Nationally, some 1,000 putting patients at risk
A new survey of various health care providers who give medications through injections reveals that 3% of anesthesiologists admit reusing the same needles and syringes on multiple patients, according to the American Association of Nurse Anesthetists (AANA). Overall, 1% of health care professionals surveyed admitted to the practice.
"There is no excuse for ever reusing a needle or syringe on different patients," says Rodney Lester, CRNA, PhD, president of the AANA. "It is most disturbing that even 1% of health care providers surveyed do this, potentially exposing millions of patients each year to needles and/or syringes contaminated with hepatitis, HIV, or other life-threatening infectious diseases."
The survey was prompted by recent reports of hepatitis C virus outbreaks — including one in Norman, OK — linked to health care providers reusing needles and/or syringes on multiple patients.
In the Oklahoma case, more than 50 patients were infected with hepatitis C at a pain management clinic when a nurse reused a syringe and needle for injections into a heparin lock of the patients’ IV line. The case, which still is under investigation, represents the largest known nosocomial transmission of hepatitis C in the United States, says Michael Crutcher, MD, state epidemiologist with the Oklahoma State Depart-ment of Health in Oklahoma City.
The nurse anesthetist drew medication into a single large syringe and injected it into the IV lines of numerous patients, Crutcher says. The nurse tested negative for hepatitis C.
"The hypothesis is that a chronically infected person served as a reservoir of infection for other persons," says Crutcher, who noted that 15 patients also tested positive for hepatitis B. "Once you’ve infected one person and that person comes back in, [he or she] can serve as a reservoir. It can amplify over a short period of time where you have numerous patients who are infected."
The telephone survey, conducted by Cooper Research Inc. of Cincinnati, included a random selection of health care providers in five different categories: anesthesiologists, other physicians, certified registered nurse anesthetists (CRNAs), other nurses, and oral surgeons.
The study reflected the opinions of health care providers from 48 states. One health care provider per facility was used for the survey. Among the different categories of health care professionals surveyed, 3% of anesthesiologists who responded indicated they reuse needles and/or syringes on multiple patients; other physicians, CRNAs, other nurses, and oral surgeons reported reuse at 1% or less for each group.
A thousand too many
Lester points out that even though the percentages of health care providers who reuse needles on multiple patients appear to be low, they translate into an alarming number of actual health care providers. "In the anesthesia field alone, 3% of physician anesthesiologists and 1% of CRNAs amounts to roughly 750 anesthesiologists and 250 nurse anesthetists, or a total of 1,000 providers," he says. "That is 1,000 too many."
As infection control professionals well know, reuse of the same needle and/or syringe on multiple patients is strictly forbidden in the infection control guidelines and practice standards of various professional associations, including the AANA, American Society of Anesthesiologists, and Association for Professionals in Infection Control and Epidemiology. Using the same needle and syringe on multiple patients is not allowed, regardless of whether the provider uses needles or a needleless system to administer medications.
Many health care facilities have gone to needleless systems in recent years as a safeguard against contamination and as a precaution against needlesticks for health care providers. However, even with needleless systems, the reuse of syringes from patient to patient is not permissible, Lester emphasizes. "Plain old common sense dictates that the safest practice is single use, then disposal," he says.
The survey also suggests that the reuse of a needle and/or syringe on the same patient is somewhat of a gray area for health care providers. Thirty-one percent of the survey respondents who only use needles (and syringes) indicated that they reuse on the same patient. The percentage jumps to 35 when taking into account providers using needleless systems, in which case the syringe would be reused on the same patient. Discussion among health care professionals about the appropriateness of reuse with needleless systems is ongoing.
In contrast, 57% of the health care providers surveyed responded "no" when asked, "Are there any circumstances when it is acceptable to reuse syringes or needles?"
"Clearly, the [survey] results indicate a great need for extensive research on infection control guidelines and compliance, as well as an investigation of the use of needleless systems and whether these systems clearly reduce the chance of spreading infection," Lester says.
In addition to advocating additional research, the AANA is working with other health care organizations to address the issue. The association also is developing a public education campaign to make patients and their families aware of standards for needle and syringe reuse.
"The public deserves to know what they should expect from their health care providers when they enter a doctor’s office, hospital, or other facility," Lester says.