What are Safe Injection Practices and Why Follow Them?

Injected medicines are commonly used in healthcare settings for the prevention, diagnosis, and treatment of various illnesses. Unsafe injection practices put patients and healthcare providers at risk of infectious and non-infectious adverse events and have been associated with a wide variety of procedures and settings. This harm is preventable. Safe injection practices are part of Standard Precautions and are aimed at maintaining basic levels of patient safety and provider protections. As defined by the World Health Organization, a safe injection does not harm the recipient, does not expose the provider to any avoidable risks and does not result in waste that is dangerous for the community.

What are safe injection practices?

The following is an excerpt from the Centers for Disease Control and Prevention's (CDC) "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007":

III.A.1.b. Safe Injection Practices
The investigation of four large outbreaks of HBV and HCV among patients in ambulatory care facilities in the United States identified a need to define and reinforce safe injection practices. The four outbreaks occurred in a private medical practice, a pain clinic, an endoscopy clinic, and a hematology/oncology clinic. The primary breaches in infection control practice that contributed to these outbreaks were 1) reinsertion of used needles into a multiple-dose vial or solution container (e.g., saline bag) and 2) use of a single needle/syringe to administer intravenous medication to multiple patients. In one of these outbreaks, preparation of medications in the same workspace where used needle/syringes were dismantled also may have been a contributing factor. These and other outbreaks of viral hepatitis could have been prevented by adherence to basic principles of aseptic technique for the preparation and administration of parenteral medications. These include the use of a sterile, single-use, disposable needle and syringe for each injection given and prevention of contamination of injection equipment and medication.

Whenever possible, use of single-dose vials is preferred over multiple-dose vials, especially when medications will be administered to multiple patients. Outbreaks related to unsafe injection practices indicate that some healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic technique. A survey of U.S. healthcare workers who provide medication through injection found that 1% to 3% reused the same needle and/or syringe on multiple patients. Among the deficiencies identified in recent outbreaks were a lack of oversight of personnel and failure to follow up on reported breaches in infection control practices in ambulatory settings. Therefore, to ensure that all healthcare workers understand and adhere to recommended practices, principles of infection control and aseptic technique need to be reinforced in training programs and incorporated into institutional polices that are monitored for adherence. 

IV.H. Safe Injection Practices
The following recommendations apply to the use of needles, cannulas that replace needles, and, where applicable, intravenous delivery systems:

IV.H.1. Use aseptic technique to avoid contamination of sterile injection equipment. Category IA

IV.H.2. Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae, and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient. Category IA

IV.H.3. Use fluid infusion and administration sets (i.e., intravenous bags, tubing, and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or administration set. Category IB

IV.H.4. Use single-dose vials for parenteral medications whenever possible. Category IA

IV.H.5. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use. Category IA

IV.H.6. If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile. Category IA

IV.H.7. Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if sterility is compromised or questionable. Category IA

IV.H.8. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients. Category IB


Why follow safe injection practices?

Safe injection practices are a set of measures to perform injections in an optimally safe manner for patients, healthcare providers, and others.

In the last decade, more than 150,000 patients in the United States were advised to get tested for hepatitis B virus (HBV),  hepatitis C virus (HCV), and HIV due to the reuse of syringes and misuse of medication vials.

A review of outbreaks by the Centers for Disease Control and Prevention (CDC) was published in the January 2009 edition of the Annals of Internal Medicine. In that article, CDC researchers identified 33 hepatitis outbreaks between 1998-2008 resulting from deficient healthcare practices. The study focused on outbreaks that occurred in outpatient settings such as doctor’s offices, outpatient clinics, dialysis centers, and nursing homes. Unsafe injection practices, such as reuse of syringes, accounted for most of the infections and exposures.
Data from a survey of U.S. healthcare workers who provide medication through injection indicate that some healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic, or infection prevention, techniques. According to the American Association of Nurse Anesthetists’ Reuse of Needles and Syringes by Healthcare Providers Puts Patients at Risk, 1% to 3% of healthcare providers reuse the same needle and/or syringe on multiple patients.

Only when patients and providers both insist on One Needle, One Syringe, Only One Time for each and every injection will the risk of contracting infectious disease through injections be eliminated.