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Syringe reuse and other unsafe injection practices still occurring across all healthcare settings

December 2, 2010

Premier Safety Institute - Safety Share Newsletter

Bulletin brought to you by the Premier Safety

Most professionals follow recommended practices for injections – a few need additional training, Premier healthcare alliance study finds

Although the vast majority of the 5,500 U.S. healthcare professionals surveyed are following recommended safe injection practices, a small minority are reusing syringes (1 percent) and single-dose vials (6 percent), putting some patients at risk of infection, according to a
peer-reviewed study.*
*Pugliese G, Gosnell C, Bartley J, Robinson S. Am J Infect Control; Dec 2010; 38:789-98.


Recent outbreaks of hepatitis B and C viruses and bacterial pathogens in healthcare settings due to unsafe injection practices and lapses in basic infection control and aseptic technique have focused attention on this issue. The purpose of the survey, conducted by the Premier healthcare alliance, was to gain a fuller understanding of current injection practice patterns across hospital and non-hospital settings in the U.S. to guide expanded outreach, education and prevention efforts. In addition, sharing the results in a journal article and this newsletter provides an opportunity to educate the healthcare industry about the importance of safe injection practices, as the risk of infection can occur anywhere injections are administered.


Highlights of results:

The majority, 99.2 percent “never” reuse a syringe or needle. However, nearly 1 percent, or 45, “sometimes or always” reuse a syringe, only changing the needle for use on a second patient.

Six percent, or 318, “sometimes or always” use single-dose/single-use vials on more than one patient.

Fifteen percent, or 797, reported reuse of a syringe to enter a multi-dose vial.


Of this group, 6.5 percent, or
51, reported saving vials for use on
another patient, representing
approximately 1 percent of all

Half of the 51 reported working in hospital settings, and the other half reported working in non-hospital settings such as ambulatory surgical centers and physician offices.

CDC guidelines
CDC guidelines recommend syringes and needles be used only once, not reused for another patient or to access a medication or solution that might be used for a subsequent patient. The guidelines also recommend that single-dose vials
not be used for multiple patients and that multi-dose vials be assigned to a single patient whenever possible.


Elimination of risk

Complete elimination of the risk to patients from unsafe injection practices will require continued monitoring of adherence to policies and practices, competency assessment, surveillance, oversight, enforcement, and provider and patient education, according to Premier. There are many ongoing collaborative efforts by healthcare and professional organizations, regulatory agencies, and accreditation organizations to further ensure that healthcare providers are protecting patients. These include:


The CDC’s broad dissemination of

on injection safety.

Joint Commission accreditation surveys, including a recent
Q and A addressing multi-dose vials.

CMS surveys of hospital and non-hospital settings, including a new standard for ambulatory surgical centers and other outpatient healthcare settings. The new standard includes an infection control
worksheet that focuses on injection safety.

Safe Injection Practices Coalition (SIPC), a collaborative partnership of healthcare-related organizations and their public and provider education and awareness program,
One & Only Campaign, and its healthcare training video.


Free training video also available from

Training, education, position papers, and outreach on injection safety from public, private, professional, governmental and other healthcare-related organizations.

Visit the Premier Safety Institute’s website (
for education and training resources, CDC guidelines on safe injection practices, and a copy of the article.


Safe injection practice is a component of the safety culture of an organization. This includes empowering patients to speak up and healthcare professionals to follow and promote safe injection practices. Premier also recommends continued partnerships among professional, governmental and non-governmental organizations with a focus on education and redesigning devices, products and processes.

Safety Institute