May 19, 2016
Two seemingly harmless practice habits that breach aseptic technique might lead to contamination of sterile injection equipment and increase the risk of a healthcare-associated infection of the bloodstream or tissues: 1) failing to place a sterile cap on the end of a reusable intravenous (IV) administration set that has been removed from a primary administration set, saline lock, or catheter hub, and left hanging between use; and 2) failing to properly disinfect the port when accessing needleless valves on an IV set. In the first instance, the tip of the IV administration set is exposed to potential contaminants, which could lead to infection if the contaminated IV set is reconnected to the patient’s IV access. In the second instance, the port is exposed to potential contaminants that can be pushed into the patient’s IV line once the port has been accessed by tubing or a syringe.
These risks may be unintended consequences of needleless IV system implementation. Before needleless systems, practitioners typically replaced the needle used to connect the infusion to the IV tubing with a new sterile, capped needle to prevent contamination when the line was hanging between uses. Now it appears that practitioners are not considering the risk of contamination and are not placing a sterile cap on the exposed tubing. Some have speculated that the lack of a needle or cannula on a syringe, or at the end of the tubing, may suggest that protection and disinfection are not required.
As a pharmacist, are you aware of unsafe injection practices that take place outside of the pharmacy? What is your role in identifying and resolving these issues?
Matthew Grissinger, RPh, FISMP, FASCP, is the Director of Error Reporting Programs at the Institute for Safe Medication Practices.