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Medication Safety Best Practices: Eliminating Glacial Acetic Acid


March 03, 2014

In celebration of the organization’s 20th anniversary as a nonprofit, the Institute for Safe Medication Practice (ISMP) is launching a national medication safety initiative: the 2014-15 Targeted Medication Safety Best Practices for Hospitals. This initiative, intended to mobilize widespread adoption of consensus-based best practices on safety issues that continue to cause harmful errors despite prior ISMP warnings, are realistic practices, already adopted by many organizations, upon which hospitals can focus their medication safety efforts over the next two years.

This week’s blog focuses on Best Practice #6:

  • Eliminate glacial acetic acid from all areas of the hospital.

The goal of this best practice is to prevent harm from the use of glacial acetic acid applied directly to patients. The use of hazardous chemicals in pharmacy compounding or for special therapeutic procedures and diagnostics is common in many hospitals. Patient harm has occurred when toxic chemicals have been misidentified as oral products, or when a very concentrated form of a chemical has been erroneously used in treating patients. Of particular concern is glacial acetic acid. Accidental topical application of “glacial” (greater than or equal to 99.5%) acetic acid has repeatedly resulted in serious patient harm, including severe pain and serious tissue damage, third-degree burns, and in one case, bilateral leg amputation. Often in these cases, this item was either accidentally purchased or used in place of a much more diluted form of acetic acid, such as vinegar or a commercially available 0.25% acetic acid solution.

We encourage organizations to remove and safely discard this product from all clinical areas of the hospital (including the pharmacy, clinics, and physician office practices), and replace it with vinegar (5% solution) or commercially available, diluted acetic acid 0.25% (for irrigation) or 2% (for otic use). 

Does your pharmacy currently use or have chemicals like glacial acetic acid stored in the pharmacy?

Matthew Grissinger, RPh, FISMP, FASCP, is the Director of Error Reporting Programs at the Institute for Safe Medication Practices.

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