Nurse anesthetists group stresses safe practices
Infection control guidelines distributed nationally
In response to a hepatitis C virus outbreak in an endoscopy center in Las Vegas, the American Association of Nurse Anesthetists (AANA) in Park Ridge, IL, is reiterating safe needle practices to all of its members. The issues and recommendations being reiterated by the AANA include the following:
Administration of Drugs and Solutions
The potential for infection and transmission of microorganisms exists during the administration of drug therapy. Instructions for preparation, storage, and administration of all pharmaceutical agents provided by each manufacturer shall be read and followed. Drug administration by injection offers many opportunities for contamination. These include previously used needles, syringes, drug administration sets, intravenous tubing, and fluid containers. Whenever eye ointment, nose drops, topical medications, aerosol sprays, and other noninjectable drugs or agents are used, the risk of cross-contamination also is present. Because it is not always possible to identify all patients who have a bloodborne pathogen, every patient must be treated with the same precautions. These include but are not limited to the following:
- Strict adherence to infection control procedures and Standard Precautions is required.
- Multiple-dose vials should be limited to a single patient use unless strict aseptic technique is used and a new sterile syringe and access device are used each time the vial is penetrated. The danger of cross-contamination from multiple dose vials used for more than one patient must be weighed against any cost savings.
- Properly dispose of all needles and syringes after use. Do not reuse needles and syringes. Once used, all needles and syringes are contaminated. They are single-use items.
- Do not recap needles, purposely bend or break them by any means, remove them from disposal syringes, or otherwise manipulate them. An exception to this requirement may be made in circumstances in which the employer can demonstrate no feasible alternative. Needle recapping may be accomplished by using a mechanical device or a one-handed technique.
- Place contaminated needles and syringes in a readily available puncture-resistant container that is leakproof. It shall be color-coded to demonstrate that a biohazard is present.
- Contaminated needles and syringes should be contained in an appropriate receptacle at all times. The receptacle should be stored upright and disposed of in accordance with the facility's hazardous waste program.
- Alternatives to the needlestick test are available to determine the level of a regional anesthetic and include: a peripheral nerve stimulator, a tactile stimulation device, or a special temperature sensor. If needles are used, they must be considered contaminated and disposed of in the appropriate manner.
- The use of sterile, disposable equipment for performing regional anesthesia is recommended. There is limited economic incentive for processing reusable regional anesthesia trays.
- Ampules should be appropriately cleaned prior to opening. Their contents should be aspirated with a filter needle, which is removed prior to administration.
- Cleanse rubber stoppers of vials prior to each use. Only sterile access systems should be used for each penetration of the stopper.
- Do not reprocess for multiple use any intravenous fluids, tubing, or other intravascular infusions or connectors that are single-use disposable items. This includes transducers, tubing, and other items that make contact with the vascular system or other body compartments. Stopcocks and injection ports are major sites of contamination. When administering medications intravenously, all access portals must be maintained with sterile technique.
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