Single-Use Vials -- The Debate Continues

Laura A. Stokowski, RN, MS


December 11, 2012

In This Article

Frankly, My Dear, I Don't Believe It

Several of those who participated in the discussion clearly do not believe that the recent reports of infectious outbreaks justify the condemnation of reusing single-use vials. For example, an anesthesiologist wrote, "This appears to be an unfortunate case of bureaucratic overreaching based on unsubstantiated allegations. Well-trained, conscientious practitioners have, for many years, delivered medications safely to billions of patients. If proper basic injection practices are employed, there is no scientific basis for this recent indictment of medication vials. One would not throw out a gallon of milk after pouring 1 glass."

Referring to the outbreak reports, an emergency department nurse commented, "I still question these findings. I have an intubated patient with an order for 1 mg lorazepam intravenous. The vial comes in 2 mg/mL. Our hospital is broke and this patient is on Medicare or has no insurance, and you want me to get a second vial to repeat medicating this person in 15-30 minutes? It is not happening; it is purely waste."

"Although the case reports are concerning, compared with the sheer number of physicians doing this, the infection rate is likely minimal," claimed a physician. "The drug shortages that could result really should be considered by the CDC rather than their response of 'Primum non nocere.' When we waste medications and there are shortages, we are doing harm. If you are going to make policy on a few scary case reports...we are all doomed."

CDC responded to this comment. "CDC is aware of more than 40 outbreaks in recent years of disease associated with unsafe injection practices including improper use of syringes, needles, and medication vials. Because it takes fairly advanced detective work (surveillance) and often a bit of luck to detect these types of outbreaks, these 40 are likely just the tip of the iceberg. In addition, we routinely hear from medical colleagues across the country that when they look for unsafe practices, they find them -- even in the clinics advanced enough to employ quality audits."