Nurse Smith uses a clean, sterile syringe to draw up IV fluid from a 1,000cc bag and injects the fluid into the IV tubing for Patient A. She then uses the same syringe to draw up more fluid from the same bag and inject it into the IV tubing for Patient B. She repeats the same process for 2 more patients in the pre-op bays. Because the syringe is being used to inject fluid into tubing that's located several inches from each patient's injection site, Ms. Smith believes there's no contamination risk. As an added bonus, she reasons, she's saving her surgical facility some money by not opening additional syringes.

Is she right? Hardly. Research has shown that blood cells can be found all the way up IV tubing, far from the injection site, and bacteria and viruses can also congregate in the Y-shaped IV ports. Therefore, Ms. Smith has potentially contaminated both the source of the IV fluid and every patient she subsequently injects with that fluid. As for the few dollars she's just saved her employer? That's nothing compared to the liability she's just opened her facility up to if an outbreak were to occur.

Brush up on best practices
High-profile outbreaks stemming from unsafe injection practices in Las Vegas, New York and elsewhere over the past several years suggest that some healthcare providers tasked with delivering medications via injection are either unaware of or not adhering to the policy of using just 1 syringe and 1 needle per patient, regardless of the circumstances. Indeed, a 2002 survey of healthcare providers sponsored by the American Association of Nurse Anesthetists revealed that 1% to 3% of anesthesiologists, CRNAs and other nurses said they reused the same needle or syringe on multiple patients, and 31% said they reused needles or syringes on the same patient.

Now is as good a time as any to re-educate your staff about the right way and the wrong way to deliver medications via injection. The AANA recently released a new position statement on "Safe Practices for Needle and Syringe Use" that provides a good framework on which to base your staff training and education:

• Never administer medications from the same syringe to multiple patients, even if the needle is changed.
• Never reuse a needle, even on the same patient.
• Never fill a syringe once it has been used, even for the same patient.
• Never use infusion or intravenous administration sets on more than 1 patient.
• Never reuse a syringe or needle to withdraw medication from a multi-dose medication vial.
• Never re-enter a single-use medication vial, ampoule or solution.

The Safe Injection Practices Coalition's One and Only Campaign, which is focusing its efforts on the ambulatory care community, has additional resources you can use to beef up your staff education, including posters you can download for free, at www.oneandonlycampaign.org.

Bolster your oversight
Outbreaks stemming from unsafe injection practices aren't unique to the ambulatory care setting. But one of the reasons many of the most recent widely reported cases have come from outpatient clinics is that more procedures are being done in those facilities today than were 5 or 10 years ago. State and federal policymakers, as well as facility administrators, are beginning to recognize that this rapid growth requires more vigilant oversight measures such as process observations of various injection practices, including the insertion of intravenous lines, intravenous medication injections, and the handling and labeling of fluids, tubing and medications.

Some aspects of the ambulatory care setting heighten the risk of infection control lapses going unnoticed or unchecked. Your patients are only spending a few hours in your care, and outbreaks from unsafe injection practices can go undetected for weeks or even months. If your patients do get sick as a result of unsafe practices at your facility, they're likely to go to their physician or to the local hospital for treatment, and neither they nor the hospital or physician may ever report the incident to you. Compounding those problems is the fact that the staff member dedicated to infection control in an ambulatory surgery center is often someone who wears many other hats and may not have the time or resources to track down cases of post-operative infection that happen months after a patient has come and gone.

Here are 3 steps you can take to bolster your infection control and injection safety oversight:

1. Appoint an infection preventionist. Designate a staff member to the task of monitoring infection control practices and give her an adequate amount of time to perform the job well (2 hours a week is probably not enough).

2. Support your preventionist. Give your infection control person the financial, staffing and moral support she needs to stay educated and up to date with the latest recommendations and best practices. She should join professional organizations (such as APIC), set and enforce policies, perform process and outcome surveillance or improvement projects and run training sessions.

3. Develop a solid reporting system. Your goal should be a simple, consistent system of reporting infection control infractions and tracking outbreaks. Network with hospitals and other facilities in your area to ensure outbreaks don't slip through the cracks.

If your infection control manager is reporting 100% compliance with infection prevention policies, chances are that's not the reality. Create an environment where your staff feel comfortable reporting incidents, whether the culprit is a surgeon, anesthesia provider, nurse or other staff member.