Injection Safety: Updates from Michigan and the U.S.

October 9, 2015Emily Goerge, MPH, MSN, RN, CIC

Objectives

• Discuss examples of unsafe injection practices that can lead to healthcare-associated transmission of pathogens

• Describe available training materials to educate

staff

Protecting patients from disease, one injection at a

time

Safe Injection Practices Are Every Provider’s Responsibility

ImmunizationsIVs

Insulin Injections

Pain Management InjectionsBlood Glucose Monitoring

DOCTOR OFFICE

The ED

Acute Care

Ambulatory Surgery Center

Infusion CenterLTC Facility

Ambulance

Principles of Injection Safety

▫Guiding principle: One needle, one syringe, one time

Principles of injection safety▫Single-Dose Vials

To be used for only ONE patient▫ IV Bags

Not to be used as a common source▫Multi-dose Vials

Use a new, sterile needle and syringe each time enter the vial

▫Fingerstick devices and insulin pens Never to be shared

▫Glucometers If must be shared, ensure cleaned according to

manufacturers instructions prior to each use

Why injections?

•Unsafe practices put patients and healthcare workers at risk▫Infectious and non-infectious events

•The adverse events are PREVENTABLE•Can happen in a variety of settings

▫Acute care, long-term care, ambulatory care

•Just takes one mistake…•…or it may involve many unsafe practices

Injection Safety Outbreaks• Between 2008 and 2013 there have been 38

healthcare-associated outbreaks of hepatitis B or C:▫385 patients acquired HBV or HCV▫Over 100,000 persons were notified of being at risk▫94% of these outbreaks occurred in outpatient

settings

• These outbreaks likely represent only the ‘tip of the iceberg’:▫Asymptomatic carriage▫Most cases undiagnosed

Reporting

•Report possible outbreaks•Report cases (of viral hepatitis)•Importance of case reporting and follow-

up▫Control the spread of disease▫Exploring risk factors for specific disease

We encourage all LHDs to follow-up on cases of acute and chronic HCV; especially in priority populations

What is Michigan doing?▫2013 Survey -- ASCs

99%

2%

Medications from Single-Dose or Single-Use vials should not be

used for more than one patient.

True False

2% 2%

97%

How often do you use medica-tions from a Single-Dose vial for more than one patient?

Always Usually Sometimes RarelyNever

What is Michigan doing?

21.2%

74.2%

4.5%

Fingerstick or lancing devices can be used on more than one pa-

tient as long as the lancet is changed and the device is prop-erly cleaned and disinfected be-

tween patients.

True False Not Sure

6.2% 1.2%1.5%

2.3%

88.8%

How often do you use fingerstick or lancing devices for more than one pa-tient (including when you change the

lancet between patients)?

Always Usually Sometimes Rarely Never

What is Michigan doing?• 2014 Survey – LTC Facilities

What is Michigan doing?▫Injection Safety website

www.michigan.gov/injectionsafety Modules

Most 10 minutes or less in length Address topics such as:

o Injection Prep and Admin, o 3 Simple Rules for Diabetes Care, o Drug Diversion

www.michigan.gov/injectionsafety

What is Michigan doing?▫Member of One and Only Campaign

www.oneandonlycampaign.org Monthly conference calls

Healthcare facilities are also welcome to join the One and Only Campaign

www.oneandonlycampaign.org/content/one-only-campaign-members

▫Drug Diversion MI NADDI Chapter

www.naddi.org/aws/NADDI/pt/sp/home_page

What about on a national level?•One and Only Campaign

▫Drug Diversion

http://www.oneandonlycampaign.org/content/risks-healthcare-associated-infections-drug-diversion

U.S. Outbreaks Associated With Drug Diversion by Healthcare Providers, 1983-2013

www.cdc.gov/injectionsafety/drugdiversion

▫Oncology and pain clinic patients

▫FAQ document for healthcare providers

▫Healthcare Provider brochure

http://www.oneandonlycampaign.org/

•Video

http://www.oneandonlycampaign.org/content/audio-video

Recent updates•From the One and Only Campaign

▫FDA label on multidose insulin pens http://

www.fda.gov/Drugs/DrugSafety/ucm435271.htm

▫WHO – worldwide use of smart syringe http://www.who.int/mediacentre/news/release

s/2015/injection-safety/en/

Recent Updates

•From CDC▫September 11, 2015 CDC issued Health

Advisory alerting facilities to review procedures for cleaning, disinfecting and sterilizing reusable medical devices Include glucometers http://emergency.cdc.gov/han/han00382.asp

Other important tools▫CDC has toolkit to assist with patient

notification http://www.cdc.gov/injectionsafety/pntoolkit/index.html

▫Investigation guide http://

www.cdc.gov/hepatitis/outbreaks/healthcareinvestigationguide.htm

▫CDC’s Sharps Safety for Healthcare Workers webpage: http://www.cdc.gov/sharpssafety/?s_cid=dhqp_019 Workbook Teaching Tools

Things to consider in your facility

•How well do you know your healthcare workers’ injection safety knowledge and practice?▫What about in your outpatient areas and

clinics?

•How are your controlled substances monitored?

•Do you perform any chart review on viral hepatitis patients that seroconvert or have acute disease?

What can ICPs do?• Survey your healthcare workers to determine areas of need

• Educate staff

• Encourage staff to intervene/report unsafe injection practices

• Perform chart review on new viral hepatitis cases

• Report potential HAIs to local/state health departments (even if only one case!)

Take Home Points

•Always perform safe injection practices•Be aware of possibility of drug diversion

in facility•Investigate suspicious cases; acute cases

to rule out HAI transmission•Report possible outbreaks to LHD, State

HD

Thank You!

Emily Goerge, MPH, MSN, RN, CICViral Hepatitis Nurse ConsultantGoergeE@michigan.gov

**NEW** MDHHS-Hepatitis@michigan.govwww.michigan.gov/hepatitiswww.michigan.gov/injectionsafety