1. Unsafe injection practices. You should dedicate multi-dose
vials to a single patient whenever possible, yet I continue to see staff
draw up medication at the point of use, put the vial back in the anes-
thesia cart and use it for the next patient. Or I see multi-dose vials of
irrigation medication for orthopedic procedures left with the needle
and syringe in the diaphragm for many procedures (treat irrigation
vials the same as injectables). As a rule: If a multi-dose injectable
medication vial enters an immediate patient treatment area such as
the operating and procedure rooms, anesthesia and procedure carts,
and patient rooms or bays, it should be dedicated for single-patient
use only.
This is not to say you can't use multi-dose vials for more than one
patient. If you do, keep and access the vials in a dedicated medica-
tion preparation area (the nurses station or outside the procedure
room) away from immediate patient treatment areas. This is to pre-
vent not only the risk of entering the vial with the same needle and
syringe used during the procedure, but also the inadvertent contami-
nation of the vial through direct or indirect contact with potentially
contaminated surfaces or equipment. The key word to remember is
access. If you access the multi-dose vials in the room where surgery
is taking place or some other immediate patient treatment area, ded-
icate the vial to that patient. If you draw up the medication outside
the immediate patient care area, you can use the vial for more than
1 patient, provided the anesthesia provider labels it appropriately
according to CMS requirements.
You might consider ordering and using prefilled syringes for your
anesthetic agents and antibiotics. This would virtually (if not totally)
eliminate the risk of a bloodborne pathogen exposure as a result of
multi-dose vial usage. It might appear more expensive to use prefilled
syringes, but in calculating the risk of bloodborne infection as well as
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