Reusing single-dose vials and needles can lead to outbreaks - 14 News, WFIE, Evansville, Henderson, Owensboro

The Centers for Disease Control is sounding the alarm about a dangerous healthcare error responsible for at least 19 known infection outbreaks.

The practice of reusing single-dose vials is spreading life-threatening bacterial, fungal and viral infections.

All of the outbreaks have involved outpatient settings like pain clinics, but the risk is just as real about anywhere you receive an injection from a single-dose vial.

The safe way to administer a single-dose vial of medication is by using the needle or syringe on one patient only.

"The assumption is, you're going to open it, pull out medicine and be done," says Michael Bell, deputy director of the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta.

Unlike multi-use vials which are intended for multiple patients, single-dose vials do not contain antimicrobial preservatives.

Once a single-dose vial has been used on one patient, it should never be used again.

"When you go in with a needle, you can actually push bacteria into the sterile medication," Bell explains.

This is how life-threatening infections like hepatitis B virus (HBV) and hepatitis C virus (HCV), as well as bacterial infections including Staphylococcus aureus, known as Staph, have spread to unsuspecting patients.

This may cause you to wonder, why would a medication vial intended for use on one person be reused?

America Now took this question to Steve Jarrett who is the medication safety officer at Carolinas Healthcare System in Charlotte, NC.

Jarrett says one reason for reusing single-dose vials is due to prescription drug shortages.

"As physician practices and hospitals try to stretch the medication they have to treat their patients, there are times where a single-dose vial has been used for more than one dose," Jarrett says.

The practice of reusing a single-dose vial is also common when the size of the patient, for example a small child, doesn't require all of the medication contained in a single-dose vial.

Discarding the leftovers may be expensive, but so are the costs associated with outbreaks or lawsuits.

Combining or splitting medication must follow strict pharmacy guidelines, and it must be done in a sterile setting.

So, how can a patient protect themselves and know they're safe if they are receiving medication via a needle or syringe?

Bell says every patient should ask questions about their doctor's safety practices before arriving at a healthcare facility and well before any injection is administered.

"Your doctors and nurses want to do the right thing, but reminders never hurt," and Bell adds, "You can ask nicely and they won't get upset. If they do, you should probably find another doctor!"

Jarrett agrees that patients simply need to ask questions to the medical staff like – What are you doing to keep me safe?

Experts say you shouldn't be afraid to ask questions when it comes to your medical care.

"It's not wrong to say, upfront, I have a strong need to see you fill the syringe in front of me and see you break open a fresh packet," Bell says.

If you are too sick or shy to ask these questions, Bell recommends you ask a family member or friend to go with you on your next appointment.

"It's much easier for me to ask questions on behalf of my friend or family member than to do it myself," Bell says.

Tracking the source of an infection from a single-dose vial that was inappropriately administered to multiple patients can be nearly impossible for health officials to do weeks or months later.

This is why the CDC recommends if your injection site becomes unusually inflamed, red or painful, you should seek medical care immediately.

An infection at the sight of an injection could indicate contamination resulting from a vial that was inappropriately used on subsequent patients. If this happens to you, be sure to report the incident to your local health department.

Ultimately, it is critical for you to add your own dose of precaution by asking questions and taking charge of your care upfront. 

Additional Information:

The following information is from Steve Jarrett, a medication safety officer at Carolinas Healthcare System in Charlotte, NC.

• He says the most important thing is to have a good relationship with your provider.
• Look for a provider who is well-respected in the community and who is recommended by your insurance provider. Do your homework.

Michael Bell is the deputy director of the Division of Healthcare Quality Promotion at the Centers for Disease Control in Atlanta.

• He recommends that hospitals and clinics take any leftover single-dose vial medication to their pharmacy, where under a hood and in a sterile environment they can separate out doses.
• He notes that while it's been beneficial to patients to expand hospital care into outpatient settings (easier access, home faster), there are consequences involved in taking away the extra staff and layers of safety practices commonly found in a hospital setting.
• He says it would be nearly impossible for a patient to know that their sickness came from an injection weeks or months ago.
• If your injection site turns red, infected or painful, seek care immediately.
• Let your Health Department know if you think your infection is due to an injection.
• He notes that since medications are not made in various vial sizes, healthcare facilities often have leftovers.
• In the case of drug shortages, healthcare providers may split doses to provide the right amount for small patients when a drug is in limited supply. (i.e. children)
• He says the challenge in healthcare will be to rebuild the safety nets found inside hospitals, into outpatient facilities, without the extra staffing.
• Asking questions reminds your provider to double check their work.
• Any situation where there are lots of injections, in small volumes, lends itself to errors. 

