Though it seems unimaginable, health care providers have some knowledge gaps surrounding contamination and have reported syringe reuse. Direct syringe reuse, just as it sounds, involves the use of a single syringe for multiple patients. This includes reuse of insulin pens, administering medication through intervening lengths of tubing with the same syringe, or administering vaccines to multiple patients after changing the needle but reusing the syringe. As an example of this in a Colorado pediatric office in 2011 a medical assistant performing vaccinations removed the needle from what she believed was an adult dose and saved the syringe for a second pediatric dose, this also occurred at an obstetrics office in New York in 2008 where the staff put six doses of flu vaccine in a syringe changing only the needle between patients. Direct syringe reuse does happen but the most common cause for these large Hepatitis outbreaks is indirect reuse or double dipping. This happens when a used, contaminated syringe, is used to re-enter a vial or bag that is a common source for multiple patients. As you can imagine, just one entry into a bag with a contaminated syringe can lead to multiple exposures if the medication is used for subsequent patients. Previous outbreaks and notification events have shown that some Dangerous Misperceptions surrounding safe injections exist. As illustrated with the Nevada example, some providers believe that changing the needle makes a syringe safe for reuse. False. Back-flow from the injection can contaminate the syringe. Another Misperception is that syringes can be reused if there is a sufficient length of tubing between the patient and the injection sight. False, everything from the medication bag to the patient's IV catheter is a single interconnected unit. Distance from the patient, gravity, or even infusion pressure do not insure that the syringe will not become contaminated. Lastly, some providers might think that the lack of visible blood means the supplies are safe for reuse. Again, this is false. Pathogens like HIV and Hepatitis B and C can be present in sufficient quantities to cause infection without blood being visible. An easy rule to remember is this, once a needle and syringe are used, both are contaminated and must be discarded. A single dose vile lacks antimicrobial preservatives to prevent bacterial growth, it should be discarded after a single use. Even if there is leftover medication. Intravenous fluids are for single patient use and should not be used for more than one patient. Just like single dose vials these fluids lack antimicrobial preservatives to prevent growth of contaminating bacteria. A multiple-dose vial has antimicrobial preservatives to prevent bacterial growth, and can be used for more than one patient. Multiple-dose vials should be discarded when the beyond-use date is reached, when doses are drawn in patient treatment areas, and when sterility of the vial is in doubt. The size of the vial does not matter. Single dose vials and multiple dose vials come in a variety of sizes. Do not assume a vial is a single dose or multiple dose based on size. Always read the label. As a result of outbreaks resulting from single dose vial misuse, the CDC restated it's position on the use of single dose, single use vials in 2012. The CDC stated that vials labeled by the manufacturer as single dose or single use should only be used for a single patient. Ongoing outbreaks provide ample evidence to support that this misuse results in patient harm. Leftover medication should not be pooled or stored for later administration. And in times of shortage, medications can be repackaged only if it's done in accordance with established standards. Failure to use aseptic technique when preparing medications, is another major cause of outbreaks relating to unsafe injections. In this context, aseptic technique means handling and preparing supplies used for injections in a manner that prevents microbial contamination between the injection materials and the non-sterile environment. Failure to use aseptic technique is most often linked to the spread of Hepatitis B. Hepatitis B is a hardy virus and has has been demonstrated to remain infectious in dried blood on environmental surfaces for at least seven days at a New Jersey oncology office in 2009, failure to use aseptic technique resulted in 29 outbreak associated cases and an additional 68 possible cases and 4,600 patients who were considered potentially exposed and were notified to be tested. As a result, the practice was closed and the physician's license was revoked. The outbreak that lead to so many people becoming infected with Hepatitis B was due to the following infection control breaches, lack of hand