Safe Injection Practice: A Comprehensive Checklist for Monitoring Practice

The transmission of pathogens to patients during routine care processes continues to occur primarily due to the use of unsafe and
improper injection, infusion, and medical vial practices by healthcare workers. These unsafe practices occur in a variety of clinical
settings and the results can be devastating for the patient. The areas of practice that are of greatest concern include:
1. Syringe and/or needle reuse
2. Contamination of medication vials
3. Contamination of intravenous bags
4. Failure to follow safety practices when preparing and administering parenteral medication
5. Inappropriate care/maintenance of single use medical devices
6. Inappropriate care/maintenance of reusable medical equipment
7. Lack of written policies/procedures/prevention protocols
8. Staff training and education
9. Monitoring of healthcare personnel practice
10. Feedback of results as a part of the improvement process
The following checklist has been developed by infection preventionists and can be used to evaluate care practices in any healthcare
setting and may provide insight and guidance regarding care improvements. When using the checklist, all Yes responses indicate
that the observed practice(s) follow safe injection practices. A No response indicates that immediate corrective action is indicated.
A Do Not Know response indicates that further investigation is necessary to ensure patient and healthcare personnel safety.

Preventing syringe/needle reuse

Yes
Sterile syringes are used for all medication administered in this setting, regardless of route medication is
administered (e.g., intramuscular, intravenous, intradermal)
Sterile needles are used for all medication administered in this setting, regardless of route medication is
administered (e.g., intramuscular, intravenous, intradermal)
Sterile syringes, needles, cannulas are removed from their packaging immediately before use
Storage of syringes that have been removed from their packaging (even with capped needles) is prohibited
New sterile syringes are used for each patient and are never reused or shared between patients
Medication transfer from one syringe to another is prohibited (e.g., drawing up solution into one syringe then
transferring into another syringe with the plunger removed or injected into the bevel or another syringe prior to
administration)
Storing or medication in syringes in pockets or clothing while awaiting administration is prohibited
Preparation of medication in syringe occurs immediately prior to administration and not drawn up awaiting future
administration
Safety needles/syringes are used for administration of all injectable medication

No

Do not
know

Preventing contamination of medication vial

Yes
A new sterile syringe and sterile needle are used for every entry into a medication vial
Single-use or single-dose vials are used whenever possible
Single-dose vials are discarded after use.
Medication left in a vial is never pooled, added to another vial, or added to another dose from another vial
Access diaphragms of vials are cleansed with a sterile 70% alcohol, iodophor, or chlorhexidine/alcohol combination
solution using friction immediately prior to entry
For patients requiring repeated doses from a multi-dose vial (e.g., anesthetic agents), that multi-dose vial is used
only for that individual patient
Multiple entries into multi-dose vials are done using a new sterile syringe and a new sterile needle
Multi-dose vials are maintained in a clean medication preparation area and not in the patient examination or
treatment room
Multi-dose vials placed on contaminated surfaces, used during a procedure or during an emergency situation are
disposed of at the completion of that patient encounter
The practice of inserting and leaving a needle or spike device in a multi-dose vial is prohibited
Multi-dose vials are dated at the time of first use
Multi-dose vials are discarded within 28 days after first use
All medication vials are inspected prior to use and are disposed of if the contents are noted to be discolored,
turbid, contain particulate matter, or if sterility has been compromised or is in doubt

No

Do not
know

Preventing contamination of intravenous bags

Yes
A new sterile syringe and sterile needle are used for every entry into an intravenous bag
Use of community IV bags or bottles to obtain flu solutions or for any other use involving more than one patient
is prohibited
Use of infusion supplies (e.g., needles, syringes, IV bags/bottles, administration sets, flush solution) shared among
more than one patient is prohibited
Medication/solutions are drawn from the IV bag or bottle immediately prior to use
Prefilling of syringes for storage and future use is prohibited
The pooling of medication left in an IV/bag or bottle, adding to another vial/bag/bottle, or adding to another dose
from another vial/bag/bottle is prohibited
Access ports of IV bags/bottles are cleansed with a sterile 70% alcohol, iodophor, or chlorhexidine/alcohol
combination solution using friction immediately prior to entry
IV bags/bottles are maintained in a clean medication preparation area and not in the patient examination or
treatment room
The practice of inserting and leaving a needle or spike device in an IV bag/bottle is prohibited
All IV bags/bottles are inspected prior to use and are disposed of if the contents are noted to be discolored, turbid,
contain particulate matter, or if sterility has been compromised or is in doubt

No

Do not
know

Ensuring safety practices when preparing and administering parenteral medication

Yes
All staff having a role in medication preparation or administration have received the hepatitis B vaccination series
All staff having received the hepatitis B vaccination series have been tested to ensure presence of hepatitis B
antibodies
All staff without documented seroconversion after hepatitis B vaccination series have been tested for the presence
of hepatitis B surface antigen or other such test as recommended by the CDC
Safety devices (e.g., retractable needs, retracting lancets, covered needles) are used for all patient encounters
There is a process in place for recognition and reporting of occupational exposure to blood/body fluids including
needlestick/sharps injury
It is required that all medication preparation occur in a designated clean area
Used items are disposed of in appropriate sharps containers immediately after use
Preventing inappropriate use or reuse of single use medical devices
Sharing of medical devices (e.g., finger stick devices, lancet holding devices, insulin pens, capillary blood sampling
devices) is prohibited
Reuse of finger stick devices is prohibited
Used devices are disposed of in appropriate sharps containers immediately after use

No

Do not
know

Preventing inappropriate care/maintenance of reusable medical equipment

Yes
Durable medical equipment that must be shared among patients (e.g., glucosemeters, intravenous pumps) is
cleaned and disinfected between patients prior to reuse using an EPA-registered disinfectant effective against HBV,
HCV and HIV
Manufacturer guidance is followed regarding processes for cleaning and disinfection of reusable medical
equipment
Providing written policies/procedures/prevention protocols
Written policies and procedures are in place that outline the elements of safe injection practice relevant to the
activities performed in the individual setting
Written policies and procedures are available to all staff at all times during their work hours
Written policies and procedures are reviewed at least annually and updated as needed
There is an individual(s) directly assigned responsibility for writing and revising policies and procedures involving
safe injection practices
The individual(s) responsible for writing and revising policies and procedures involving safe injection practices is
competent for this responsibility

No

Do not
know

Providing staff training and education

Yes
A process is in place that verifies all staff are provided with access to written policies and procedures regarding safe
injection practice
Safe injection practices are reviewed with each staff member, at least annually
Written record of training is maintained for all staff members
Staff input regarding safe injection practices are solicited and discussed, as appropriate
A designated expert in infection prevention has been identified to assist with questions regarding safe injection
practice
Monitoring of practice and improving performance
The injection practices of all staff are observed at least annually using a checklist or other such format
Identified breaches in safe injection practice are reported to designated individual(s)
Investigation of the root causes of breaches in safe injection practices are performed as soon as possible after the
breach has been identified.
Consultation occurs with designated infection prevention expert and/or local public health as a means of improving
performance

No

Do not
know

Providing feedback of results from practice/performance monitoring

Yes
Results from staff monitoring of practice/performance are shared with staff members at least annually
Measurable goals for performance improvement are identified and shared with staff members at least annually
Data are collected for the identified measurable goals and results shared with staff members at least annually
Identified breaches in safe injection practice are shared with staff members as a means of preventing reoccurrence
and improving performance
Consultation with local public health officials occurs in the event unsafe injection practices are discovered and
there is evidence or suspicion of bloodborne pathogen transmission

June 2011
Ruth Carrico PhD RN FSHEA CIC. Used with permission. Ruth.carrico@louisville.edu

No

Do not
know