Unsafe injection practices remain a concern

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Unsafe injection practices remain a concern

New study shows majority are compliant, but simple misconceptions still a problem

After reading this article, you will be able to:

  • List noncompliance statistics for safe injection practices
  • Recognize common misconceptions involving syringes and IVs
  • Explain the importance of empowering staff members to speak up when they see unsafe injection practices

There’s good news when it comes to safe injection practices: The majority of healthcare workers are consistently compliant with current best practices. 

However, there is still a problem with the small minority of employees that have reused single-dose vials on more than one patient, changed the needle but reused a syringe on multiple patients, or reused a syringe to enter a multi-dose vial and then saved that vial for later use.

A study published in the December 2010 American Journal of Infection Control indicates that only a few healthcare workers participate in these unsafe procedures, but even a few is still too many. The study surveyed 5,546 healthcare workers on current injection practices. 

“We did the study to really assess where we are at right now in 2010,” says Gina Pugliese, RN, MS, vice president of Premier Safety Institute in Charlotte, NC, and lead author of the study. “How bad is this? We’ve had some outbreaks and we know there have been some problems, but what really is the extent of it in the healthcare setting? We were surprised to see there was still quite a bit of [noncompliance].”

The results of the study broke noncompliance into specific scenarios:

  • 6% sometimes or always use single-dose or single-use vials for more than one patient
  • 0.9% sometimes or always reuse a syringe but change the needle for use on a second patient
  • 15.1% reuse a syringe to enter a multi-dose vial, and 6.5% of those (1.1% overall) save that vial for use on another patient


“Although the majority of respondents indicated they were following recommended safe injection practices, even the small percentage of healthcare providers that were identified as not complying with recommended practices is alarming,” the authors wrote in the study. “Anything less than 100% compliance with infection control guidelines and aseptic technique contributes to risk of transmission of bloodborne viruses resulting in infections; both individual cases and outbreaks may go undetected for some time.”


Reasons for noncompliance

Reasons for continued noncompliance with safe injection practices usually boil down to education, training, and a general lack of understanding regarding how bloodborne infections—such as hepatitis B, hepatitis C, or HIV—are transmitted. 

“What was interesting was that the people that answered [incorrectly] did not know it was an incorrect practice,” Pugliese says. “Part of that is because of mistaken belief about how you transmit an infection. It could be lack of training; it could be people just haven’t walked through their mind what the correct process is.”

Although correct injection practices are not any more time-consuming or difficult, Pugliese says a breach in aseptic technique is not always easily recognizable, since the absence of visible blood doesn’t necessarily indicate sterility. 

“Aseptic technique is not something you can see,” she notes. “It’s a philosophy and a practice to prevent contamination. You make them sterile and you keep them sterile, and there are all kinds of aseptic procedures around that.”


Speaking up

An alarming revelation in the study showed up in the comments section of some of the survey questions. Although some practitioners answered that they had not personally engaged in unsafe injection practices, they wrote that they had seen coworkers do things such as reusing a syringe on multiple patients.  

“So they had a sense that it was wrong and they didn’t do it, but were aware that some of their colleagues did,” Pugliese says. “Well, why aren’t they commenting on it?”

She points to the work that has been done to prevent central-line bloodstream infections, in which an important component of prevention is changing the culture of the facility to empower nurses and other healthcare professionals to speak up when someone strays from the correct aseptic procedure.


Mistaken beliefs lead to infection risks

Editor’s note: One of the vehicles for continued noncompliance with safety injection best practices is the perpetuation of incorrect beliefs surrounding the transmission of bloodborne pathogens, some of which are listed below. Many more are listed in the full publication of the study in the December 2010 American Journal of Infection Control.


Misconception: If the IV tubing is not contaminated with any visible blood, there is no risk. 

Fact: IV tubing can still become contaminated. Evidence shows that the length of the tubing or the use of locks or valves do not eliminate contamination during IV administration. 


Misconception: You can reuse syringes after use on a patient to access large bags of IV fluid, such as saline, to flush an IV line.

Fact: The syringe may be contaminated. By reusing it, the entire IV bag is contaminated and every subsequent patient is put at risk of contracting whatever the first patient had.


Misconception: If you are only pushing on the plunger of a syringe and not withdrawing, you are not contaminating that syringe and it can be reused. 

Fact: Studies have shown that contamination can occur in the barrel of the syringe regardless of injection or withdrawal. 


Misconception: Contamination only occurs in the needle, so if you change the needle, you can reuse the syringe. 

Fact: Contamination can exist in both the needle and the syringe, and neither should be reused. 


Misconception: Multi-dose vials can be accessed multiple times for one patient with the same syringe and then used on another patient.

Fact: Needles and syringes are sterile, single-use items; they should not be reused to access a medication or solution that might be used for a subsequent patient. The CDC recommends that multi-dose vials be assigned to a single patient whenever possible. If multi-dose vials must be used, both the needle and syringe used to access the multi-dose vial must be sterile.