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Safe Injection Practices

What are safe injection practices?

Safe injection practices are intended to prevent transmission of infectious diseases between one patient and another, or between a patient and dental health care personnel (DHCP) during preparation and injection of medications. DHCP most frequently handle parenteral medications when administering local anesthesia, during which needles and anesthetic cartridges are used for one patient only, and the dental cartridge syringe is cleaned and heat-sterilized between patients. Other safe practices apply to use of injected medications in IV fluids, such as for patients undergoing conscious sedation. A safe injection does not harm the recipient and does not expose DHCP to any avoidable risks.

Because of reports of transmission of infectious diseases by inappropriate handling of injectable medications, CDC now considers safe injection practices to be a formal element of Standard Precautions.

For more information, visit CDC’s Injection Safety website.

What are the Centers for Disease Control and Prevention’s (CDC’s) safe injection practice recommendations for dentistry?

  • Prepare injections using aseptic technique in a clean area.
  • Disinfect the rubber septum on a medication vial with alcohol before piercing.
  • Do not use needles or syringes for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
  • Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when withdrawing additional doses for the same patient.
  • Use single-dose vials for parenteral medications when possible.
  • Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
  • Do not combine the leftover contents of single-use vials for later use.
  • The following apply if multidose vials are used:
    • Dedicate multidose vials to a single patient whenever possible.
    • If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.
    • If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use.
    • Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a different date.
  • Do not use fluid infusion or administration sets (e.g., IV bags, tubings, connections) for more than one patient.

References

CDC. Basic Expectations for Safe Care Training Module 6 – Safe Injection Practices. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/safe-care-modules.htm. Accessed May 8, 2018.

CDC. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf [PDF – 834 KB]. Accessed March 31, 2016.

CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. Available at: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf [PDF-1M]. Accessed March 18, 2016.

CDC. Injection Safety. Available at: https://www.cdc.gov/injectionsafety/providers/provider_faqs_general.html. Accessed March 18, 2016.

Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007:1–219. Available at: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf [PDF-1M]. Accessed March 18, 2016.

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