1. Safe Injection Practices

2. SITUATION • Confirmed patient-to-patient transmission of blood borne & other pathogens in US healthcare facilities • Transmission have been linked to unsafe injection practices

3. BACKGROUND Past Decade, US • > 35 reported outbreaks of viral hepatitis among patients • > 250 confirmed cases since 2008 • Outbreaks linked to unsafe injection practices • > 90,0000 patient notifications re: potential exposures to blood borne pathogens

4. BACKGROUND Mar 2012 • Orthopedic clinic-DE • 7 patients / 5 same procedure date • All admitted to hospital for Rx of septic arthritis or bursitis • 6 pts. and 1 HCW had MSSA w/ indistinguishable PFGE type • Reuse of single-dose vials of bupivacaine for multiple patients Apr 2012 • Outpatient Pain Management clinic – AZ • 3 patients / same procedure date • 1 Pt. developed MRSA mediastinitis & bacteremia • 2 Epidural steroid injections / 1 stellate ganglion block • Contrast medium drawn up in procedure room • Change in vial size due to drug shortages

5. ASSESSMENT • Unsafe injection practices place patients at risk • Use of single-dose vials for multiple patients • Contamination of multi-use vials & containers via reuse of needles/syringes • Other related consequences include: • Negative media • Malpractice suits • Disciplinary action by licensing boards

6. ASSESSMENT • Variable practices exist and may differ between health care facilities / settings • Healthcare facilities MUST develop processes to • Assure policies/protocols set clear expectations • Assess existing practices • Evaluate existing products • Educate and train staff on safe injection practices

7. RECOMMENDATIONS Assure policies/protocols set clear expectations

8. RECOMMENDATIONS Assess Existing Practices • TIPS • Include all settings where injections may be administered • Targeted audits/mock surveys • Annual IP Program Review

9. RECOMMENDATIONS Evaluate Existing Products • TIPS • Work closely with Pharmacy • Targeted audits/mock surveys • Single dose vials whenever possible • If not possible, review alternatives • Use multi-dose vial as single-dose vial • Can Pharmacy support drawing doses in controlled setting (e.g. in pharmacy under laminar hood)?

10. RECOMMENDATIONS Educate and train staff on safe injection practices http://www.cdc.gov/injectionsafety/1anOnly.html

11. References • CDC -The One & Only Campaign - Injection Safety • HICPAC. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. June 2007 • Sue Dill Calloway. Safe Injection Practices Presentation. 2012 • MMWR. Invasive Staphylococcus aureus Infections Associated with Pain Injections and Reuse of Single-Dose Vials — Arizona and Delaware, 2012. July 13, 2012 / 61(27);501-504

12. Questions for the CHAIN Gang??