Perilous Infection Control Practices with Needles, Syringes, and Vials Suggest Stepped-up Monitoring is Needed

ISMP Medication Safety Alert 

In This Article

Safe Practice Recommendations

Given the lapses in infection control practices and misconceptions regarding unsafe injection practices described via this survey, academic settings, licensing bodies, and healthcare providers must enhance their ongoing surveillance of proper technique and devote resources to ensure staff knowledge and skills associated with even the most basic concepts of infection control and injection safety. The One & Only CampaignONE needle, ONE syringe, ONLY ONE time—led by the CDC and the Safe Injection Practices Coalition offers free posters, educational brochures for healthcare providers and patients, and a 13-minute video on the topic (

All staff should understand that any form of syringe and/or needle reuse is dangerous and should be avoided. The current CDC guidelines[2] recommend that syringes and needles be used only once. Single-dose or single-use vials should be used clinically only for one dose for one patient, and then discarded after initial entry into the vial. If multiple-dose vials are used, both the needle and syringe used to access the vial must be sterile, and strict attention must be paid to aseptic technique.

ISMP and CDC also recommend limiting the use of multiple-dose vials of medication to single patients, whenever possible, as an extra barrier of protection against unrecognized syringe reuse or other means of unintended vial contamination. It's safest to use prefilled syringes or single-dose vials whenever possible to reduce the risk of contamination. Certainly, there are a few settings where it makes sense to use multiple-dose vials: 1) for a single patient; 2) during aseptic pharmacy compounding; and 3) for expensive medications, which should be prepared and dispensed from the pharmacy in unit doses. The relatively inexpensive drugs and solutions that often require multiple entries into the vial (e.g., sodium chloride injection 0.9%, bacteriostatic water, lidocaine) should not be saved for use with other patients. These should be provided in single-use containers that are discarded after first use. Also, do not use bags or bottles of IV solutions as a communal supply for multiple patients unless the bags or bottles are used during aseptic pharmacy compounding, using a fluid dispensing system.


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