In a recent (July 13) issue of MMWR, the CDC has reported that 10 patients in Arizona and Delaware have contracted severe methicillin-susceptible Staphylococcus aureus (staph) or methicillin-resistant S. aureus (MRSA) infections after receiving care at outpatient facilities where practitioners improperly performed injections, specifically reusing medication from single-dose/single-use medication vials for multiple patients.
In Delaware, seven patients were diagnosed with severe staph infections after they had received joint injections at an outpatient orthopedic practice. According to the MMWR report, staff at the clinic had recently started using single-dose/single use vials for multiple patients after their supply of smaller-sized vials was interrupted due to a national shortage. In addition to the seven patients, two staff members who were responsible for preparing the injections were found to be colonized with S. aureus, and one happened to be an identical match to the strain found to be infecting the seven patients.
Single-dose/single-use vials were also to blame in the Arizona cases. Three patients were found to have contracted invasive MRSA infections after receiving injections from the same vial at an outpatient pain management clinic. Patients received treatment afterwards for acute mediastinitis, bacterial meningitis, epidural abscess and sepsis. A fourth patient, who also received an injection from the same vial, was found dead at home six days following treatment at the clinic. Although invasive MRSA could not be ruled out, the cause of death was determined as a multiple drug overdose.
According to the CDC, since 2007, the year that safe injection practices were included as part of Standard Precautions, at least 20 outbreaks have been associated with the use of single-dose or single-use medication vials for more than one patient. Typically, medication contained in single-dose/single-use vials is preservative free, making it unsafe for use with more than one patient.
These types of infections are completely preventable. Patient safety should always be the highest priority, even in cases of drug shortages. Splitting of doses should only be done as a last resort, and only with full adherence to USP 797 standards to minimize the risk.
Reference: Centers for Disease Control and Prevention. Invasive Staphylococcus aureus Infections Associated with Pain Injections and Reuse of Single-Dose Vials — Arizona and Delaware, 2012. Morbidity and Mortality Weekly Report (MMWR), 61(27);501-504 (July 13, 2012).
CDC’s Injection Safety Website: http://www.cdc.gov/injectionsafety/
One and Only Campaign: http://www.oneandonlycampaign.org/
One and Only Campaign, Healthcare Provider Toolkit: http://www.oneandonlycampaign.org/content/healthcare-provider-toolkit
Healthcare Provider Injection Safety Checklist: http://www.cdc.gov/injectionsafety/PDF/SIPC_Checklist.pdf
CDC Position Statement on Single-use/single-dose vials: http://www.cdc.gov/injectionsafety/CDCposition-SingleUseVial.html