It's not crashed. You pin as is. Its supposed to look milky. I don't Like the idea of heating the water based simply because heating and cooling several times could encourage bacteria growth in the water base.
MESO-Rx
Anabolic Steroids
Would you inject this (pics)
- Thread starter lucabratzi
- Start date
Well I'm sure glad you told me that or I'd still be trying to get that shit hot lol! Learn something new every day. This is not the first time I've heard about higher chance of bacteria with the water based. Is that common? If so I may just use it once or twice to get a feel then toss it so it's not sitting with a punctured stopper with a high risk of contamination.
I know alot of old school vets who never had a problem with suspension. But I have heard of guys getting abscesses after mixing the suspension with other oil based compounds in one shot. I think you will be okay as long as you are clean and careful. Id just use it as quick as possible after you puncture the stopper. I used alot of test suspension with water base in college during wrestling season. Neither I nor any of my teammates had issues.
RThoads
Subscriber
here is an idea for anyone that needs to warm gear -- I do it just to make it flow fast through small gauge pins but I am sure it would help with crashed gear also.
I put a bowl of dry rice into the microwave for about a minute (I re-use the same bowl many times so I don't waste all my rice).
Then I stir it around to make sure the heat is all even.
I submerge the vials down into the warm rice and let it sit there for a few minutes while I get everything else ready.
I put a bowl of dry rice into the microwave for about a minute (I re-use the same bowl many times so I don't waste all my rice).
Then I stir it around to make sure the heat is all even.
I submerge the vials down into the warm rice and let it sit there for a few minutes while I get everything else ready.
You guys have really a lot of time or I must be some kind of caveman because the only thing I do is: clean the stopper, draw, change needle, clean skin, inject.
Less then 2 mins
Never had the need to heat up anything
Less then 2 mins
Never had the need to heat up anything
Pharmaceutical standars is rubbing skin with alcohol should be done for a minimum of 30 seconds then allowed to fully dry. If youre spending close to a min what another couple more?You guys have really a lot of time or I must be some kind of caveman because the only thing I do is: clean the stopper, draw, change needle, clean skin, inject.
Less then 2 mins
Never had the need to heat up anything
Wrong. You should pass on The skin only once or You will keep
Contaminating it. That's what I got told, anyway when I go to donate blood they don't stay 30 seconds and they don't wait ages to let it dry. I don't do it as well
When injecting and never had a problem. I usually clean skin and then draw so while I draw the alcohol dry and I'm ready to inject.
Its funny how you say im wrong when both my hospital, where i get my trt bloods, and lifestream(blood donation center) both told me the same thing. Also, at lifestream, they told me if they didnt follow proper protocol thats grounds for being terminated(fired from job) keep telling me im wrong just because you dont do it this way.
Didn't I write that when i Go to donate blood in The fucking hospital no One has ever did that procedure? Didn't i tell You that when I got in The hospital for a CAR accident and needed a painkiller injection no one has ever did that procedure?
So in my opinion you are wrong saying it's necessary to do it that way
Well since the thread is bumped anyway I'll update. Simec has samples and i expect results in the next few weeks.
Wow, im truly sorry that it truly doesnt follow sanitary guidelines the way we do. My apologies, my prayers are with you that you dont catch an infection. (You can look up the proper way of doing it on google as well) @lucabratzi sorry for hijacking, my mistakeDidn't I write that when i Go to donate blood in The fucking hospital no One has ever did that procedure? Didn't i tell You that when I got in The hospital for a CAR accident and needed a painkiller injection no one has ever did that procedure?
So in my opinion you are wrong saying it's necessary to do it that way
And for the record, no you didnt say any of those things you claim to have said.Didn't I write that when i Go to donate blood in The fucking hospital no One has ever did that procedure? Didn't i tell You that when I got in The hospital for a CAR accident and needed a painkiller injection no one has ever did that procedure?
So in my opinion you are wrong saying it's necessary to do it that way
That looks like it's from DS. Did you ask him?
Sure, as vague as it is. You win buddy, hope this makes your day!I didn't say it? lol
Damn! I'm so happy! Gonna pop a cherry Today!Sure, as vague as it is. You win buddy, hope this makes your day!
Intramuscular injections - To swab or not to swab
Angela Cocoman and John Murray write about the practice of skin disinfection prior to administrating an intramuscular injection
Intramuscular injections are a frequently used nursing procedure with an estimated 12 billion administered on an annual basis throughout the world.1
Since the 1950s, nurses in inpatient and community settings have become proficient at administering intramuscular antibiotics, vaccines and depot neuroleptic agents. In recent years increasing demands have been placed on nurses to practise evidenced-based care. Many healthcare settings are addressing this by developing policies and guidelines regarding the administration of injections which include or exclude the infection control issue of skin cleansing, prior to the injection.
Nurses in clinical practice are debating the importance of skin preparation prior to intramuscular injections and are placed in the predicament of what to do when the evidence base is lacking, unclear or open to different interpretations.
Examining the evidence
Research over the last 30 years has questioned the value of skin preparation prior to injections. A landmark study by Dann was carried out at a university medical centre where more than 5,000 injections were given without skin preparation to patients between four and 66 years of age.2 No cases of infection, either local or systemic, were identified. As a result of this study it was suggested that routine skin preparation was unnecessary and questioned the assumption that infection could be introduced via the needle from unsterilised skin.
A study on 13 people who have diabetes, found that although a five second skin preparation with alcohol swabs prior to injection reduced skin bacterial counts by over 82%, such disinfection is not necessary to prevent infection at the injection site.3
When 1,700 injections were given without an alcohol swab no infection occurred. Other studies concur with these findings and suggest that generally there was insufficient contaminating of skin to cause infection following injection without disinfection and that skin cleansing was an unnecessary procedure.4
Further research has reinforced the importance of ensuring that the skin of the patient is physically clean and that healthcare providers maintain high standards of hand hygiene prior to the procedure.5 Scientific evidence to support the use of soap and water for skin cleansing is limited, however it has been suggested that the physical action of washing has long being accepted for the removal of transient flora which may contaminate the skin.6
Another study carried out a review of best practice in relation to the prevention of injection associated infection for the World Health Organisation (WHO). In association with their Safe Injection Global Network, the WHO no longer recommend swabbing clean skin with a disinfectant before giving intradermal, subcutaneous, and intramuscular needle injections.7
Regarding “live vaccines” there was little literature uncovering this topic. The American Centre for Disease Control and Prevention (2002) issued the following guidance specifically for smallpox vaccine administration. It states that alcohol, soap and water or chemical agents are not needed for preparation of the skin prior to vaccination, unless the skin is grossly contaminated in which case, cleansing with soap and water are the preferred agents. Skin must be thoroughly dry in order to prevent inactivation of the vaccine being administered. If soiled, skin should be cleaned, based on basic common standards with soap and water.
However other reseachers8,9 have recommended the cleaning of the injection site in order to minimise the risk of infection, the most common solutions for preparing the skin prior to injections are ethyl alcohol and iodophors. Some studies have cautioned not to use the alcohol swab post injection as the cleaning material can be tracked along the needle path causing irritation.8
Other research10 suggests that antiseptics in current use cannot act in the time that is generally used in practice; approximately five seconds on average and cannot possibly provide complete sterility. They suggest best practice by advising nurses to clean the skin prior to injection to reduce the risk of contamination from the patient’s skin flora.
Swabbing the injection site with a saturated 70% alcohol swab for 30 seconds and allowing to dry for 30 seconds is essential in order to reduce the number of pathogens. Allowing the site to dry prevents stinging if alcohol is taken into the tissues upon needle entry.10
It should be borne in mind that although many authors,2-4 consider skin disinfection to be unnecessary their research methodologies have been questioned. Therefore there are doubts about the reliability of their results and whether they should be generalised.
Medico-legal implications need to be considered by nurses and they should always follow the guidelines laid down by their employer/health authority in relation to skin cleansing prior to injection.
It has been suggested that it would be difficult to defend a case of local sepsis which resulted from an injection where skin disinfection had being omitted.11 The organisms usually responsible for causing abscesses at intramuscular site arestaphylococcus’s aurous and haemolytic streptococcus pyogenes.12
These organisms are pathogenic. Nonetheless the need to remove them from the skin before injections has been debated over the last few years. One study cautions that failure to disinfect skin contaminated with soil or road dust could result in INOculation of gram-positive, anaerobic, spore-forming bacteria.13 These bacteria can survive for indefinite periods in soil or road dust and can cause gas gangrene and tetanus. Controversy remains regarding the need for skin cleansing since Dann concluded that routine skin preparation before injection was unnecessary and has no useful effect in reducing risk from the patient’s own skin flora.
Despite these findings in 1969 there is a lack of research to establish a firm evidence base for cleaning the skin prior to the administration of an intramuscular injection, leaving nurses in a precarious position as to whether to perform this routine practice or not. Although the literature is far from definitive in the area, many Irish inpatient and community settings continue to advocate the practice of cleaning at the injection site.
It has been reported that it can be difficult to interrupt a well-established ritual: eight years after a policy decision to cease routine pre-injection skin swabbing, 78% of staff surveyed at a UK hospital continued the practice.14 The main reason given by 52% of those continuing to swab was cited as ‘sterilisation’. However, another study interestingly noted that it is impossible to sterilise living skin.15
Angela Cocoman is lecturer at the School of Nursing, DCU, Dublin 9; John Murray is community mental health nurse, Waterford
References
WHO Best Practices for Injections and Related Procedures Toolkit.
http://www.ncbi.nlm.nih.gov/books/NBK138495/__NBK138495_dtls__
Search term
< PrevNext >
2Best practices for injection
This chapter assimilates the best practices for delivering injections in health-care and related facilities. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). The chapter outlines recommended practices, skin preparation, preparation and administration of injections, and related health procedures.
Best injection practices described are aimed at protecting patients, health workers and the community.
Go to:
2.1. General safety practices
This section describes the following practices that are recommended to ensure the safety of injections and related practices:
Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis (25). It is the best and easiest way to prevent the spread of microorganisms. Hand hygiene should be carried out as indicated below, either with soap and running water (if hands are visibly soiled) or with alcohol rub (if hands appear clean).
Practical guidance on hand hygiene
Perform hand hygiene BEFORE:
Avoid giving injections if your skin integrity is compromised by local infection or other skin conditions (e.g. weeping dermatitis, skin lesions or cuts), and cover any small cuts.
Indications and precautions for hand hygiene are shown in Table 2.1.
Table 2.1
Indications and precautions for hand hygiene.
2.1.2. Gloves
Health workers should wear non-sterile, well-fitting latex or latex-free gloves when coming into contact with blood or blood products (26). Indications for glove use in injection practice are shown in Table 2.2.
Table 2.2
Indications for glove use in injection practice.
2.1.3. Other single-use personal protective equipment
Masks, eye protection and other protective clothing ARE NOT indicated for the injection procedures covered by this document unless exposure to blood splashes is expected.
Practical guidance on single-use personal protective equipment
When using single-use personal protective equipment, dispose of the equipment immediately after use.
2.1.4. Skin preparation and disinfection
Table 2.3 shows the skin preparation protocols for different types of injection.
Table 2.3
Skin preparation for different types of injection.
Practical guidance on skin preparation and disinfection
To disinfect skin, use the following steps (27–29):
DO NOT use alcohol skin disinfection for administration of vaccinations.
2.1.5. Summary of best practice
The steps outlined above are summarized in Table 2.4, below.
Table 2.4
Infection prevention and control practices.
Go to:
2.2. Injection devices and medications
2.2.1. Injection devices
Health-care settings should ensure that an adequate supply of single-use devices is available, to allow providers to use a new device for each procedure.
Practical guidance on use of injection devices
When using a sterile single-use device (i.e. a syringe and hypodermic needle that is not separated or manipulated unless necessary (7):
Types of medication containers and recommendations on their use are given in Table 2.5.
Table 2.5
Recommendations on medication containers.
Practical guidance on giving medications
Injections should be prepared in a designated clean area where contamination by blood and body fluids is unlikely (1,7).
Practical guidance on preparing injections
Three steps must be followed when preparing injections.
Wipe the access diaphragm (septum) with 70% alcohol (isopropyl alcohol or ethanol) on a swab or cotton-wool ball before piercing the vial, and allow to air dry before inserting a device into the bottle.
An aseptic technique should be followed for all injections.
Practical guidance on administering injections
General
2.3. Prevention of sharps injuries to health workers
Use of best practices can help to prevent sharps injuries to health workers (31–33). Further information on this topic can be found in Chapter 4.
Practical guidance on prevention of sharps injuries
To avoid sharps injuries:
2.4. Waste management
Use of sealed, puncture and leak-proof sharps containers helps to prevent access to used devices (24, 34).
Practical guidance on waste management
To ensure that waste is dealt with safely:
Copyright © 2010, World Health Organization.
All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail:tni.ohw@snoissimrep).