hygiene, failure to establish a clean medication area, and the preparation of medications in areas with visible blood contamination. Use of a common use saline bag, and reuse of single dose vials for multiple patients. [MUSIC] >> Three judges. >> Show me the technique. >> Contestants from around the country. One great prize. This season on the technique. [MUSIC] >> [APPLAUSE] >> Hi folks, and welcome back. I'm Rob Moreno and this is the technique. Last night we watched Jennifer from Charleston squeak through the first round after failing to label her multi-use vial. And Kim from Oklahoma had to turn her car back home after a disastrous attempt to use a single dose vial on two residents. What does tonight's continuation of round one have in store for us? [APPLAUSE] >> Hi, I'm David. And I'm from Sunnyside Nursing Home and I'm going to win The Technique. >> [APPLAUSE] >> David, loving the confidence today. What does the audience not know about you going in to these auditions? >> Well Rob, this is my second time competing, I made it to the top two last year but my grandma got sick and I knew that my perfect techniques were needed more at home than on TV. I love you grandma. >> What a touching story and is your grandma watching you on the TV this time around? >> Yep. The Nursing Home that she's in they air the technique in the main lobby for all the residents to cheer me on. They've seen me personally in action. And tonight, they're ready for me to win. >> [APPLAUSE] >> Touching story. Now let's see if David can perform like he promises. >> So, David, you can begin when you're ready. >> His confidence. He sees the multi-dose vial pen labels it at the get go. He knows his 28 day rule. >> Rob, I am loving him already. >> I agree, hand hygiene is looking great. A good amount of time with the hand rubbing. Oh. >> Oh. >> Snafu there. >> Change he got another pair. >> He did. [MUSIC] >> I'm rubbing the rubber septum with alcohol for at least ten seconds prior to drawing up the medication. Now, I'm administering the injection. Now I'm disposing of the injection equipment properly. >> [APPLAUSE] >> And you have no intention of using the multi-use file on another resident, hm? >> Never. >> Well way to go Menerver. Why don't you tell him exactly what to say. >> [LAUGH] >> I have to say I wished he had said that on his own. >> Yes. >> But his technique speaks to his knowledge of not sharing multi-use vials whenever possible. David, can you tell me correct protocol if multi-use vials need to be used on more than one resident? >> Not only can I tell you, I can show you. >> Let's get the camera on this. [SOUND] >> The multi-dose vial should always be stored and accessed in a clean, dedicated area for medication preparation and never in the immediate resident treatment area or a resident room. This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could lead to infections in subsequent residents. Now if a multi-dose vial enters the immediate resident treatment area, it should be dedicated to the resident only or discarded after use. In addition, a new sterile needle and syringe should always be used to access the medication of multi-dose vial because the reuse of needles and syringes to access multi-dose vial medication can result the contamination of the medicine with microbes that can spread to others when the medicine is used again. >> Well, Jean, satisfied there? >> [APPLAUSE] >> David, I think it's safe to say you're on to round two. [APPLAUSE] [MUSIC] >> Oh, and one last contestant, a late arrival from New York City. Amber. >> My name is Amber, and I'm from Seabrook Nursing Home in New York City. >> Amber, great. Why don't you begin? >> Mm-hm. >> Great hand hygiene. >> Okay. >> I can't see past her hair. >> Well, it's definitely up out of the way. You know there's something familiar about how she did the gloves, don't you think? >> She reminds me of someone. So far so good. [MUSIC] >> Well at least she's hygienic. [MUSIC] [NOISE] Amber are you missing something? >> I don't think so. >> Amber I'm sorry. But you just left the needle in the vial. That's an immediate fail. And not to mention that it's in a single use vial which is another indication of your inability to practice the technique. >> Wait just a second. This looks like a very sloppy performance that we saw earlier in the day. Is that a wig? >> Is this Kim? >> Are you trying to cheat your way on to a spot on the technique. >> I can't even deal with this. Get off our stage immediately. Rob, what happened to screening the contestants first? >> Join us next week as our contestants hone their skills for round two where the technique will turn its focus to glucometer care. I'm Rob Moreno and this is The Technique. [APPLAUSE] [MUSIC]
