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Medication Vial Safety


by Stuart M. Caplen, MD

Thousands of patients have been adversely affected by the misuse of single use and multiple-dose medication vials, causing infections which include bacteremia, hepatitis, meningitis, and epidural abscesses.[1,2] From 2007—2012, 19 outbreaks associated with single-dose medication vials were reported to the Centers for Disease Control and Prevention (CDC).[2] Single-dose vials typically lack preservatives, so more than one use of such a container carries substantial risks for contamination and infection.[1,2] Unsterile double dipping can occur when a previously used needle and/or syringe is used to get more of the medication, which can potentially contaminate the vial.

A survey of 5,446 healthcare providers (the majority being registered nurses) found that 6% of respondents sometimes or always used single-dose vials to treat more than one patient.[3] 0.9% of those surveyed sometimes or always reused a syringe, but changed the needle, for use on a second patient. In addition, 15.1% reused a syringe to enter a multidose vial with 6.5% of these individuals—or 1.1% of the total surveyed—saving that vial to use on another patient.

The full medical InBrief on Medical Vial Safety includes:

Recommendations for Safe Medication Administration

Single-dose Vials

Multiple-dose Vials

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#InBrief #MedicalSafety



Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a former emergency physician and emergency department medical director, now retired from clinical practice. His current interests include how quality is produced and maintained in health care, and he recently achieved greenbelt certification in lean/six sigma.


1. Joint Commission. Preventing infection from the misuse of vials. Sentinel Event Alert. 2014;52:1-6. Accessed April 22, 2019.

2. Centers for Disease Control and Prevention (CDC). Protect patients against preventable harm from improper use of single-dose/single-use vials. CDC Web site. August 30, 2016, Accessed April 22, 2019.

3. Pugliese G, Gosnell C, Bartley JM, Robinson S. Injection practices among clinicians in United States health care settings. Am J Infect Control. 2010;38:789-797.


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