Take your pic
mands
Angela Cocoman and John Murray write about the practice of skin disinfection prior to administrating an intramuscular injection
Intramuscular injections are a frequently used nursing procedure with an estimated 12 billion administered on an annual basis throughout the world.1
Since the 1950s, nurses in inpatient and community settings have become proficient at administering intramuscular antibiotics, vaccines and depot neuroleptic agents. In recent years increasing demands have been placed on nurses to practise evidenced-based care. Many healthcare settings are addressing this by developing policies and guidelines regarding the administration of injections which include or exclude the infection control issue of skin cleansing, prior to the injection.
Nurses in clinical practice are debating the importance of skin preparation prior to intramuscular injections and are placed in the predicament of what to do when the evidence base is lacking, unclear or open to different interpretations.
Examining the evidence
Research over the last 30 years has questioned the value of skin preparation prior to injections. A landmark study by Dann was carried out at a university medical centre where more than 5,000 injections were given without skin preparation to patients between four and 66 years of age.2 No cases of infection, either local or systemic, were identified. As a result of this study it was suggested that routine skin preparation was unnecessary and questioned the assumption that infection could be introduced via the needle from unsterilised skin.
A study on 13 people who have diabetes, found that although a five second skin preparation with alcohol swabs prior to injection reduced skin bacterial counts by over 82%, such disinfection is not necessary to prevent infection at the injection site.3
When 1,700 injections were given without an alcohol swab no infection occurred. Other studies concur with these findings and suggest that generally there was insufficient contaminating of skin to cause infection following injection without disinfection and that skin cleansing was an unnecessary procedure.4
Further research has reinforced the importance of ensuring that the skin of the patient is physically clean and that healthcare providers maintain high standards of hand hygiene prior to the procedure.5 Scientific evidence to support the use of soap and water for skin cleansing is limited, however it has been suggested that the physical action of washing has long being accepted for the removal of transient flora which may contaminate the skin.6
Another study carried out a review of best practice in relation to the prevention of injection associated infection for the World Health Organisation (WHO). In association with their Safe Injection Global Network, the WHO no longer recommend swabbing clean skin with a disinfectant before giving intradermal, subcutaneous, and intramuscular needle injections.7
Regarding “live vaccines” there was little literature uncovering this topic. The American Centre for Disease Control and Prevention (2002) issued the following guidance specifically for smallpox vaccine administration. It states that alcohol, soap and water or chemical agents are not needed for preparation of the skin prior to vaccination, unless the skin is grossly contaminated in which case, cleansing with soap and water are the preferred agents. Skin must be thoroughly dry in order to prevent inactivation of the vaccine being administered. If soiled, skin should be cleaned, based on basic common standards with soap and water.
However other reseachers8,9 have recommended the cleaning of the injection site in order to minimise the risk of infection, the most common solutions for preparing the skin prior to injections are ethyl alcohol and iodophors. Some studies have cautioned not to use the alcohol swab post injection as the cleaning material can be tracked along the needle path causing irritation.8
Other research10 suggests that antiseptics in current use cannot act in the time that is generally used in practice; approximately five seconds on average and cannot possibly provide complete sterility. They suggest best practice by advising nurses to clean the skin prior to injection to reduce the risk of contamination from the patient’s skin flora.
Swabbing the injection site with a saturated 70% alcohol swab for 30 seconds and allowing to dry for 30 seconds is essential in order to reduce the number of pathogens. Allowing the site to dry prevents stinging if alcohol is taken into the tissues upon needle entry.10
It should be borne in mind that although many authors,2-4 consider skin disinfection to be unnecessary their research methodologies have been questioned. Therefore there are doubts about the reliability of their results and whether they should be generalised.
Medico-legal implications need to be considered by nurses and they should always follow the guidelines laid down by their employer/health authority in relation to skin cleansing prior to injection.
It has been suggested that it would be difficult to defend a case of local sepsis which resulted from an injection where skin disinfection had being omitted.11 The organisms usually responsible for causing abscesses at intramuscular site arestaphylococcus’s aurous and haemolytic streptococcus pyogenes.12
These organisms are pathogenic. Nonetheless the need to remove them from the skin before injections has been debated over the last few years. One study cautions that failure to disinfect skin contaminated with soil or road dust could result in INOculation of gram-positive, anaerobic, spore-forming bacteria.13 These bacteria can survive for indefinite periods in soil or road dust and can cause gas gangrene and tetanus. Controversy remains regarding the need for skin cleansing since Dann concluded that routine skin preparation before injection was unnecessary and has no useful effect in reducing risk from the patient’s own skin flora.
