Archive Megatrends 2018

Can We End Cross-Contamination?

Shoot for zero healthcare infections by focusing on these 3 overlooked sources of recontamination.

Dan O

Dan O'Connor, Editor-in-Chief


Cross Contamination
BORESCOPE Reprocessing technicians can now inspect the internal channels of devices with borescope technologies.
If eliminating cross-contamination were as simple as wiping dirty surfaces and washing dirty hands, the infection preventionist's job would be a lot simpler and surgical site infections would be a lot scarcer. But of course that's far from true. Hiding out in the shadows are many other sources of recontamination that can spread harmful bacteria during surgery — leading to the transmission of infection when the threat of wound contamination is at its highest. We're going to shine a light on 3 of them: unsafe injection practices, unsanitary anesthesia providers and unseen residual debris on reprocessed instruments. Can we end cross-contamination? Probably not, but you can shoot for zero healthcare infections.

1. Unsafe injection practices

Bacterial and bloodborne infections from unsafe injection practices are entirely preventable, but misconceptions about safe injection practices abound, says Libby Chinnes, RN, BSN, CIC, FAPIC, an infection prevention and control consultant in Mt. Pleasant, S.C. She says it's not OK to:
  • administer medication in the same syringe to more than one patient so long as they change the needle between patients or administer the injection through a length of IV tubing.
  • access the same medication vial for more than one patient with a syringe that has already been used to administer medication to a patient.
  • use a common bag of IV fluid or saline for more than one patient and to access the bag with a syringe you already used to flush the catheter of a patient.
  • use medications packaged as single-use for more than one patient.
  • keep multi-dose vials in immediate patient care areas, including operating and procedure rooms, anesthesia and procedure carts, and patient rooms or bays. Those are the don'ts. Ms. Chinnes offers these do's for safe injection practices.
  • To access patient medications in an aseptic manner, use a new sterile needle as well as a new sterile syringe to draw up medications while preventing contact between the injectable materials and the non-sterile environment. Other aspects of proper technique include hand hygiene before handling medications and disinfecting the rubber septum of the vial with alcohol before piercing it.
  • Use single-dose vials for use on a single patient. Yes, even if the vial contains more medication that's needed for one patient, don't store the vial for later use on the same or other patients. Order the smallest vial necessary for your facility's needs.
  • Discard medication vials, whether single-dose or multi-dose, whenever sterility is questionable. Discard a single-dose vial that has been opened or accessed (punctured by needle) per the manufacturer's specific time guidance for opened vials or at the end of the case — whichever comes first. Don't store opened single-dose vials for future use. Discard single-dose vials that haven't been opened or accessed by the manufacturer's expiration date.
  • Use fluid infusion and administration sets (IV bags, tubing and connectors) for one patient only. Dispose after use on one patient. Don't use bags or bottles of IV fluid as a common source for multiple patients such as IV flushes.
  • You can assign multi-dose vials to one patient, but single-dose vials are the best option for a patient. If this isn't possible, keep multi-dose vials in a dedicated medication preparation area — away from the immediate patient treatment area as noted above — to prevent inadvertent contamination of the vial through contact with potentially contaminated equipment or surfaces. This could then lead to infection in subsequent patients. If the multi-dose vial enters the immediate patient treatment area, discard it at the end of the case.
  • Date and discard a multi-dose vial that has been opened or accessed within 28 days unless the manufacturer specifies a shorter or longer date for that opened vial. Discard a multi-dose vial that has not been opened or accessed per manufacturer's expiration date.
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