The following information is from the Centers for Disease Control and Prevention in an online article entitled "Protect Patients Against Preventable Harm from Improper Use of Single-Dose/Single-Use Vials" (Source: http://www.cdc.gov/injectionsafety/cdcposition-singleusevial.html).

• Medications labeled as "single dose" or "single use" should be used for only one patient to protect them from life-threatening infections that occur when medications get contaminated from unsafe use.
• Concerns over whether the CDC's guidelines contribute to drug shortages and increased medical costs.
• CDC says shortages are due to manufacturing, shipping and other issues.
• Single dose vials lack antimicrobial preservatives and can become contaminated.
• In critical need, medicines from UNOPENED single-dose vials can be repackaged for multiple patients when done according to the United States Pharmacopeia's standards.
• Reuse of syringes on multiple patients, sharing medications, medicine from a single-dose vial to multiple patients and failure to use aseptic technique when giving injections are all unsafe practices.
• Since the CDC's guidelines were published in 2007, the CDC has become aware of at least 19 outbreaks associated with single-dose medications.
• 7 involved blood borne pathogen infections and 12 involved bacterial infections.
• All outbreaks involved outpatient settings with most occurring in pain remediation clinics.
• In a study published in the Journal of the American Medical Association, two-thirds of the outpatient facilities inspected had lapses in basic infection control practices. (Source: http://blogs.cdc.gov/safehealthcare/?p=419)
• Any potential savings from stretching medication would be quickly offset by the costs associated with viral hepatitis, bloodstream infections, meningitis, epidural abscesses . Legal costs and the loss of medical licenses may also occur.
• To prevent unnecessary waste or the temptation to use contents from single-dose or single-use vials for more than one patient, clinicians and purchasing personnel should select the smallest vial necessary for their needs when making treatment and purchasing decisions.
• There have been outbreaks resulting from pooling of contents of single-dose or single-use vials and/or storage of contents for future use.

The following information is from the Centers for Disease Control and Prevention website devoted to the "One Needle, One Syringe, Only One Time" public health campaign (Source: http://www.oneandonlycampaign.org/about/the-campaign).

• Since 2001, more than 130,000 patients in the US have been notified of potential exposure to Hepatitis B, hepatitis C and HIV all due to lapses in basic infection control practices (reusing syringes, contaminated vials, etc).
• Data from a survey of U.S. healthcare workers who provide medication through injection indicate that 1% to 3% of healthcare providers reuse the same needle and/or syringe on multiple patients.
• Since 2007, at least 19 outbreaks associated with single-dose vials or IV solutions have been reported.
• 7 outbreaks of hepatitis B and/or C
• 12 outbreaks of bacterial infections
• What to ask your healthcare provider before receiving an injection:
• Will there be a new needle, new syringe and new vial?
• Can you tell me how you prevent the spread of infections in your facility?
• What steps are you taking to keep me safe? 

The following information is from the Centers for Disease Control and Prevention in an online article entitled "FAQs for Patients" (Source: http://www.cdc.gov/injectionsafety/patients/patient_faqs.html).

• Incorrect practices have been identified during the administration of anesthetics, administration of IV medications (chemotherapy, cosmetic procedures, etc), saline use to flush IV lines, administration of intramuscular vaccines.
• Incorrect practices can transmit bacterial, fungal and viral infections.

The following information is from the Centers for Disease Control and Prevention in an online article entitled "Invasive Staphylococcus aureus Infections Associated with Pain Injections and Reuse of Single-Dose Vials – Arizona and Delaware, 2012" (Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6127a1.htm?s_cid=mm6127a1_w).

• The CDC released a report in July of 2012 on an investigation of two outbreaks of invasive Staphylococcus aureus infection confirmed in 10 patients being treated in outpatient clinics.
• Infection was associated with use of single-dose vials on more than one patient.

Copyright 2013 America Now. All rights reserved.