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Safe Injection Practices

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10 minutes
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When receiving an injection, protection from infections, including bloodborne pathogens, is a basic requirement and expectation anywhere healthcare is provided. For employees, the Needlestick Safety and Prevention Act requires appropriate, commercially available, and effective safer medical devices designed to eliminate or minimize occupational exposure. Whenever unsafe injection practices occur, it indicates that healthcare personnel are unaware of, do not understand, or do not adhere to basic principles of infection control and aseptic technique. Unfortunately, there have been thousands of reported potential infections each year in the United States from unsafe injection practices. Infections can range from bacterial, fungul, and viral including HIV, hepatitis B and hepatitis C. The most common unsafe injection practices are: reinsertion of used needles into a multiple-dose vial or solution container (like a bag of normal saline) and the use of a single needle or syringe to administer intravenous medication to multiple patients. Safe injection practices are integral to Standard Precautions, and include the following key ideas: Needles and other sharps must be discarded in leak-proof, rigid, puncture resistance containers Sharps with Engineered Sharps Injury Protections are defined as "a non-needle sharp or a needle device used for withdrawing blood or body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident." So, an angiocath for example, as you can see it has this button here, that once we've inserted the actual catheter into the vein, we can actually withdraw the needle, while the catheter stays in the vein, and now we have a very protective covering over this needle, so we can dispose that in the sharps container, and we don't run the risk of getting poked. Make sure not to bend, shear, break or recap needles. If you must recap, use a one-handed method. For example, this is most often used when we are going to be drawing up medication. We need to obviously put the air into the vial to get the medication out. After we've withdrawn the appropriate amount of medication, now we're probably going to set this on a tray, or get ready for the actual injection in the room. This is where a one-handed needle recapping is gonna come in handy, and we can mark that, and leave that on the tray safely. Make sure to use aseptic technique to avoid contamination of sterile injection equipment. This means washing our hands, using clean gloves; using alchol wipe to clean injection portals, vials, and skin where a needle will be inserted. So for example, in a real situation, maybe we have our gloves on after we've washed our hands, depending on your protocols, your local protocols, we can clean the top of that vial with the alcohol wipe, before we actually draw up the medication. Again, having gloves available is always a good idea. Having multiple available in case one gets contaminated is important. And then changing gloves in-between patients, and in-between the different types of tasks that you're doing. And example a needle that's still capped, you can see this here, it's not done yet, so you know, if we're changing needles, you're going from the actual drawing up, to the actual injection needle. Again, this is all gonna be done with aseptic and clean technique. Do not administer medications from a syringe to multiple patients, even if the needle of the syringe is changed. Needles and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or a solution that might be used for a subsequent patient. A good rule of thumb to remember is "One Needle, One Syringe, One Time only" Use fluid infusion and administration sets (IV intravenous bags, tubing and connectors) for one patient only and dispose of those appropriately after use. Consider a syringe or needle / cannula contaminated once it has been used to enter or connect to a patient's intravenous infusion bag or either that, or the administration set as well. Use single-dose vials for medications should always be used whenever possible. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use. Whenever possible, use a single-dose vial. It's preferred over multiple-dose vials, especially when medications will be administered to multiple patients. If it is a multidose vial and you have to use it, both the needle and syringe used to access the multidose vial must be sterile. Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer's recommendations; discard if the sterility is compromised or questionable. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients. And for spinal lumbar puncture procedures, wear a surgical masks when placing a catheter or injecting material into the spinal canal or subdural space (for example: during myelograms, lumbar puncture and spinal or epidural anesthesia.) Remember, OSHA requires that Exposure Control Plans reflect how employers implement new developments in control technology. It also requires employers to solicit input from employees responsible for direct patient care in the identification, evaluation, and selection of engineering and work practice controls; and it also requires certain employers to establish and maintain a sharps injury log of percutaneous injuries from contaminated sharps. The sharps injury log must include the specified minimum information regarding the device that was involved (if you know what it was), the location of the incident, and the description of the events that resulted in the injury. The level of detail presented should be sufficient to allow ready identification of the device, the location, and circumstances surrounding an exposure incident so that the intended evaluation of risk and device effectiveness can be accomplished. Employers are required to record sharps injuries involving contaminated objects on the OSHA 300 Log of the Work-Related Injuries and Illnesses and the OSHA 301 Injury and Illness Incident Report. So be sure that if you're stuck by a needle or other sharp, or get blood or other potentially infectious materials in your eyes, nose, mouth, or broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if at all available. Report this immediately to your employer and seek immediate medical attention. Now let me demonstrate the basic aseptic technique in preparing an injection: Keep the area free of clutter so all surfaces can be easily cleaned and disinfected, be sure to wash your hands appropriately. Remember, gloves are not usually needed when giving injections. However, if excessive bleeding is expected or other bloodborne pathogen risks exist, wear gloves; for example, the healthcare worker has dry cracked skin on his hands. When you attach needle to a syringe to draw up medication, remember to discard the needle if it touches a hand, a surface or any other non-sterile object. Just throw it away. And then use another clean, sterile needle. Check the medication and the corresponding patient's name dosage and make sure to have the right medication, the right dose, the right route, and the right person before giving any medication. Swab the top of the vial with an individual alcohol pad. Just a sidenote here: if you're using a glass ampule, don't use your bare fingers. Use a gauze pad to break it open. And remember to use a filtered needle when you draw up from a glass ampule like that. You'll change the needle to actually administer the medication after you've drawn up to a non-filtered needle when you deliver the medication. I'm going to be drawing up three or four, let's say four CC's of medication, I'm actually going to insert that amount of air into the vial. This gives me enough pressure to be able to actually withdraw the appropriate amount of medication. Remember to use the one hand recapping technique and then use the new sterile needle on the actual syringe to deliver the medication. Remember, never reenter a multi-dose vial with the same needle and syringe. Always use a new sterile needle and a new syringe.

