Injection Safety in the OR Kerri A. Thom, MD, MS Assistant Professor of Epidemiology University of Maryland School of Medicine

Injection Safety in the OR

Kerri A. Thom, MD, MSAssistant Professor of Epidemiology

University of Maryland School of Medicine

NOTHING TO DISCLOSE

Key Point

• Unsafe injection practices have led to many recent outbreaks with larges number of exposed patients and transmission of infectious diseases

Key Points

• Needles and syringes are always single use • Do not use single dose vials for >1 patient

– All IV bags are single use • Limit use of multidose vials

– Use for single patient when possible

Protect your patient Protect yourself

Objectives

• Define injection safety and identify safe practices in comparison to unsafe practice

• Recognize harms associated with unsafe injection practices

• Avoid common mistakes relative to unsafe injection practices

Injection Safety

I’m an average American. I was raised on a Nebraska farm. I enjoy traveling, reading, hiking, going to parties with family and friends. I’m married to a family practice physician. We have three sons, all of whom are in medical training. I’m an audiologist with a busy practice.

Ten years ago, I was diagnosed with breast cancer. It took all the energy I had to come to our local clinic for treatment. I had no idea that syringes were being reused and saline bags were being used improperly. To my dismay, I was one of the 99 people in Fremont, Nebraska, who was infected with hepatitis C in 2001 while undergoing treatment for cancer.

Dr. Evelyn McKnight

What is Injection Safety?

• Can I use the same syringe to inject and IV medication to more than one patient if I change the needle between patients and I don’t draw back before injecting?


• If I use a syringe to infuse medications into an IV port distal to the patients IV catheter site (e.g. several feet away), is it okay to use the same syringe for another patient?


• Can I use reuse the same syringe to infuse medication and access the vial during for a single patient who requires additional medication as long as the vial will not be used for another patient?

http://www.oneandonlycampaign.org/single-dose-multi-dose-vial-infographic

2 cases acute HCV to Nevada HD

Jan 2nd

Labus B, MMWR, May 2008

3rd case of acute HCV reported

Jan 2nd Jan 3rd


Jan 2nd Jan 3rd

All 3 recent endoscopy at same clinic w/ 30-90 days


CDC Investigation Initiated

Jan 2nd Jan 3rd Jan 9th


CDC began notifying patients

Jan 2nd Jan 3rd Jan 9th Feb 27th


CDC began notifying patients


40,000 patientsGoing back 4 years

Tested for HIV, HBV, HCB


CDC publishes report

Jan 2nd Jan 3rd Jan 9th Feb 27th May 16th




> 40,000 exposed$16-21 million dollars

6 + patients w acute HCV

May 16th




> 40,000 exposed$16-21 million dollars

6 + patients w acute HCV

May 16th


2 CRNAs, 1 MDAIndicted, 28 felony

charges



Re-use of syringe Inappropriate use of MDV

May 16th


http://www.cdc.gov/HAI/settings/outpatient/outbreaks-patient-notifications.html

Keys to Injection Safety - #1

Needles and syringes are always single use


Do not use single-dose vials for multiple patientsIV bags are all single use

Single vs. Multi-dose Vials

http://www.oneandonlycampaign.org/single-dose-multi-dose-vial-infographic


Limit use of multi-dose vials

Use for single patient whenever possible

Outcomes …

• Harm to patients– Transmission of pathogenic bacteria – Transmission of blood-borne viral pathogens

• Resource intensive investigations – Notification of thousands of patients – Emotional distress – Cost

• Disciplinary actions to providers • Malpractice suits

Protect Yourself! And your colleagues!

• Properly dispose of sharps • Do NOT recap needles

• Nearly 400,000 sharps injuries per year– Injuries decreased 36% from 2001-2006– BUT INCREASING in surgical areas by 6.5%

When do injuries occur?

Outcomes

• Emotional stressors • Loss of time at work • Laboratory testing • Investigation • Cost of treatment• Side effects of treatment • Risk for infection

Risk of Transmission

• HIV 0.3% • HCV ~ 3% • HBV up to 30%

Monitoring Injection Safety

• CMS pilot of ambulatory surgical centers– 68 centers in OK, NC, MD

• Infection Control worksheet • Problems identified

– Failure to clean equipment between use – Re-use of single dose vials for multiple patients – Re-use of single-use devices





Answer: NO!• Syringe and needle may be contaminated

• Even if positive pressure was applied





Answer: NO!• Entire system from bag to patient is connected

• Gravity and distance do not protect





Answer: NO! • Use a new syringe whenever possible

• Extra-layer of protection

Drug Diversion and Injection Safety

• Theft of Rx drugs intended for use in a patient– If Intravenous – becomes an injection safety issue– Can lead to outbreaks

Oh, And…

• Healthy 26 yo woman presents in active labor – Receives spinal anesthesia – 15 hrs later bacterial meningitis

• 2nd Healthy 30 yo woman in active labor – Same day – Spinal anesthesia

• Same anesthesiologist

– 12 hrs later, meningitis • Same organism

– Also found in anesthesiologist

Fijter. MMWR, January 2010

Oh, And…

• Healthy 26 yo woman presents in active labor – Receives spinal anesthesia – 15 hrs later bacterial meningitis

• 2nd Healthy 30 yo woman in active labor – Same day – Spinal anesthesia

• Same anesthesiologist

– 12 hrs later, meningitis • Same organism

– Also found in anesthesiologist

Fijter. MMWR, January 2010

No Mask!

Key Points – Injection Safety

• Needles and syringes are always single use • Do not use single dose vials for >1 patient

– All IV bags are single use • Limit use of multidose vials

– Use for single patient when possible

Protect your patient Protect yourself

One and Only Campaign

Documents

Injection Safety in the OR Kerri A. Thom, MD, MS Assistant Professor of Epidemiology University of Maryland School of Medicine