Challenges to Safe Injection Practices in Ambulatory Care

Weissburg, Benjamin; Rogers, Kelli; Musuuza, Jackson; Safdar, Nasia; Shirley, Daniel

doi:10.1017/ice.2017.31

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…Understanding the SEIPS barriers and facilitators that prevent or assist safe injection practices can help guide clinical interventions to reduce disease risk exposure. In a recent study by Anderson et al, 15 HCWs self-reported a high knowledge of injection safety and no barriers to safe usage of medication vials; however, observation data collected in the same study revealed significant nonadherence to safe usage of medication vials. In addition, 2 other studies that collected anonymous survey data from clinicians reported that reuse of syringes for multiple patients still occurs in practice 16 …”

mentioning

confidence: 82%

“…13 The continued occurrence of unsafe medicationvial usage suggests that the knowledge of safe practices alone is not enough to ensure adherence. 14,15 The Systems Engineering Initiative for Patient Safety (SEIPS) model, which emphasizes persons, organization, technologies and tools, tasks, and environment 12 is one framework used to evaluate healthcare systems.…”

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confidence: 99%

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Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Leback

Johnson

Rogers

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVEIdentify factors referred to as barriers and facilitators that can prevent or assist safe injection practices in ambulatory care settings to guide quality improvement.DESIGNIn this mixed-methods study, we utilized observations and interviews.SETTINGThis study was conducted at ambulatory clinics at a midwestern academic medical center from May through August 2017. Sites included a variety of clinical settings that performed intramuscular, intradermal, intravenous, or intra-articular injections.PARTICIPANTS AND INTERVENTIONSDirect observations of injections and interviews of ambulatory care staff were conducted. An observation checklist was created, including standards of injection safety from nationally recognized guidelines. Interview questions were developed using the System Engineering Initiative for Patient Safety (SEIPS) model. Interviews were recorded, transcribed, and then coded by 2 investigators.RESULTSIn total, 106 observations and 36 interviews were completed at 21 clinics. Injection safety standards with the lowest adherence included using needleless access devices to prepare injections (33%) and the proper use of multidose vials (<80%). Of 819 coded interview segments, 461 (56.3%) were considered facilitators of safe injection practices. The most commonly identified barriers were patient movement during administration, feeling rushed, and inadequate staffing. The most commonly identified facilitators were availability of supplies, experience in the practice area, and availability of safety needles and prefilled syringes.CONCLUSIONSPerceived barriers and facilitators to infection control elements of injection safety are interconnected with SEIPS elements of persons, organizations, technologies, tasks, and environment. Direct observations demonstrated that knowledge of safety injection standards does not necessarily translate to best practices and may not match self-reported data.Infect Control Hosp Epidemiol 2018;39:841-848.

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confidence: 82%

mentioning

confidence: 99%

Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Leback

Johnson

Rogers

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…33 In an observational study of 31 clinics, almost 20% stored single use vials for use on another patient. 34 Unsafe injection practices resulted in notification of more than 66,768 patients related to 38 events in 24 states between 2012 and 2018. 35 More than half of the events involved exposures occurring in a nonhospital setting (n = 21, 55%) and were identified on the basis of unsafe practices without documentation of disease transmission (n = 25, 66%).…”

Section: Discussionmentioning

confidence: 99%

Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

Tressler

Rosario

Kirby

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. Design: Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. Setting: Outpatient cardiology clinic. Patients: Patients undergoing MPI. Methods: Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. Results: During 2012–2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%–99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. Conclusions: This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.

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“…Kossover-Smith et al [ 25 ] reported that there have been more than 50 outbreaks of viral and bacterial pathogens due to unsafe injection practices since 2001, a majority of which occurred in ambulatory settings [ 26 ]. Identified issues with injection safety include no access to hand hygiene [ 19 ], reuse of single-dose vials [ 27 ], reuse of a syringe, multidose vials not dated [ 28 ], drug diversion [ 26 ], and multidose vials entering a patient treatment area [ 28 ]. In 1 study regarding an outbreak of septic arthritis related to intra-articular injections, complex compounding was a culprit.…”

Section: Injection Safetymentioning

confidence: 99%

Outpatient Infection Prevention: A Practical Primer

Steinkuller

Harris

Vigil

et al. 2018

Open Forum Infectious Diseases

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As more patients seek care in the outpatient setting, the opportunities for health care–acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas.

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Challenges to Safe Injection Practices in Ambulatory Care

Cited by 6 publications

References 7 publications

Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

Outpatient Infection Prevention: A Practical Primer

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