Single-Dose or Multi-Dose?

Not all vials are created equal.

Dozens of recent outbreaks have been associated with reuse of single-dose vials and misuse of multiple-dose vials. As a result of these incidents, patients have suffered significant harms, including death. CDC and the One & Only Campaign urge healthcare providers to recognize the differences between single-dose and multiple-dose vials and to understand appropriate use of each container type.

This information can literally save a life.

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The Provider

Do You Multi-dose?

A SINGLE-DOSE VIAL (SDV) is approved for use on a SINGLE patient for a SINGLE procedure or injection.

SDVs typically lack an antimicrobial preservative. Do not save left over medication from these vials. Harmful bacteria can grow and infect a patient.

DISCARD after every use!

Size Does Not Matter!

SDVs and MDVs can come in any shape and size. Do not assume that a vial is an SDV or MDV based on size or volume of medication.

ALWAYS check the label!

A MULTIPLE-DOSE VIAL (MDV) is recognized by its FDA-approved label.

Although MDV's can be used for more than one patient when aseptic technique is followed, ideally even MDVs are used for only one patient.

MDVs typically contain an antimicrobial preservative to help limit the growth of bacteria. Preservatives have no effect on bloodborne viruses (i.e. hepatitis B, hepatitis C, HIV).

Discard MDVs when the beyond-use date has been reached, when doses are drawn in a patient treatment area, or any time the sterility of the vial is in question!

 
 

Safety Steps

Follow these injection safety steps for success!

Before the Procedure

Carefully read the label of the vial of medication.

  • If it says single-dose and it has already been accessed(e.g. needle-punctured), throw it away.
  • If it says multiple-dose, double-check the expiration date and the beyond-use date if it was previously opened, and visually inspect to ensure no visible contamination.
  • When in doubt, throw it out.

During the Procedure

Use aseptic technique.

  • Use a new needle and syringe for every injection.
  • Be sure to clean your hands immediately before handling any medication.
  • Disinfect the medication vial by rubbing the diaphragm with alcohol.
  • Draw up all medications in a clean medication preparation area.

After the Procedure

Discard all used needles and syringes and SDVs after the procedure is over.

MDVs should be discarded when:

  • the beyond-use date has been reached
  • doses are drawn in a patient treatment area
  • any time vial sterility is in question

The Manager

Infections can be costly.

 

Educate your team!

Make sure your team uses single-dose and multiple-dose vials properly. Misuse of medicine puts your practice and patients at risk.

Risky Business

First, do no harm. Improper reuse of SDVs has caused patient infections and deaths.

Realize what's at stake

  • A person's life and well-being
  • Accreditation status
  • Clinic license or certification

Have you considered...? (CLICK BELOW)

Do you have enough supplies to ensure safe injections?

Adequate injection supplies (e.g. syringes, appropriate medications in right-sized vials when possible, personal protective equipment such as gloves and facemasks) should always be available.

Is your medication preparation area separate from the patient care area?

Facilities should have a designated clean medication area where injections are drawn up and labeled immediately before each individual patient. This space should be away from patient care areas and where any used or soiled equipment and materials might be.

Are you purchasing the safest available medication?

Think about safety when you re-supply clinic medications. Request the smallest vials that meet individual patient needs. Use FDA-approved, manufactured medications. Consult with pharmacists and others to learn whether pre-filled syringes or other "ready to deliver" unit-dose packaging is available.

Do you arrange infection control training for your healthcare personnel?

In addition to the OSHA-mandated bloodborne pathogen training, job-specific training on infection control, including safe injection practices, should be provided upon hire and at least annually for healthcare personnel.

The Patient

We are all patients.

 
 

50 outbreaks and counting

Since 2001, at least 50 outbreaks involving unsafe injection practices were reported to CDC

  • 90% (n=45) occurred in outpatient settings
  • Many hundreds of infected patients
  • Over 150,000 patients notified and tested

6% of U.S. health professionals have admitted to using single-dose vials for more than one patient.

A recent study showed that 37% of new hepatitis infections in older adults may be due to unsafe medical injections.

3 Questions every patient should be encouraged to ask:

As a provider, be prepared to answer your patients' questions about safe injection practices.

Did you wash your hands?

Did you use a clean needle and syringe to draw up this medication?

Is this medication from a single-dose-vial? Have you used this vial of medication on another person?

Quick Quiz

Which of these containers is the multiple-dose vial?

Mouse over each vial to find out.

Incorrect – Large SDV

Do not assume that a vial is an SDV or MDV based on size or volume of medication – Always check the label!

Incorrect - SDV

MDVs typically contain an antimicrobial preservative which is reflected on the label and by the use of term “multiple dose vial.” If there is no preservative, it is likely not an MDV. Read the label to verify.

Correct - Real MDV

This FDA-approved label notes that it is an MDV.

Incorrect - Compounded medication

Injectable medications are supposed to be compounded for only one patient, and should not be used on multiple patients, even if a preservative is present.

You can't use a multiple-dose vial on more than one patient.

True or False?

Incorrect. While limiting MDVs to single patients is the safest option, FDA-approved manufactured MDVs may be used for multiple patients provided that safe injection practices are followed and the vial is restricted to a central medication area.
Correct. While limiting MDVs to single patients is the safest option, FDA-approved manufactured MDVs may be used for multiple patients provided that safe injection practices are followed and the vial is restricted to a central medication area.

You can retain or pool leftover single-dose medication to save for later use.

True or False?

Incorrect. A single-dose vial is designed for use on a single patient for a single procedure or injection. The only exception is if, in times of critical need, a vial is split under certain approved pharmacy conditions.
Correct. A single-dose vial is designed for use on a single patient for a single injection. The only exception is if, in times of critical need, a vial is split under certain approved pharmacy conditions.

Imagine it was you!

At the end of the day we're all patients.

 

Knowing how to properly identify single-dose and multiple-dose vials will prevent infections and can save lives. Following basic safe injection procedures is not something to take for granted — there is too much at stake. Educate yourself and those around you.

Do your part to make healthcare safe...One injection at a time.

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