Despite these findings in 1969 there is a lack of research to establish a firm evidence base for cleaning the skin prior to the administration of an intramuscular injection, leaving nurses in a precarious position as to whether to perform this routine practice or not. Although the literature is far from definitive in the area, many Irish inpatient and community settings continue to advocate the practice of cleaning at the injection site.
It has been reported that it can be difficult to interrupt a well-established ritual: eight years after a policy decision to cease routine pre-injection skin swabbing, 78% of staff surveyed at a UK hospital continued the practice.14 The main reason given by 52% of those continuing to swab was cited as ‘sterilisation’. However, another study interestingly noted that it is impossible to sterilise living skin.15
Angela Cocoman is lecturer at the School of Nursing, DCU, Dublin 9; John Murray is community mental health nurse, Waterford
References
- Centre for Disease Control and Prevention. Department of Health and Human Services . Smallpox Vaccine Administration. Altanta. USA, 2002
- Dann TC. Routine skin preparation before injection: an unnecessary procedure. Lancet 1969; 2: 96-7
- Koivisto JA, Felig P. Is skin preparation necessary before insulin injection? Lancet 1978; 1: 1072-1073
- McCarthy JA, Covarrubis B, Sink P. Is the traditional alcohol wipe necessary before an insulin injection? Diabetes Care 1993; 16(1); 402
- Workman B. Safe injection techniques. Nursing Standard 1999; 13(39): 47-53
- Rotter M. Hand washing and hand disinfection. Mayhall CG. Ed Hospital epidemiology and infection control, 2nd Edition. Philadelphia. Lippincott, 1999
- Hutin Y, Hauri A, Chiarello L. Best infection control practices for intradermal, subcutaneous and intramuscular needle injections. Bulletin of the World Health Organisation 2003; 81(7): 491-500
- Berger KJ, Williams MS. Fundamentals of Nursing: Collaborating for Optimal Health. Appletone Large: Connecticut, 1992
- Simmonds BP. CDC guidelines for the prevention and control of nosocomial. Infections: guidelines for prevention of intravascular infections. American Journal of Infection Control. 1983; 11(5), 183-189
- Mallett J, Bailey C. The Royal Marsden NHS Trust Manual of Clinical Procedures (5th ed.) Blackwell Science: London 1996
- Lawrence JC. The use of alcoholic wipes for disinfection of injection sites. Journal of Wound Care 1994; 3(1): 1-14
- Dedgeon JA. Immunisation: Principles and Practice. London. Chapman & Hall, 1991
- Quinlan S. To the point, perspectives: practice profile. Nursing Standard May 31st, 2000; 14 (37)
- Liew J, Archer GJ. . Swabaholics? (Letter) Lancet 1995; 345(8965): 1648
- Hoffman PN. Skin disinfection and acupuncture. Acupuncture in Medicine 2001; 19(2): 112-1
WHO Best Practices for Injections and Related Procedures Toolkit.
http://www.ncbi.nlm.nih.gov/books/NBK138495/__NBK138495_dtls__
Search term
< PrevNext >
2Best practices for injection
This chapter assimilates the best practices for delivering injections in health-care and related facilities. It is based on a range of evidence and expands the scope of the WHO publication Best infection control practices for intradermal, subcutaneous, and intramuscular needle injection (7). The chapter outlines recommended practices, skin preparation, preparation and administration of injections, and related health procedures.
Best injection practices described are aimed at protecting patients, health workers and the community.
Go to:
2.1. General safety practices
This section describes the following practices that are recommended to ensure the safety of injections and related practices:
- hand hygiene;
- gloves where appropriate;
- other single-use personal protective equipment;
- skin preparation and disinfection.
Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis (25). It is the best and easiest way to prevent the spread of microorganisms. Hand hygiene should be carried out as indicated below, either with soap and running water (if hands are visibly soiled) or with alcohol rub (if hands appear clean).
Practical guidance on hand hygiene
Perform hand hygiene BEFORE:
- starting an injection session (i.e. preparing injection material and giving injections);
- coming into direct contact with patients for health-care related procedures;
- putting on gloves (first make sure hands are dry).
- an injection session;
- any direct contact with patients;
- removing gloves.
