A new CDC report detailing 2 MRSA outbreaks reiterates the CDC's recommendation for using single-use and single-dose vials for 1 patient only, even when facing medication shortages.

According to the report, at least 10 patients contracted life-threatening staph or MRSA infections and had to be hospitalized as a result of providers using medication from single-dose or single-use vials on multiple patients in a pain management center in Arizona and an orthopedic center Delaware. Another patient died, and while a multiple-drug overdose was reported as the cause of death, an invasive MRSA infection couldn't be ruled out, says the CDC. In both investigations, clinicians reported difficulty obtaining the medication type or vial size that best fit their procedural needs.

At the Delaware orthopedic clinic, staff reportedly reused single-dose vials of the anesthetic bupivacaine for multiple patients. Previously, the orthopedic practice had used 10 mL single-dose vials of bupivacaine for single-patient use. When a national drug shortage disrupted the supply of 10mL single-dose vials, office staff members began using 30mL SDVs of bupivacaine for multiple patients. The joint injection procedures typically required 1 to 8mL of anesthetic, with each injection prepared immediately in advance of the procedure in a separate, clean, medication preparation room. Only 1 30mL vial of bupivacaine was opened at any given time; each vial was accessed over a course of several hours for multiple patients until all contents were withdrawn. Occasionally, an opened 30mL vial was stored in a medical cabinet for use the next day.

Meanwhile, as many as 8,000 people could be at risk for HIV and hepatitis after a Denver oral surgeon was accused of reusing needles on his patients over the last decade. Stephen Stein, DDS, allegedly reused syringes and needles for multiple patients to give IV medications, including sedation, between September 1999 and June 2011. Needles and syringes were used repeatedly, often days at a time. Dr. Stein is not currently practicing dentistry; he reportedly stopped practicing last June.

The CDC warning recalls the case of Kristen Parker, a surgical tech serving a 30-year prison sentence.

You can review injection safety resources at the CDC's web page on the subject.

Mark McGraw

Endoscopy sedation must strike a balance between patient comfort and drug-related side effects, according to a new training curriculum issued by leading gastroenterology societies.

The Multisociety Sedation Curriculum for Gastrointestinal Endoscopy, which appears in the July issue of the journal Gastroenterology, was issued by the American College of Gastroenterology, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy and the American Association for the Study of Liver Diseases, with input from the Society for Gastroenterology Nurses and Associates.

The document outlines best practices in procedure sedation based on published data and expert opinions. It's comprised of 11 training sections touching on the skills required to safely deliver sedation during endoscopy, including: a breakdown of the levels of sedation; instances when anesthesiologists should be involved in delivering sedation; training in specific agents used for moderate sedation; airway rescue techniques; and intraprocedure monitoring requirements.

One of the main goals of the curriculum is to ensure a standardized approach to endoscopy sedation training, the document notes. Experienced gastroenterologists can also use the guidelines to update their knowledge and skills, according to the societies.

Daniel Cook

Healthcare organizations and authorities have compiled surgical safety checklists that assist OR team members in preparing a patient - and themselves - for a case. But your staff should make them their own by customizing these templates to your facility's workflow in order for them to be truly useful. Check out a Colorado surgeon's advice for making a universal pause for safety into the most important 60 to 90 seconds in each of your cases.

David Bernard

Lght-emitting diodes are brighter and cooler than halogen or incandescent bulbs. LEDs also last longer and use less energy. Help us find out what percentage of surgical facilities have LED lights hanging from their OR ceilings by taking this week's InstaPoll. Check back next week to see the results.

There's been talk within nursing for years about making a BSN the minimum requirement for RN licensure, but only 16% of the 663 respondents to last week's poll say their nurses have bacherlor's degrees.

We asked whether you require RNs to be BSNs. The results: