Storage and Access of Multi-Dose Medications Used for More Than One Patient: Q&A With Phenelle Segal of Infection Control Consulting Services

Phenelle Segal, RN CIC, is president of Infection Control Consulting Services based in Blue Bell, Pa.

Q: After reading the article "Safe Injection Practices Checklist: 12 Critical Rules to Follow," item #10 became a major topic of discussion at our facility. It reads: "Multi-dose medications used for more than one patient are not to be stored or accessed in the immediate area where direct patient contact occurs." What areas in an ASC are you referring to when you say "…immediate area where direct patient contact occurs"?

Phenelle Segal: Guidelines, recommendations and position papers don't always provide specifics but rather leave it up to the reader to interpret. In my professional opinion, I would consider any area in the facility where direct patient care is being rendered as an "immediate area where direct patient contact occurs." This could be in the admitting/holding area if medications are administered in that space or, more likely, in the operating suite during administration of anesthetic agents or other medications. The recovery area is also a possibility for direct administration of medications.

The potential for contamination in the immediate area where direct patient contact occurs is two-fold and includes the following:

• Re-entry of the multi-dose vial with a used needle and/or syringe at the patient's bedside is a possibility due to "convenience and short cuts."
• Potential contamination of the vial if it is close to the operating field whereby blood or body fluid aerosolization may occur and subsequent inadequate cleaning of the access diaphragm will pose a risk.

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Related Articles on Safe Injection Practices:

Ensure Safe Medication Practices in a Surgery Center: Practical Solutions and Rules Overview

Study: Some Healthcare Professionals Still Reusing Syringes and Single-Dose Vials

Guidance for Appropriate Use of Multi-Dose Vials: Insight From Marshall Baker of AAAHC