CDC Expert Commentary

Make Every Injection Safe!

Joseph Perz, DrPH, MA


February 14, 2011

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It is hard to believe, but in the last 10 years, across the United States, reuse of syringes and misuse of medication vials has resulted in the need to alert more than 100,000 patients to seek testing for bloodborne pathogens such as hepatitis B, hepatitis C, and HIV.

Hello. I'm Dr. Joseph Perz, Team Leader in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. I'm pleased to speak with you today as part of the CDC Expert Video Commentary Series on Medscape about some of the persistent myths and misperceptions about safe injection practices and some of the simple steps that you can take to safeguard your patients.

Every year millions of injections are administered in the United States. Every injection should be safe from infection risk. However, recent experience in the United States includes dozens of outbreaks in which infections were spread as a result of breakdowns in safe injection practices. Although all of us work to ensure that we are keeping patients safe, there are some dangerous myths on injection safety that may be putting your patients at risk.

Myth #1. Contamination of injection devices is limited to the needle and removing the needle makes the syringe safe for reuse. False! The truth is that once used, both the needle and the syringe are contaminated and must be discarded. A new sterile needle and a new sterile syringe should always be used for each patient and to access medications.

Myth #2. Intravenous (IV) tubing or valves can prevent backflow and contamination of injection devices. This is also false! The truth is that everything from the syringe or medication bag to the patient's IV catheter is a single interconnected unit. Distance from the patient, gravity, or even positive infusion pressure do not ensure that small amounts of blood won't contaminate the syringe and needle. The temptation to economize by reusing this equipment simply isn't worth the risk.

Myth #3. If you don't see blood in the IV tubing or injection equipment, there is no risk of cross‐contamination. Another false assumption. The truth is that pathogens, including hepatitis C and B viruses, and HIV, can be present in sufficient quantities to produce infection without any visible blood.

Myth #4. Single-dose vials that appear to contain multiple doses may be used for more than 1 patient. False again! The truth is that single-dose vials are intended for use in a single patient for a single procedure and should not be used for more than 1 patient, regardless of the vial size. To ensure that you are not inadvertently mistaking a larger single-dose vial for a true multidose vial you should check the medication label or package insert.

The following practices can help ensure the safety of your patients:

  • Needles and syringes are single-use devices. They should not be used for more than 1 patient or reused to draw up additional medication. Once used, the syringe and needle are both contaminated and must be discarded;

  • Do not administer medications from a single‐dose vial or an IV bag to multiple patients, and never combine leftover contents for later use;

  • In general, limit the use of multidose vials and dedicate them to a single patient, whenever possible; and

  • Finally, please take a moment to pause, with your staff and colleagues, to review injection procedures to ensure that safe practices are understood and followed by all.

For more information, please see the resources on this page. We appreciate you doing your part to make every injection safe. Thank you.

Web Resources

Dr. Joseph Perz is the Ambulatory and Long Term Care Team Leader for the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. Dr. Perz entered the field of public health after training as an engineer and environmental scientist. After receiving a doctorate in public health from Columbia University, he served as an epidemic intelligence service officer with the Tennessee Department of Health. During his 11 years with the CDC, Dr. Perz has guided dozens of outbreak investigations and special studies, drawing attention to the needs for injection safety and other basic infection control. He has authored or co-authored over 50 peer-reviewed journal articles, Morbidity and Mortality Weekly Report articles and book chapters. His team's activities are currently focused on interagency collaboration, support to health departments, and partnership efforts to expand prevention activities to ambulatory and long-term care settings.


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