Injection safety, or safe injection practices, refers to a set of measures designed to prevent the transmission of infectious diseases between one patient and another, or between a patient and a healthcare provider, during the preparation and administration of parenteral (e.g., intravenous, intramuscular, subcutaneous) medications and other injectable substances.

It also includes measures to prevent injuries to healthcare providers from contaminated sharps. The goal is to ensure that every injection is safe for the recipient, the provider, and the community.

Why Injection Safety is Critically Important

Unsafe injection practices are a major public health concern and can lead to:

• Transmission of Bloodborne Pathogens: This is the most significant risk. Pathogens like Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV) can be transmitted through contaminated needles, syringes, or medication vials.

• Outbreaks of Infectious Diseases: Numerous outbreaks have been linked to unsafe injection practices in various healthcare settings, affecting many patients.

• Bacterial Infections: Contamination of injectable medications or equipment can lead to localized infections (abscesses) or systemic infections (sepsis).

• Harm to Healthcare Providers: Needle-stick injuries can expose providers to bloodborne pathogens and cause significant anxiety and the need for post-exposure prophylaxis.

• Loss of Public Trust: Unsafe practices erode confidence in the healthcare system.

• Legal and Financial Consequences: For healthcare facilities and providers involved in transmission events.

Core Principles of Injection Safety (The “One & Only” Campaign and WHO Guidelines)

Many safe injection practices are summarized by the “One Needle, One Syringe, Only One Time” principle, but it extends beyond that. Key principles include:

1. Aseptic Technique for Preparation and Administration:
This is the foundation of safe injection practices. It involves measures to prevent microbial contamination.

• Hand Hygiene: Perform hand hygiene (using soap and water or alcohol-based hand rub) before preparing or administering injections, and after any potential exposure to blood or body fluids.

• Clean Workspace: Prepare injections in a clean, designated area where contamination by blood or body fluids is unlikely.

• Preparation of the Patient’s Skin: Cleanse the injection site with an appropriate antiseptic (e.g., 70% alcohol swab) using friction and allow it to dry completely before needle insertion.

• Medication Vial Access:

  • Disinfect the rubber septum (diaphragm) of the medication vial with 70% alcohol and allow it to dry before piercing it with a new, sterile needle and syringe.

  • Single-dose vials (SDVs) are preferred whenever possible.

  • Multi-dose vials (MDVs) require strict adherence to aseptic technique every time they are accessed.

2. Use of Sterile, Single-Use Needles and Syringes:

• One Needle, One Syringe, Only One Time:

  • A new, sterile needle and a new, sterile syringe must be used for every injection.

  • Never reuse a needle or syringe, even on the same patient for a subsequent injection.

  • Never use a needle or syringe that has been used to access a medication vial or IV bag for more than one patient.

• Changing Needles: If a needle becomes contaminated (e.g., touches a non-sterile surface), it must be discarded and replaced with a new sterile needle before proceeding.

• No “Recapping” of Used Needles (Generally): While the one-handed scoop technique is sometimes taught for situations where recapping is unavoidable (e.g., some specific procedures), the safest practice is to immediately dispose of used needles without recapping to prevent needle-stick injuries. If recapping is absolutely necessary, the one-handed scoop method is the only acceptable technique. Two-handed recapping is strictly prohibited.

3. Safe Use of Medication Vials and Containers:

• Single-Dose Vials (SDVs):

  • These are intended for use in a single patient for a single procedure or injection.

  • They typically lack preservatives.

  • Once the vial is entered, it should be used immediately.

  • Discard any remaining medication in an SDV after use on a single patient or if sterility is compromised. Do not combine leftover contents from SDVs.

  • Do not store SDVs for later use after opening.

• Multi-Dose Vials (MDVs):

  • These contain a preservative to help prevent bacterial growth but do not guarantee sterility once opened if aseptic technique is breached.

  • Whenever possible, assign an MDV to a single patient to reduce the risk of cross-contamination.

  • If MDVs must be used for more than one patient (strongly discouraged if alternatives exist), they should only be accessed in a centralized medication preparation area, never in the immediate patient treatment area (e.g., patient rooms, cubicles).

  • Always use a new sterile needle and syringe to access an MDV.

  • Discard MDVs when the beyond-use date (usually 28 days after opening, unless specified otherwise by the manufacturer) is reached, if sterility is questioned, or if they appear contaminated. Date MDVs when opened.

