Safe Injection Practice, Sharp disposal & Management for Sharp injury

Safe Injection Practice

Unsafe injection practices are associated with the transmission and outbreaks of blood-borne viruses (HIV, Hepatitis B, and C). Therefore, all staff must receive education and training in safe injection practices. In addition, the following measures must be taken to achieve safe injection practices in healthcare facilities:

• Prepare all injections in a dedicated, clean, organised area, as it is vital in preventing contamination with microorganisms. The area should meet the essential requirements for safe injection preparation. The area must not be contaminated with blood and/or body fluids. Any contaminated items, including blood samples, must not be brought to this room or area.
• Healthcare workers must always perform hand hygiene before preparing injections and before and after giving an injection.
• Carefully inspect the packaging before opening it, and discard the syringe and needle if it has been damaged or moist.
• Always use a sterile syringe and needle from a new and sealed package. If the sterility of the pack is compromised (e.g., a break in sterile packaging), use a new pack of undamaged syringes.
• Never reuse needles or syringes, as they are single-use items only.
• Use single-dose vials where feasible, as outlined in this section.
• Each medication/vaccine should be administered aseptically and separately.
• Clean skin if it is visibly dirty and then disinfect skin by applying 70% alcohol isopropyl alcohol (± 2% chlorhexidine) solution on the skin till it is dry.

Single-dose vials

• Use single-dose vials for IV medications whenever possible.
• If single-dose vials are dedicated to a single patient, always label them with the patient’s name, opening date, and expiry date per the manufacturer’s recommendations.
• Do not administer medications from single-dose vials or ampoules to multiple patients or combine leftover contents for later use.
• Don’t leave needles on the vial or cover the septum of the vial with tape or sticky plaster.
• Before access, disinfect the septum of the vial (by wiping using friction) and the blood culture bottle with 70 per cent isopropyl alcohol wipes and allow the septum to dry before inserting a needle or other device. 

Use of multi-dose vials 

• Avoid using multi-dose vials. Limit their use and dedicate them to a single patient (see above). 
• Do not keep multi-dose vials in the immediate patient treatment area. Instead, they should be locked and accessed only in a dedicated medication preparation area. It will help prevent cross-infection between patients due to accidental contamination of the vial through direct or indirect contact with potentially contaminated surfaces, items, and equipment.
• Once a multiple-dose vial is punctured, it should be assigned a ‘beyond-use’, which starts when it is entered or opened.
• Discard the vial if sterility is compromised or questionable.
• Although multi-dose vials contain antibacterial preservatives to prevent bacterial growth, they have no activity against viruses.
• Disinfect the vial’s rubber septum before piercing the vial by wiping and using friction with a 70% isopropyl alcohol swab and allow the septum to dry before inserting a needle or other device. 
• Always use a new sterile needle and a new sterile syringe to access a multi-dose vial.

Infusion bags or bottles

• Do not use ‘communal’ saline or sterile water infusion bags or bottles as a common supply of intravenous fluids to multiple patients.
• To avoid microbial contamination, don’t leave needles in the infusion bag.

Double-dipping is dangerous!

Using the same syringe to inject more than one patient from a multi-dose vial is called ‘double-dipping’.In summary, when a syringe is used to draw medication from a multi-dose vial to inject a patient, when the same syringe is re-used, with or without a new needle to draw more medication from the vial, the entire multi-dose vial is contaminated. When the multi-use contaminated vial is accessed and used on others by other patients, it leads to cross-infection. This practice is unsafe and responsible for documented infection outbreaks (See Fig. below)