safe injection practices in hospital setting

1. Safe Injection Practices
DR.ANJALATCHI MUTHUKUMARAN
NURSING SUPERINTENDENT
ELMCH , ERA UNIVERSITY

2. Why need injection safety practice ?

3. What is safe injection practices ?
 Safe injection practices are intended to prevent transmission
of infectious diseases between one patient and another, or
between a patient and health care personnel (HCP) during
preparation and injection of medications.
 HCP most frequently handle parenteral medications when
administering local anesthesia, during which needles and
anesthetic cartridges are used for one patient only, and the
special procedure cartridge syringe is cleaned and heat-
sterilized between patients. Other safe practices apply to use
of injected medications in IV fluids, such as for patients
undergoing conscious sedation.
 A safe injection does not harm the recipient and does not
expose HCP to any avoidable risks.
 Because of reports of transmission of infectious diseases by
inappropriate handling of injectable medications, CDC now
considers safe injection practices to be a formal element of
Standard Precautions.

4. Definition of safe injection practices
 As defined by the World Health Organization, a safe
injection does not harm the recipient, does not
expose the provider to any avoidable risks and does
not result in waste that is dangerous for the
community.

5. Steps of safe injection practices
 STEP 1: Clean work space.
 STEP 2: Hand hygiene.
 STEP 3: Sterile and new syringe and needle, with re-
use prevention and/or injury protection feature
whenever possible.
 STEP 4: Sterile vial of medication and diluent. STEP
5: Skin disinfection.
 STEP 6: Appropriate collection of sharps.
 STEP 7: Appropriate waste management.
 By following these simple steps, you take key
actions to ensure the risks of unsafe injections are
avoided.

6. Hand washing steps s

7. GUIDELINES FOR INJECTION SAFETY
 The specific guidelines for injection safety from the CDC are:
 Follow proper infection control practices and maintain aseptic technique during the
preparation and administration of injected medications.
 Never administer medications from the same syringe to more than one patient, even if
the needle is changed or you are injecting through an intervening length of IV tubing.
 Never enter a vial with a used syringe or needle.
 Do not use medications packaged as single-dose or single-use for more than one
patient.
 Do not use bags of intravenous solution as a common source of supply for more than
one patient.
 Limit the use of multi-dose vials and dedicate them to a single patient whenever
possible.
 Do not keep multidose vials in the immediate patient treatment area.
 Medications should be prepared in an area that is free from contamination on a clean
work surface.
 Outbreaks have been linked to preparing medications in areas contaminated with
blood or body fluids as well as in the same area that (used) syringes are
disassembled.
 Always use facemasks when injecting material or inserting a catheter into the epidural
or subdural space.

8. The Golden Rules of Injection Technique
 Golden Rule #1: Always inject into the healthy fatty
layer under your skin1
 olden Rule #2: 4mm pen needles, inserted at 90
degrees are recommended for all adults and
children1*
 Golden Rule #3: Inject diabetes medication into
areas on the abdomen, thighs, and buttocks1

10. Continued
 Golden Rule #4 Check injection sites for lumps and
bumps1
 Golden Rules #5 Rotate injection sites properly1

11. CDC guidelines
Do’s injection practices
 Prepare injections using aseptic technique in a clean
area.
 Disinfect the rubber septum on a medication vial with
alcohol before piercing.
 Do not use needles or syringes for more than one
patient (this includes manufactured prefilled syringes
and other devices such as insulin pens).
 Medication containers (single and multidose vials,
ampules, and bags) are entered with a new needle
and new syringe, even when withdrawing additional
doses for the same patient.
 Use single-dose vials for parenteral medications
when possible.

12. Don’t use injection practice
 Do not use single-dose (single-use) medication vials,
ampules, and bags or bottles of intravenous solution
for more than one patient.
 Do not combine the leftover contents of single-use
vials for later use.
 Do not use fluid infusion or administration sets (e.g.,
IV bags, tubings, connections) for more than one
patient.

13. The following apply if multidose vials
are used:
 Dedicate multidose vials to a single patient whenever
possible.
 If multidose vials will be used for more than one patient,
they should be restricted to a centralized medication area
and should not enter the immediate patient treatment
area (e.g., dental operatory) to prevent inadvertent
contamination.
 If a multidose vial enters the immediate patient treatment
area, it should be dedicated for single-patient use and
discarded immediately after use.
 Date multidose vials when first opened and discard within
28 days, unless the manufacturer specifies a different
date.

14. ACTIONS THAT HELP PREVENT UNSAFE
INJECTION PRACTICES:
 Quality Dept, Infection Prevention Dept, Risk
Management Dept: Periodically observe injection
practices by all healthcare personnel responsible for
medication preparation and administration
throughout the facility. Hospitals and Ambulatory
Surgery Centers can use the CMS infection control
checklist to conduct direct observations. To guide
observations in other types of ambulatory settings,
use the CDC’s Guide to Infection Prevention for
Outpatient Settings: Minimum Expectations for Safe
Care.

15. Contineud
 All healthcare personnel should receive regular education
and training regarding safe injection practices. To assist
with education efforts, the CDC’s One and Only
Campaign offers videos such as Safe Injection Practices
for Healthcare Providers. The CDC also offers print
materials and posters for various settings such
as Injection Safety Reminders for Oncology Clinics.
Education is particularly important considering the
research that has shown the many misconceptions held
by healthcare personnel in relation to injection safety.
Consider tailoring the education to the setting and the
most frequently observed missteps at your facility. Adults
are eager learners if they perceive education to be
valuable in their work.

16. Continued
 Lastly, look at the various medication preparation areas
throughout your facility. Don’t assume that only the
designated, official med prep areas are always used to
prepare medications. Critically assess the med prep area
to ensure it isn’t adjacent to any potential source
contamination, within 3 feet of a sink, or in a cluttered
environment. The previously mentioned references
contain this type of information as well.
 NOTE: If you are a staff member in a clinical area (rather
than one of the previously mentioned departments), look
at the med prep environment and practice in your area.
The tools mentioned earlier are still helpful in focusing on
observations. Work with your educator or your manager
to determine the best method and best information to
provide to staff and providers in your area. The results of
your observations can help guide education.

17. Conclusion
 Unsafe injection practices are no joke! Poor
practices have harmed patients and even led to
patient deaths. Be proactive and assess injection
practices now!

18. Injection safety checklist

19. References
 CDC. Basic Expectations for Safe Care Training Module
6 – Safe Injection Practices. Available
at: https://www.cdc.gov/oralhealth/infectioncontrol/safe-
care-modules.htm. Accessed May 8, 2018.
 CDC. Summary of Infection Prevention Practices in
Dental Settings: Basic Expectations for Safe Care.
Available
at: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/saf
e-care2.pdf pdf icon[PDF – 834 KB]. Accessed March 31,
2016.
 CDC. Guidelines for infection control in dental health-
care settings – 2003. MMWR 2003; 52(No. RR-17):1–66.
Available
at: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf pdf
icon[PDF-1M]. Accessed March 18, 2016.
 CDC. Injection Safety. Available
at: https://www.cdc.gov/injectionsafety/providers/provider
_faqs_general.html. Accessed March 18, 2016.