Guidance on the safe use of vials
The Joint Commission (TJC) is calling on health care organizations to develop and implement policies and procedures to prevent the misuse of vials. The accrediting agency notes that such policies should address the following practices:
• Single-dose/single-use vials should be used on one patient during a single procedure and then discarded.
• In instances in which a single-dose/single-use vial must be entered into a single patient more than one time to achieve accurate titration, a new needle and syringe should be used.
• Leftover contents from single-dose/single-use vials should never be combined or pooled for later use.
• Unopened single-dose/single-use vials may be re-packaged into multiple syringes. These should be properly labeled with expiration dates and beyond-use dates. Such re-packaging should only be done by qualified personnel in appropriate air conditions.
• Vials should be stored according to manufacturer recommendations.
• Only vials that are labeled by the manufacturer for multiple-dose use can be used more than a single time.
• Multiple-dose vials should only be used on a single patient to reduce the risk of contamination.
• When used more than one time, a new syringe and a new needle should be used for each entry.
• A vial’s rubber septum should be disinfected with an approved antiseptic swab prior to piercing. Allow the septum to dry before inserting a needle or other device.
• Once a multiple-dose vial is punctured, assign a beyond-use date. For vials with antimicrobial preservatives, this should be 28 days unless otherwise specified by the manufacturer.
• Multiple-dose vials should be stored outside patient treatment areas, according to manufacturer recommendations.
• Dispose of any vials when sterility has been compromised or questioned. This includes unopened or unused vials.
• In purchasing and treatment decisions, select the smallest vial necessary to reduce waste.
• Call on manufacturers to produce appropriate-sized vials.
• Do regular quality checks to look for open vials.
Additional resources on safe injection practices
- A position paper on safe injection practices by the Association for Professionals in Infection Control and Epidemiology: http://www.apic.org/Resource_/TinyMceFileManager/Position_Statements/AJIC_Safe_Injection0310.pdf.
- Guidance from the CDC on injection safety: www.cdc.gov/injectionsafety.