Staph Infections Linked to Reuse of Single-Dose Vials

Emma Hitt, PhD

July 13, 2012

July 12, 2012 — Repeated use of single-use medication vials has been linked to the transmission of life-threatening Staphylococcus aureus infection in 10 patients treated for pain in outpatient clinics in Arizona and Delaware, according to a new study from the US Centers for Disease Control and Prevention (CDC).

Melissa Schaefer, MD, a medical officer in the CDC's Division of Healthcare Quality Promotion, and colleagues with the CDC and the Arizona Department of Health Services published their findings in the July 13 issue of the Morbidity and Mortality Weekly Report.

Three patients initially treated at a single pain management clinic in Arizona were hospitalized from 9 to 41 days for S aureus infections after injection of a contrast solution from the same single-dose vial. A fourth patient who received an injection from the same vial was found deceased 6 days after the injection; invasive S aureus infection could not be ruled out.

In Delaware, 7 patients with S aureus–based septic arthritis or bursitis were admitted to the hospital. All had received joint injections at the same outpatient clinic during the same recent 2-day period. An additional 3 patients who received injections at the clinic during this period required outpatient treatment for symptoms that suggested infection.

The researchers found that reuse of a single-dose vial of bupivacaine among multiple patients was the only breach of safe practice at this clinic.

According to the CDC, these outbreaks demonstrate the serious consequences that can result from misuse of single-dose vials. These vials typically do not contain preservatives and are intended for single-use injection to avoid risk for infection.

The appropriate use of single-dose vials includes prompt use of the contents in a single patient during a single procedure and immediate disposal of the vial and any remaining contents, the CDC authors report. They add that difficulties in acquiring the appropriately sized medication vials, frequently a result of medication shortages, often lead to these safety breaches. "These outbreaks could be avoided if smaller medication vial sizes that better fit procedural needs were manufactured."

According to the CDC, 20 outbreaks associated with multiple-patient use of single-use or single-dose vials have been reported since 2007. "These investigations help remind health-care providers of infection prevention practices that are critical for patient safety," they note.

"When outbreaks or clusters are identified, prompt notification of public health authorities is imperative to ensure that appropriate case-finding activities and infection control measures are implemented to prevent additional harm," they conclude.

The study was not commercially supported. The authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2012;61:501-504. Full text