General Questions

Injection safety, or safe injection practices, is a set of measures taken to perform injections in an optimally safe manner for patients, healthcare personnel, and others. 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 (e.g., through inappropriate disposal of injection equipment) [13]. Injection safety includes practices intended to prevent transmission of infectious diseases between one patient and another, or between a patient and healthcare provider, and also to prevent harms such as needlestick injuries.

In this context, aseptic technique refers to the manner of handling, preparing, and storing of medications and injection equipment/supplies (e.g., syringes, needles and IV tubing) to prevent microbial contamination.

The most common practices that have resulted in transmission of viruses (e.g., hepatitis C virus (HCV), hepatitis B virus (HBV)), bacteria (e.g., methicillin-resistant Staphylococcus aureus (MRSA)) and/or other pathogens (e.g., fungi) include:

• Using the same syringe to administer medication to more than one patient, including when the needle was changed or the injection was administered through an intervening length of intravenous (IV) tubing [1,2];
• Accessing a medication vial or bag with a syringe that has already been used to administer medication to a patient, then using the remaining contents from that vial or bag for another patient [3–6];
• Using medications packaged as single-dose or single-use for more than one patient [7–9];
• Failing to use aseptic technique when preparing and administering injections [10–12].

Unsafe injection practices that put patients at risk for infections such as HBV, HCV, and MRSA have been identified during various types of procedures. Examples include:

• Administration of sedatives and anesthetics for surgical, diagnostic, and pain management procedures;
• Administration of IV medications for chemotherapy, cosmetic procedures, and alternative medicine therapies;
• Use of saline solutions to flush IV lines and catheters;
• Administration of joint injections.

No. Pathogens including HBV, HCV, and human immunodeficiency virus (HIV) can be present in sufficient quantities to produce infection in the absence of visible blood. Similarly, bacteria and other microbes can be present without clouding or other visible evidence of contamination. Just because blood or other material is not visible in a used syringe or IV tubing does not mean the item is free from pathogens. All used injection supplies and materials are potentially contaminated and should be discarded.

To help ensure that all healthcare personnel understand and adhere to safe injection practices, we recommend the following:

1. Designate someone to provide ongoing oversight for infection control issues;
2. Develop written infection control policies;
3. Provide competency-based training;
4. Perform periodic observations of infection control practices (i.e., audits) and provide feedback to personnel who prepare or administer injectable medications

CDC has a number of resources that can be used for training and auditing of adherence to safe injection practices.  Examples are available on the CDC injection safety page and in the following locations:

• Injection Safety Campaign Materials:  https://www.cdc.gov/injectionsafety/1anonly.html
• Setting-specific Infection Control Assessment Tools:  http://www.cdc.gov/infectioncontrol/tools/index.html
• Injection Safety On-line Training Module: https://www.train.org/main/course/1081807/external icon