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) . 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 hepatitis C virus (HCV), hepatitis B virus (HBV) and/or other pathogens include:
- Using the same syringe to administer medication to more than one patient, even if 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 reusing 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 HBV, HCV and other infections 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 intramuscular (IM) vaccines.
The medications used in these procedures were in single-dose or single-use vials, multi-dose vials, and bags. What they had in common was the vials or bags were used for more than one patient and were entered with a syringe that had already been used for a patient; or the syringe itself was used for more than one patient.
These unsafe injection practices put patients at risk for bacterial, fungal, viral, and parasitic infections.
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 potentially infectious agents. 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:
- Designate someone to provide ongoing oversight for infection control issues;
- Develop written infection control policies;
- Provide training;
- Conduct quality assurance assessments