InBrief
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.
Single-Use Vial Recommendations
Use a single-use vial in a single patient for a single procedure or injection.
Disinfect the vial’s rubber diaphragm by wiping with sterile 70 percent isopropyl alcohol, or other approved antiseptic, and allowing it to dry before inserting the needle.
If a single-use vial must be entered more than once, use a new needle and new syringe for each entry.
Single-use vials should be discarded after one usage.1,2
Multiple-Dose Vial Recommendations
Only vials labeled by the manufacturer for multiple-dose use, and which contain preservative should be used more than once.
Disinfect the diaphragm each time needle entry is made. Use a new needle and syringe for each entry.
To avoid contamination, do not leave needles in the entry diaphragm between uses.
After puncturing the diaphragm of a multiple-dose vial, mark the vial with an expiration date. Unless otherwise specified by the manufacturer, the standard expiration date for a multiple-dose vial is 28 days.
Use and store multiple-dose vials outside the immediate patient treatment area to avoid unsterile double-dipping into the vial and prevent contamination from a dirty procedure.
Limit the use of a multiple-dose vial to one patient whenever possible.
While the majority of healthcare workers practice correct medication vial safety, a significant minority do not, which can lead to serious morbidity in patients. We should all ensure that everyone in the workplace uses medication vials correctly to avoid causing inadvertent harm.
Editor’s note: When using either a single-use vial or a multi-dose vial, consider changing the needle after drawing up the medication or vaccine. This might decrease the risk of injection-site reaction either due to latex allergy or other idiosyncratic reaction due to any material left in the needle.
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References
1. Joint Commission. Preventing infection from the misuse of vials. Sentinel Event Alert. 2014;52:1-6. www.jointcommission.org/assets/1/6/SEA_52.pdf. 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. www.cdc.gov/injectionsafety/cdcposition-singleusevial.html. 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.
Initially published 8/21/2019