Avoid giving injections if your skin integrity is compromised by local infection or other skin conditions (e.g. weeping dermatitis, skin lesions or cuts), and cover any small cuts.
Indications and precautions for hand hygiene are shown in Table 2.1.
Table 2.1
Indications and precautions for hand hygiene.
2.1.2. Gloves
Health workers should wear non-sterile, well-fitting latex or latex-free gloves when coming into contact with blood or blood products (26). Indications for glove use in injection practice are shown in Table 2.2.
Table 2.2
Indications for glove use in injection practice.
2.1.3. Other single-use personal protective equipment
Masks, eye protection and other protective clothing ARE NOT indicated for the injection procedures covered by this document unless exposure to blood splashes is expected.
Practical guidance on single-use personal protective equipment
When using single-use personal protective equipment, dispose of the equipment immediately after use.
2.1.4. Skin preparation and disinfection
Table 2.3 shows the skin preparation protocols for different types of injection.
Table 2.3
Skin preparation for different types of injection.
Practical guidance on skin preparation and disinfection
To disinfect skin, use the following steps (27–29):
- Apply a 60–70% alcohol-based solution (isopropyl alcohol or ethanol) on a single-use swab or cotton-wool ball. DO NOT use methanol or methyl-alcohol as these are not safe for human use.
- Wipe the area from the centre of the injection site working outwards, without going over the same area.
- Apply the solution for 30 seconds then allow it to dry completely.
DO NOT use alcohol skin disinfection for administration of vaccinations.
2.1.5. Summary of best practice
The steps outlined above are summarized in Table 2.4, below.
Table 2.4
Infection prevention and control practices.
Go to:
2.2. Injection devices and medications
2.2.1. Injection devices
Health-care settings should ensure that an adequate supply of single-use devices is available, to allow providers to use a new device for each procedure.
Practical guidance on use of injection devices
When using a sterile single-use device (i.e. a syringe and hypodermic needle that is not separated or manipulated unless necessary (7):
- use a new device for each procedure, including for the reconstitution of a unit of medication or vaccine;
- inspect the packaging of the device to ensure that the protective barrier has not been breached;
- discard the device if the package has been punctured, torn or damaged by exposure to moisture, or if the expiry date has passed.
Types of medication containers and recommendations on their use are given in Table 2.5.
Table 2.5
Recommendations on medication containers.
Practical guidance on giving medications
- When giving medication:
–
DO NOT use a single loaded syringe to administer medication to several patients (i.e. ensure one needle, one syringe, one patient!);
–
DO NOT change the needle in order to reuse the syringe;
–
DO NOT use the same mixing syringe to reconstitute several vials;
–
DO NOT combine leftover medications for later use.
- Single-dose vials – Whenever possible, use a single-dose vial for each patient, to reduce cross-contaminationbetween patients.
- Multidose vials – Only use multidose vials if there is no alternative.
–
Open only one vial of a particular medication at a time in each patient-care area.
–
If possible, keep one multidose vial for each patient, and store it with the patient's name on the vial in a separate treatment or medication room.
–
DO NOT store multidose vials in the open ward, where they could be inadvertently contaminated with spray or spatter.
- Discard a multidose vial:
–
if sterility or content is compromised;
–
if the expiry date or time has passed (even if the vial contains antimicrobial preservatives);
–
if it has not been properly stored after opening;
–
within 24 hours of opening, or after the time recommended by the manufacturer, if the vial does not contain antimicrobial preservatives;
–
if found to be undated, improperly stored, inadvertently contaminated or perceived to be contaminated, regardless of expiration date.
- Pop-open ampoules – Whenever possible, use pop-open ampoules rather than ampoules that require use of a metal file to open. If using an ampoule that requires a metal file to open, protect your fingers with a clean barrier (e.g. a small gauze pad) when opening the ampoule (7).
Injections should be prepared in a designated clean area where contamination by blood and body fluids is unlikely (1,7).
Practical guidance on preparing injections
Three steps must be followed when preparing injections.
- Keep the injection preparation area free of clutter so all surfaces can be easily cleaned.
- Before starting the injection session, and whenever there is contamination with blood or body fluids, clean the preparation surfaces with 70% alcohol (isopropyl alcohol or ethanol) and allow to dry.
- Assemble all equipment needed for the injection:
–
sterile single-use needles and syringes;
–
reconstitution solution such as sterile water or specific diluent;
–
alcohol swab or cotton wool;
–
sharps container.
