Unsafe Injections: More Preventive Action Needed, GAO Says

Emma Hitt, PhD

August 13, 2012

August 13, 2012 — The extent of unsafe injection practices may be underestimated because of a lack of proper documentation, according to a new report from the Government Accountability Office (GAO).

"Data on the extent and cost of blood-borne pathogen outbreaks related to unsafe injection practices in ambulatory care settings are limited and likely underestimate the full extent of such outbreaks," the authors write.

Two agencies, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC), both part of the Department of Health and Human Services (HHS), need to improve their efforts in this area, the report notes.

The CMS took steps to expand oversight of unsafe injection practices in ambulatory care settings in 2009 by requiring surveyors to use an Infection Control Surveyor Worksheet for documentation. However, the agency stopped collecting data from surveyor worksheets after fiscal year 2011.

"CMS may be undermining its efforts by stopping data collection after fiscal year 2011, in part because of concerns that the time and effort required in collecting the data placed a burden on surveyors," the report states.

The authors also suggest that the absence of comprehensive data underestimates outbreaks of blood-borne pathogens (hepatitis B and C) linked to a specific healthcare facility or clinician that uses unsafe injection practices.

Likewise, data from the CDC indicate that from 2001 through 2011, at least 18 outbreaks of viral hepatitis associated with unsafe injection practices in ambulatory settings, such as physician offices or ambulatory surgical centers, were reported.

Unsafe injection practices that led to outbreaks included syringe reuse, mishandling of medication vials, failure to prepare and store intravenous infusions under aseptic conditions, and medication preparation in a contaminated environment.

The GAO now recommends that HHS do the following: "(1) resume collecting data on unsafe injection practices that will permit continued monitoring of such practices, (2) use those data for continued monitoring of [ambulatory surgical centers], and (3) strengthen the targeting efforts of the One and Only Campaign for health care settings."

The One and Only Campaign is a program designed to educate both clinicians and patients about safe injection practices.

According to the report, HHS concurred with the above GAO recommendations and stated that the CMS intends to resume collection of the Infection Control Surveyor Worksheet data beginning in fiscal year 2013 for a state-stratified, randomly selected subset of ambulatory surgical centers surveyed in that year, and that the agency will repeat this sampling and data collection approximately every 3 years thereafter.

In addition, HHS said that the CDC supports targeting the outreach of the One and Only Campaign toward specific clinician groups and setting types, "though the agency further noted that broad outreach also remains critical as demonstrated by the wide variety of settings where blood-borne pathogen outbreaks and unsafe injection practices have been identified."