INJECTIONS WITHOUT INFECTIONS: SAFE INJECTION PRACTICES ONE NEEDLE, ONE SYRINGE, ONLY ONE TIME

Transcription

1 INJECTIONS WITHOUT INFECTIONS: SAFE INJECTION PRACTICES ONE NEEDLE, ONE SYRINGE, ONLY ONE TIME Patsy Kelso, PhD State Epidemiologist for Infectious Disease Vermont Department of Health

2 INJECTIONS & INFUSIONS CENTRAL TO HEALTHCARE DELIVERY Likely the most common invasive procedure across the healthcare continuum Chemotherapy IV antibiotics Sedation/anesthesia Immunizations Joint injections Cosmetic procedures Alternative medicine

3 WHY UNSAFE INJECTION PRACTICE IS UNACCEPTABLE Injection safety is part of Standard Precautions Healthcare practices should not provide a pathway for transmission of life-threatening infections Patient protections regarding injection safety should be on par with healthcare worker safety

4 TRUE OR FALSE? Iʼm preventing contamination and infection transmission as long as Iʼm changing the needle between patients. injecting through intervening lengths of intravenous tubing. maintaining pressure on the plunger to prevent backflow of body fluids. not able to observe contamination or blood. FALSE FALSE FALSE FALSE One and Only Campaign. Injection Safety: Every Provider s Responsibility. Toolkit - PowerPoints.

5 THREE THINGS EVERY PROVIDER NEEDS TO KNOW ABOUT INJECTION SAFETY 1.Needles and syringes are single use devices. They should not be used for more than one patient or reused to draw up additional medication. 2.Do not administer medications from a single-dose vial or IV bag to multiple patients. 3.Limit the use of multi-dose vials and dedicate them to a single patient whenever possible.

6 EVELYN MCKNIGHTʼS STORY Dr. Evelyn McKnight was battling breast cancer and was infected with hepatitis C during treatment because of syringe reuse to access saline flush solution. Along with Evelyn, 99 cancer patients were infected in one of the largest outbreaks of hepatitis C in American healthcare history. Evelyn co-founded HONOReform, a foundation dedicated to improving injection safety practices, and was the catalyst of the formation of the Safe Injection Practices Coalition. One and Only Campaign. Injection Safety: Every Provider s Responsibility. Toolkit - PowerPoints.

7 THE ONE AND ONLY CAMPAIGN Launched in response to outbreaks resulting from unsafe injection practices Led by the Centers for Disease Control (CDC) and Safe Injection Practices Coalition (SIPC) Goals: Increase understanding and implementation of safe injection practices among healthcare providers Ensure patients are protected each and every time they receive a medical injection One and Only Campaign. Injection Safety: Every Provider s Responsibility. Toolkit - PowerPoints.

8 COMMON SOURCES OF DISEASE TRANSMISSION Failing to use aseptic techniques when preparing and administering injections Using the same syringe for more than one patient, even with a new needle or through a new intervening length of intravenous (IV) tubing Using a single bag of saline or insulin pens for more than one patient Using multi-dose vials after they ve expired and/or after they ve been open too long Most last only 28 days and should always be properly labeled and double checked Using single-dose vials more than once or for more than one patient Single-dose vials often lack preservatives, allowing bacteria to grow

9 INJECTION PRACTICES AMONG CLINICIANS IN US HEALTH CARE SETTINGS Survey of 5,500 US healthcare professionals 1% sometimes or always reuse a syringe on a second patient 1% sometimes or always reuse a multi-dose vial for additional patients after accessing it with a used syringe 6% use single-dose/single-use vials for more than one patient Pugliese G., Gosnell C., Bartley J., & Robinson S. (December 2010). Injection practices among clinicians in United States health care settings. American Journal of Infection Control, 38 (10), Retrieved from

10 US OUTBREAKS ASSOCIATED WITH UNSAFE INJECTION PRACTICES, Bacterial Viral One and Only Campaign. Injection Safety: Every Provider s Responsibility. Toolkit - PowerPoints.

11 Over 150,000 patients have been notified as a result of incidents and outbreaks involving unsafe injections practices City alerts 450 patients of Hylan Boulevard clinic to hepatitis C Concern June 17, 2011 Parents horror as they are told to test their infants for HIV after flu vaccine mix-up April 13, 2011 Nurse accused of stealing pain meds gets probation September 20, 2011 NJ doctor loses license after hepatitis B outbreak September 15, 2011 Guh, A et al. Patient Notification for Bloodborne Pathogen Testing Due to Unsafe Injection Practices in U.S. Healthcare Settings, Fifth Decennial International Conference on Healthcare-Associated Infections. Centers for Disease Control and Prevention, Atlanta, GA. 20 March Retrieved from shea.confex.com/shea/2010/webprogram/paper1789.html.

12 NEVADA, ENDOSCOPY CLINIC, acute HCV infections identified in Las Vegas Investigation pointed to procedures at the same endoscopy clinic during the incubation period 50,000+ patients notified of potential exposure and advised to seek testing 6 additional cases confirmed Two breaches contributed to transmission: Re-entering vials with used syringes Using contents from these single-dose vials on more than one patient One and Only Campaign. Injection Safety: Every Provider s Responsibility. Toolkit - PowerPoints.

