written infection control policies
• Provide training
• Conduct quality assurance assessments
• Establish culture of safety

CDC Injection Safety Workbook

https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
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Establishing a Culture of Safety

• Introduce workers to a safety culture when they are first
hired
• Have written safety guidelines and policies
• Engage worker participation in safety planning
• Provide appropriate safety devices and protective
equipment; include healthcare workers in the selection
process
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Organizational Steps to Ensure Safe Injection

Practices

CDC Injection Safety Workbook

https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
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Step 1: Develop Organizational Capacity

• Create an institution-wide injection safety program
• Engage a leadership team focused on eliminating unsafe
injection practices
• Create an administration commitment to the program
• Involve senior-level management
• Involve a small core group of clinical staff on team
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Step 2: Assess Program Operation Processes

• Assess the safety culture
• Analyze existing data
• Develop a feedback system
• Promote individual accountability for safety
• Determine educational needs of workers
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Step 3: Prepare Baseline Profile of Injuries and

Prevention Activities
• How many unsafe injection practices have been reported?
• In the past year, what proportion of injuries occurred due to
the following circumstances?
• Manipulating needle in patient
• Manipulating needle in IV line
• Recapping, discarding sharp into container, discarding
sharps improperly
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Step 4: Determine Intervention Priorities

• Injection safety should have priority attention
• Establish an action plan for performance improvement
• List priorities for improvement, as identified in the baseline
assessment
• Specify which interventions will be used
• Identify performance improvement measures
• Establish time lines and define responsibilities
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Step 5: Develop and Implement Action Plans

• The baseline profile will identify the strengths and
weaknesses of the organization’s injection safety and injury
prevention programs
• Team can create a list of priorities for performance
improvement and then decide how to accomplish the
necessary tasks
• Team should be sure that the areas for process
improvement are clear and measurable
• To increase the likelihood of success, only a few
improvements should be taken on at a time
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Step 6: Monitor Performance Improvement

• Develop a checklist of activities
• Create and monitor a timeline for implementation
• Schedule periodic reviews for assessing performance
improvements
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Safe Injection Practices Coalition (SIPC)

The Safe Injection Practices Coalition (SIPC) is a partnership of
health care organizations, patient advocacy organizations, industry
partners, and other public health partners, led by the Centers for
Disease Control and Prevention (CDC)

CDC One & Only Campaign

https://www.cdc.gov/injectionsafety/1anonly.html
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Summary
• Safe injection practices prevent infection transmission and
outbreaks of bloodborne diseases to both patients and
health care providers
• Health care facilities should evaluate their injection safety
practices and, as needed, implement a 6-step program to
improve injection safety
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Additional Resources

• CalOSHA frequently asked questions

http://www.dir.ca.gov/dosh/Safe%20Patient%20Handling%20FAQ.pdf
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Questions?

For more information,

please contact any
HAI Program Liaison IP Team member

Or email
HAIProgram@cdph.ca.gov