As the safe handling of single- and multiple-dose vials continues to be a top priority of surveyors from both regulatory and accrediting bodies, make sure your staff adheres to the following policies and procedures regarding this critical infection prevention measure.

It should be your facility's policy that single- and multiple-dose vials are prepared and administered according to acceptable standards of practice to ensure safe medication management and to optimize the efficacy of all medications. Minimize the use of multiple-dose vials wherever possible.

Use vials that are labeled "single-patient use only," "single-dose vial" or "single-use only." Some common single-use drugs used in ambulatory surgery include Brevibloc (esmolol), vials of metoprolol and preservative-free products such as certain lidocaine preparations. Propofol is also a single-patient-use product. Check the other products in your formulary to verify which are designated single-use only.

Date multiple-dose vials when first opened and discard them either at 28 days from opening or on the manufacturer's expiration date — whichever occurs first. Some exceptions to this rule include:

• Anectine (succinylcholine). Discard 14 days after removal from refrigerator opened or unopened; always date when first removed from refrigerator.
• Zemuron (recuronium). Discard 30 days after removal from refrigerator if opened or 60 days after removal if unopened.
• Antibiotics. Expiration dates after dilution are specified on the vial by the manufacturer.

To ensure compliance with your facility's infection prevention, control and safety goals:

• Use each needle for only 1 patient.
• Use each syringe for only 1 patient.
• Always enter medication vials with a new needle.
• Always enter medication vials with a new syringe.
• Label pre-drawn medications with the drug's name and strength, the date and time, and the initials of the person drawing the medication.
• Use manufactured prefilled syringes for only 1 patient each.
• Disinfect the rubber septum on a multiple-dose vial used for more than 1 patient with alcohol (using friction) before each entry.
• Don't store multiple-dose vials used for more than 1 patient where direct patient contact may occur.

Practice what you preach
CMS surveyors are instructed to observe staff who prepare and administer injectable medications to determine whether they're following the above policies and procedures. Review these policies at your next staff meeting, and include them in written form in your meeting minutes, to ensure that all nurses and anesthesia personnel at your facility are aware of and compliant with safe injection practices.