13 REUSING SYRINGES: HOW INFECTION SPREADS Backflow from the injection or removal of the needle contaminates the syringe. Contaminated syringe contaminates the medication vial. Reused vial exposes subsequent patients to risk of HCV. Adapted from MMWR (May 16, 2008 / 57(19); )

14 INFANTS AND FLU VACCINE, CO 2011 Medical assistant halved the amount of flu vaccine given to each child, assuming it was an adult dosage (it was premeasured for children). Because the children needed two doses, the assistant removed the used needle from each syringe and replaced it with a sterile needle but didn t replace the syringe, still half full of vaccine. The assistant stored the used syringes in a box marked 'second doses'. That box also contained unused, fully-filled pediatric vaccines. When the children returned for their 2 nd dose some of the half-used vaccines were used on them.

15 NEW JERSEY, ONCOLOGY PRACTICE, 2009 Outbreak of Hepatitis B at an oncology practice 29 cancer patients infected with HBV and 4,600 notified Two breaches in infection control: Reusing single-dose vials for multiple patients Use of a common source saline bag for multiple patients One and Only Campaign. Fast Facts: Unsafe Injection. Retrieved Sept from:

16 INSULIN PEN REUSE INCIDENTS Reuse of insulin pens for multiple patients, reportedly after changing needles has resulted in large notifications NY hospital, patients notified TX hospital, ,114 patients notified WI hospital and outpatient clinic, ,401 patients notified Infection Prevention during Blood Glucose Monitoring and Insulin Administration (2012). Retrieved March 9, 2012 from Important Patient Safety Notification (2011). Retrieved March 9, 2012 from

17 ONE AND ONLY JOE

18 MRSA OUTBREAKS, 2012 Arizona, April 2012 Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) at an outpatient pain management clinic Three patients treated for serious infection, one died Patients injected with a diluted contrast medium from a single-dose vial for radiologic imaging Delaware, March patients who received joint injections at an outpatient clinic Only breach of safe practice was the reuse of single-dose vials of anesthetic for multiple patients, which had occasionally been stored overnight Usually ordered 10mL vials, but a national drug shortage interrupted their supply chain and resulted in the availability of 30mL vials only One and Only Campaign. Fast Facts: Unsafe Injection. Retrieved Sept from:

19 NYS DEPARTMENT OF HEALTH EXPERIENCE

20 NYS PAIN MANAGEMENT CLINIC Routine surveillance found 2 acute HCV cases with epidural injections by the same physician within the exposure period 3 rd case found after review of registry During site visit, physician observed re-using syringe attached to spinal needle attached new needle to used syringe and drew up medications. Instructed to change practice immediately. Initial round of testing on patients receiving injections the week before, during, or after each of the 3 cases: 7/84 HCV positive (8.3%)

21 NYS PAIN MANAGEMENT CLINIC (CONT.) Physician in practice since late 1980s. Initially gave a list of 627 at-risk patients for next round of testing. Health department found at-risk patients not on that list, so sent letters to 8,532 patients. Medical board placed conditions on practice for 3 years

22 NH CARDIAC CATH LAB DRUG DIVERSION HCW worked in 17 facilities in 8 states >12,000 patients possibly exposed 46 HCV infected patients associated with the outbreak 32 New Hampshire, 7 Maryland, 6 Kansas, 1 Pennsylvania Infected HCW criminally charged, including: fraudulently obtaining drugs tampering with a consumer product Pleaded guilty to all charges in August 2013 Sentenced to 39 years in prison in December

23 HUMAN TOLL OF OUTBREAKS AND PATIENT NOTIFICATIONS Surgery Center in Colorado Springs Infected surgery tech accused of stealing syringes of painkillers and slipping the used needles back into the OR after the syringes were refilled with saline 5,700 patients notified and tested

24 DENTAL CLINICAL, MEMPHIS TN, 2016

25 WHAT YOU NEED TO KNOW Hands must be washed immediately before preparing and administering any medications and PPE must be worn appropriately Injections should be prepared in a clean environment free from contaminants and away from patients Needles, syringes, and tubing/connectors are only used one time and for one patient Medical vials should be aseptically cleaned and entered with a new, sterile needle Single means single use single dose vials once Multi-dose vials should be used by only one patient whenever possible and need to be stored and labeled properly and discarded appropriately

26 INJECTION SAFETY CHECKLIST

27 A CALL TO ACTION Injection safety is every provider s responsibility We need to pay attention to all healthcare settings including nursing homes, skilled nursing facilities, oncology clinics, and physician offices Ensure protocols are up to date and documented in your facility As healthcare providers and recipients, we are all at risk and we all have a stake in assuring safe injections Join the One & Only Campaign!

28 SOCIAL MEDIA

29 RESOURCES AND INFORMATION ONEandONLYcampaign.org Keep an eye out for our new VT page launching soon!!

30 MATERIALS AVAILABLE FOR ORDER CDC-INFO

31 ACKNOWLEDGEMENTS CDC Safe Injection Practices Coalition One and Only Campaign Mary Beth Wenger & NY Dept. of Health Kayla Donohue, MPH

32 VDH CONTACTS Kayla Donohue, MPH CDC/CSTE Applied Epi Fellow (HAI) Carol Wood-Koob, RN, CIC HAI Coordinator Patsy Kelso, PhD State Epidemiologist