A basic expectation that exists in any healthcare setting is the protection from an infection (blood and other potentially infectious materials) while receiving an injection. In this lesson, we'll cover some ways in which you can better help protect the patient, as well as yourself.

Safer Devices Equals a Safer Environment

For employers, the Needlestick and Prevention Act requires that they provide appropriate, effective, safe, and commercially available medical devices that are designed to eliminate or minimize your occupational exposure if ever unsafe injection practices occur.

However, combining those safer devices with a better awareness of the potential risks, along with aseptic infection control techniques, should ultimately be your goal, as thousands of infections occur each year in the U.S. as a result of unsafe injection practices.

Warning: The most common unsafe injection practices include re-using needles, using multiple-dose medications or bags of solutions, and administering the same intravenous medications to multiple patients.

Safe injection practices are instrumental to following the standard precautions and include safe sharps disposal practices – such as using leak-proof, puncture-resistant appropriate sharps containers – along with using sharps and needle devices that have been engineered with injection protections. This includes any time you withdraw blood or other bodily fluids, access a patient's vein or artery, or administer medications and other fluids.

An example of a device with injection protection would be an angiocatheter with a button on the side that allows you to easily withdraw the needle once inserted into the catheter, while the catheter remains in the patient's vein. The needle now has a protective covering so there is no risk of getting poked and can safely be disposed in a sharps container.

Pro Tip #1: Don't bend, break, or recap needles. However, if you must recap a needle, do so using the one-hand method shown in the video for this lesson. A recapping situation would include withdrawing medication from a multi-dose vial. Rather than leave on a tray or table with the needle exposed, you can use the one-hand method to reinsert the needle into its protective sheath while waiting to administer the medication to the patient.

Aseptic Techniques Equals a Safer Environment

Make sure to always use aseptic techniques to avoid the contamination of sterile injection equipment. This includes washing your hands, using clean gloves, and using alcohol wipes to clean injection portals, the tops of vials, and the skin where needles will be inserted.

Remember to always change your gloves between patients and between tasks that may increase the chances of infection. And it's a good idea to have a generous supply of gloves so you don't run out.

Pro Tip #2: Never administer medication from a single syringe to multiple patients, even if the needle has been replaced. Needles and syringes are sterile, single-use items. You can remember this rule with this little ditty: 1 needle, 1 syringe, 1 time only!

Other single-use pieces of equipment are fluid infusion and administration sets (IVs, IV bags, tubing, connectors, etc.) and syringe and needle cannulas. One use, one time, then dispose of these items safely. And remember, if any sterile item touches a non-sterile item, throw it away and get another.

When preparing an injection, keep work areas free of clutter and wash your hands appropriately. Gloves are not usually required when giving an injection, but there are some exceptions:

  • If excessive bleeding is expected
  • If other bloodborne pathogen risks exist
  • If you have dry, cracked skin or cuts, abrasions, etc.

If using a glass ampule, don't use your bare fingers to open it. Instead, use a gauze pad to break the seal and use a filtered needle when drawing from any glass ampule. Then change to a non-filtered needle before administering the medication to the patient.

Also, make sure to check the name, dosage, and proper delivery method before administering any medications. And never re-enter the same vial with the same needle and syringe; always use a new needle and syringe.

Single-Dose vs. Multi-Dose Vials

Use single-dose vials whenever possible to reduce the chances of infection, especially when the same medication is being administered to multiple patients. And do not combine the contents of one vial to another.

If you are using multi-dose vials, make sure both the syringe and the needle are sterile. If there is any doubt, toss them out. Store all medication vials according to the manufacturers' recommendations and don't keep multi-dose vials in patient treatment areas.

Also, don't use bags or bottles of IV solutions as a common source of supply for multiple patients.

Pro Tip #3: Whenever performing spinal lumbar puncture procedures, be sure to wear a surgical mask when placing the catheter or injection material into the spinal canal or the subdural space.

OSHA's Requirements

OSHA requires that any exposure control plan reflect how employers implement new developments in control technology.

OSHA requires employers to solicit input from employees who are responsible for direct patient care, and this includes the identification, evaluation, and selection of better engineering and work practice controls.

OSHA also requires that certain employers establish and maintain a sharps injury log of all percutaneous injuries from contaminated sharps. The sharps injury log must include the location of the incident, the device involved, and a description of the incident (at minimum) to properly evaluate future risks and device effectiveness.

Employers are required to record all work-related sharps injuries involving contaminated objects on both the OSHA 300 log and the OSHA 301 log.

Warning: If you're ever stuck by a needle or other sharp, or get blood or OPIM in your eyes, nose, mouth, or by contact with broken skin, immediately flood the exposed area with water. Clean any wound or broken with soap and water or a skin disinfectant if available. Report the incident to your employer and get immediate medical attention.