Public Health

5 unsafe injection practices that can harm dialysis patients

Jennifer Lubell , Contributing News Writer

The Centers for Disease Control and Prevention (CDC) has reported 50 outbreaks linked to unsafe injection practices affecting 150,000 patients since the turn of the century. Outpatient dialysis facilities are one type of site where such outbreaks can happen.

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A video module featured on the AMA Ed Hub™ instructs users on how to avoid common injection-safety errors. The video is part of a series that seeks to educate nephrologists and other health professionals about infection control in outpatient dialysis facilities. The goal is to protect clinicians and their patients from preventable infections.

AMA Ed Hub is an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to physicians and medical professionals, with automated credit reporting for some states and specialty boards. Learn more about AMA CME accreditation.

Additional AMA Ed Hub CME modules cover:

The AMA released the dialysis safety CME series in conjunction with the American Society of Nephrology as part of the CDC’s Project Firstline initiative.

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“Injection safety” is meant to prevent transmission of infectious diseases between patients or between patients and health care personnel during prep and administration of medications. Some of the most common reservoirs for contamination include people’s bodies, surfaces, and devices.

The module instructs why injection safety is important in dialysis and goes over the common mistakes healthcare workers make when injecting patients.

Unsafe practices that can lead to patient harm include:

  • Use of a single syringe with or without the same needle to administer medication to multiple patients.
  • Reinsertion of a used syringe with or without the same needle into a vial to obtain additional medication to the same patient, then using the same container for subsequent patients.
  • Preparation of medications in close proximity to contaminated supplies or equipment.
  • Not cleaning rubber vials according to protocol.
  • Not cleaning hands before and after injection.

Health professionals might prepare medication in the patient treatment area instead of in a medication room or designated clean area. They might use needles that don’t have caps or are uncapped too early before injection, which increases risk of contamination.

Using medication from opened and undated vials or failing to scrub medication ports with antiseptic are other common mistakes.

The module walks through an interaction between Jason, 73, a retired primary care physician who has end-stage kidney disease, and Pete, a nurse at a dialysis center. Jason is a long-time dialysis patient who has come into the center for treatment.

Pete initially disinfects his hands but doesn’t disinfect the rubber septum of the vial. Then he drops the medication on the floor.

Things could go very wrong from here. But Pete checks himself and discards the potentially contaminated medication in a sharps disposal container. He gets a new syringe and this time, disinfects the rubber septum of the vial, then puts the medication in a clean, designated area. He disinfects his hands again and wears gloves before he handles the medication and enters the dialysis area.

He tells the patient, Jason that he dropped the medication and had to start over.

“Thanks for being careful,” Jason tells him.

Then the patient reminds Pete that he hasn’t cleaned the medication ports on the bloodlines equipment before administering the medication. This could allow germs to spread through the medication into the patient’s bloodstream.

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“Thank you for keeping me on track,” Pete says to Jason.

The interaction underscores the importance of staying in the moment and acting on any infection control risks.

Health professionals should consider their workflow and setup and focus on personal habits to create a culture of infection prevention.

Good practices include:

  • Wiping down medication rooms often.
  • Storing syringes, vials and other equipment in clean and easily accessible areas.
  • Making alcohol prep pads readily available in a clean area to scrub medication ports.
  • Ensuring that waste bins and sharps disposal containers are also easy to access.

Designated clean areas should be separated from the patient treatment areas, and free of contamination sources such as used supplies or equipment, or lab prep areas and sinks, which can lead to contaminated medication.