Wipe the access diaphragm (septum) with 70% alcohol (isopropyl alcohol or ethanol) on a swab or cotton-wool ball before piercing the vial, and allow to air dry before inserting a device into the bottle.
- Use a sterile syringe and needle for each insertion into a multidose vial.
- Never leave a needle in a multidose vial.
- Once the loaded syringe and needle has been withdrawn from a multidose vial, administer the injection as soon as possible.
- After reconstitution of a multidose vial, label the final medication container with:
–
date and time of preparation;
–
type and volume of diluent (if applicable);
–
final concentration;
–
expiry date and time after reconstitution;
–
name and signature of the person reconstituting the drug.
- For multidose medications that DO NOT require reconstitution, add a label with:
–
date and time of first piercing the vial;
–
name and signature of the person first piercing the vial.
An aseptic technique should be followed for all injections.
Practical guidance on administering injections
General
- When administering an injection:
–
check the drug chart or prescription for the medication and the corresponding patient's name and dosage;
–
perform hand hygiene;
–
wipe the top of the vial with 60–70% alcohol (isopropyl alcohol or ethanol) using a swab or cotton-wool ball;
–
open the package in front of the patient to reassure them that the syringe and needle have not been used previously;
–
using a sterile syringe and needle, withdraw the medication from the ampoule or vial.
- If reconstitution using a sterile syringe and needle is necessary, withdraw the reconstitution solution from the ampoule or vial, insert the needle into the rubber septum in the single or multidose vial and inject the necessary amount of reconstitution fluid.
- Mix the contents of the vial thoroughly until all visible particles have dissolved.
- After reconstituting the contents of a multidose vial, remove the needle and syringe and discard them immediately as a single unit into a sharps container.
- If a needleless system is available:
–
wipe the rubber septum of the multidose vial with an alcohol swab;
–
insert the spike into the multidose vial;
–
wipe the port of the needleless system with an alcohol swab;
–
remove a sterile syringe from its packaging;
–
insert the nozzle of the syringe into the port;
–
withdraw the reconstituted drug.
- If the dose cannot be administered immediately for any reason, cover the needle with the cap using a one-hand scoop technique.
- Store the device safely in a dry kidney dish or similar container.
- DO NOT allow the needle to touch any contaminated surface.
- DO NOT reuse a syringe, even if the needle is changed.
- DO NOT touch the diaphragm after disinfection with the 60–70% alcohol (isopropyl alcohol or ethanol).
- DO NOT enter several multidose vials with the same needle and syringe.
- DO NOT re-enter a vial with a needle or syringe used on a patient if that vial will be used to withdraw medication again (whether it is for the same patient or for another patient).
- DO NOT use bags or bottles of intravenous solution as a common source of supply for multiple patients (except in pharmacies using laminar flow cabinets).
2.3. Prevention of sharps injuries to health workers
Use of best practices can help to prevent sharps injuries to health workers (31–33). Further information on this topic can be found in Chapter 4.
Practical guidance on prevention of sharps injuries
To avoid sharps injuries:
- ensure that the patient is adequately prepared for the procedure;
- do not bend, break, manipulate or manually remove needles before disposal;
- avoid recapping needles, but if a needle must be recapped, use a single-handed scoop technique;
- discard used sharps and glass ampoules immediately after use in the location where they were used, disposing of them into a robust sharps container that is leak and puncture resistant;
- place the sharps container within arm's reach (preferably in a secured area) to allow for easy disposal of sharps;
- seal and replace sharps container when the container is three quarters full.
2.4. Waste management
Use of sealed, puncture and leak-proof sharps containers helps to prevent access to used devices (24, 34).
Practical guidance on waste management
To ensure that waste is dealt with safely:
- transport and store sharps containers in a secure area before final disposal;
- close, seal and dispose of sharps containers when the containers are three quarters full; assign responsibility in written policy for monitoring the fill level of sharps containers and replacing them when three quarters full;
- discard waste that is not categorised as sharp or infectious in appropriate colour-coded bags;
- ensure that infectious waste bags and sharps containers are closed before they are transported for treatment ordisposal.
Copyright © 2010, World Health Organization.
All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail:tni.ohw@snoissimrep).
Take your pic
mands
CdnGuy
New Member
Any news bro ?
I emailed simec today to get an update. Today was 3 weeks that they've had it and that's when they said they'd be done
I emailed simec today to get an update. Today was 3 weeks that they've had it and that's when they said they'd be done
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