• Ampoules: These are single-use glass containers that must be broken open. Use a filter needle to withdraw medication to prevent glass particles from being drawn up, then change to a new sterile needle for administration. Discard any unused portion.

• Pre-filled Syringes: Intended for single use in a single patient. Do not attempt to use for multiple patients or combine leftover contents.

4. Prevention of Contamination of Injection Equipment and Medications:

• Never leave a needle or other device (e.g., spike) inserted into a medication vial septum, IV bag, or bottle for later use. This provides a direct route for contamination.

• Do not use bags or bottles of intravenous solution as a common source of supply for more than one patient (e.g., for flushing IV lines or diluting medications for multiple patients).

• Medication Preparation Area: Prepare medications in a clean area, physically separated from areas where potentially contaminated items are placed (e.g., used equipment).

• Avoid Contamination of Syringe Hubs/Tips: Ensure the sterile parts of the syringe (tip, inside of barrel, plunger shaft) and needle (hub, shaft, bevel) do not touch non-sterile surfaces.

5. Safe Sharps Disposal:

• Immediate Disposal: Dispose of used needles and other sharps immediately after use in a designated, puncture-resistant, leak-proof sharps disposal container.

• Accessible Containers: Sharps containers should be readily accessible in all areas where injections are given (e.g., at the point of use).

• Do Not Overfill: Sharps containers should be sealed and replaced when they are no more than three-quarters full (or per manufacturer’s fill line).

• Proper Handling of Containers: Handle sharps containers carefully to avoid spillage or puncture. Ensure they are securely closed before transport and disposal.

• Follow Local Regulations: Adhere to local and national guidelines for the appropriate treatment and final disposal of sharps waste.

6. Use of Safety-Engineered Devices (Sharps with Engineered Sharps Injury Protections – SESIPs):

• Purpose: These devices are designed to reduce the risk of needle-stick injuries to healthcare workers.

• Examples:

  • Needles with safety features (e.g., retractable needles, self-sheathing needles, needles with hinged caps).

  • Needle-free IV systems.

• Use: When available, SESIPs should be used. Healthcare workers must be trained in their correct activation and use. Even when using SESIPs, safe handling and disposal practices are still essential.

7. Worker Education and Training:

• All healthcare personnel who prepare or administer injections must receive comprehensive training on safe injection practices, including aseptic technique, sharps safety, and bloodborne pathogen prevention.

• Training should be ongoing, with regular refreshers and updates.

• Competency should be assessed regularly.

8. Monitoring and Quality Improvement:

• Healthcare facilities should have policies and procedures for safe injection practices.

• Regular audits and observations of practice should be conducted to ensure adherence to policies.

• Needle-stick injuries and other adverse events related to injections should be reported, investigated, and used to identify areas for improvement.

• A culture of safety should be fostered where staff feel comfortable reporting concerns or near misses without fear of reprisal.

Specific Considerations:

• Point-of-Care Testing (e.g., blood glucose monitoring):

  • Fingerstick devices should never be shared between patients, even if the lancet is changed. Use auto-disabling single-use lancet devices.

  • Blood glucose meters should be assigned to individual patients if possible. If shared, they must be cleaned and disinfected after every use according to manufacturer’s instructions.

• Lumbar Puncture and Other Spinal/Epidural Procedures: Strict aseptic technique is paramount. Use of a surgical mask by the person performing the procedure is recommended to prevent droplet transmission of oral flora.

• Vaccination Clinics/Mass Immunization: Safe injection practices must be rigorously maintained even in high-volume settings. Ensure adequate supplies of sterile needles, syringes, and sharps containers.

What NOT to Do (Common Breaches of Injection Safety):

• Reusing a syringe for another patient, even if the needle is changed.

• Entering a medication vial with a used syringe or used needle.

• Using a single-dose vial for more than one patient.

• Using a common bag of saline or other IV fluid for flushing or diluting medications for multiple patients.

• Administering medications from the same syringe to multiple patients (e.g., by changing only the needle).

• Saving leftover medication from a single-dose vial for later use.

• Inadequately disinfecting vial septums or skin sites.

• Two-handed recapping of used needles.

• Overfilling sharps containers.

Adherence to these comprehensive injection safety methods is a fundamental responsibility of all healthcare providers and is essential for protecting patients and themselves from harm. It requires vigilance, knowledge, and a commitment to best practices at all times.