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The Safety of Multi-Dose Vials

November 7, 2014 Leave a comment

It has long been embraced in the healthcare industry that using multi-dose vials is cost-effective and saves the organization lots of money. Some healthcare providers will argue that they are safe. ..that safeguards in place in the organization deem the possibility of an infection contacted from the use of multi-dose vials to be remote. The argument is presented over and over and over in many institutions. However, evidence refuses to support these arguments.\

It is true that multi-dose vials do, in fact, contain common preservatives that are effective against most bacteria. However, these same preservatives are NOT ant-viral. Furthermore, the true hazard lies in the potential for contamination with multiple penetrations of the protective seal/lid/stopper. According to a paper published by Barbara DeBaun, RN, MSN, CIC contaminating pathogens can live for longer than two hours in the container before the preservative “kicks in”. It is possible, according to Ms. DeBaun, that endotoxins survive even after the preservative inactivates the organism.

Faulty aseptic technique is the leading cause for contamination in MDVs. It has been reported that 25% of practitioners reentered a vial with a needle that had been introduced into a patient. At the least, it is common to see the provider use a needle to administer the medication into an IV line, then stick the needle and syring back into the vial awaiting the next dose. Nursing staff report numerous incidents of contamination of MVDs especially by the anesthesia providers in the OR or Procedure Room. Some studies show the incident of contaminated vials to be as high as 27%. In the face of this totally unacceptable statistics, anesthesia providers, especially,continue to refuse to follow protocal It is the responsibility of the nurse circulator in the room to monitor the use of the MVDs and to report on an incident report breaks in technique in using these containers.

When discussing infections and the use of MVDs, HCWs tend to look only at stopper penetration. Stopper penetration is, of course, crucial to maintaining the sterility of the contents of the container. No MVDs should be used without a transfer device to minimize the number of stopper penetrations. Everytime the stopper is penetrated there is an increased risk of contamination. Surveyors have reported seeing stoppers with so many penetrations as to look like the stopper is mesh. Again, a transfer device MUST be used for MVDs.

Other considerations for the safe use of MVDs has to do with storage. This author noted in one center that in the medication room, half of the inventory of a specifice MVD medication was stored in a cupboard while the remainder was divided between the drug refrigerator and the anesthesia cart. Care must be taken to identify the correct storage requirements for all medication and to follow those carefully.

Labeling MVDs becomes crucial, and yet, surveyors continue to find containers where there is no label, or where the outdated medication is still in circulation. Arguments may be that it is just the preservative and not the medication. Say what?????

Some of the pathogens identified in contaminated MVDs include:

  • HIV, hepatitis B and C, staph aureus, klebsiella pneumonia, streptococcus A, serratia marcescens, pseudomonas aeruginosa and candida albicans.

Lipoid medications such as propofal are more likely to be associated with outbreaks than others followed by preservative free medications. One contaminated vial can lead to widespread outbreaks. Protection of our patients is the primary responsibility of the staff in any healthcare setting. This is not the place to note that the anesthesia provider stuck the syring and needle back into the MVD and left it there after administering the drug into the IV line. This “one little time” could be deadly—and we all know there is no such thing as “this one little time”

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