Unsafe Injection Practices Expose Patients to Bloodborne Illnesses, Like Hepatitis and HIV, and to Life-Threatening Bacterial Infections

More than 150,000 patients have been impacted by unsafe injection practices since 2001. Breakdowns in proper infection control often involve providers reusing needles, syringes or single-dose medication vials, all of which are meant for one patient and one procedure. These breaches can cause irreparable damage exposing patients to bloodborne illnesses, such as hepatitis and HIV, and to life-threatening bacterial infections. Although safe injection practices represent very basic infection control measures, the CDC routinely identifies and investigates outbreaks associated with deficient practices.


Since 2001, at least 48 outbreaks have occurred that CDC is aware of. Twenty-one of these outbreaks involved transmission of hepatitis B or hepatitis C, and the other 27 represented outbreaks of bacterial infections, most of which involved invasive bloodstream infections. All of these outbreaks were not from intrinsically contaminated products received from a pharmacy or drug company. More specifically, from 2001 through 2011, there were at least 18 outbreaks of viral hepatitis associated with unsafe injection practices in ambulatory settings, such as physician offices or ambulatory surgical centers.


Examples of recent outbreaks and patient notification events occurred in a variety of outpatient settings including primary care clinics, pediatric offices, ambulatory surgical centers, pain remediation clinics, imaging facilities, oncology clinics, and even health fairs. The documented number of patients affected by unsafe injections likely represents only a small sample of a much larger problem. Some diseases and infections spread through unsafe infection practices can take years to show up. By the time symptoms arise, the disease or infection can cause irreparable damage.


The consequences of unsafe injection practices include: infection transmission to patients, notification of thousands of patients of possible exposure to bloodborne pathogens, referral of providers to licensing boards for disciplinary action, and malpractice suits filed by patients.


One example of a recent outbreak caused by unsafe injection practices occurred in April 2012. An outbreak of methicillin resistant Staphylococcus aureus (MRSA) occurred at an outpatient pain management clinic in Arizona, where patients had been injected with a diluted contrast medium for radiologic imaging. Due partly to the difficulty in obtaining a reliable supply of a low concentration contrast medium, the clinic staff prepared two batches of contrast medium, taken from a single-dose vial, and diluted with saline solution. One batch was used for all of the morning’s patients and a second was used in the afternoon. All of the patients who contracted MRSA received an injection on the same day from the same batch of medication.

Three patients were treated for severe infections, requiring hospitalization ranging from nine to forty-one days. A fourth patient died from multiple drug overdose but invasive MRSA infection could not be ruled out.


In March of 2012, seven patients who had received joint injections at an outpatient orthopedic clinic in Delaware contracted methicillin-susceptible Staphylococcus aureus. The only breach of safe practice that had taken place at the clinic was the reuse of single-dose vials (SDVs) of the anesthetic bupivacaine for multiple patients. Clinic staff had until recently been using 10 mL SDVs for single-patient use. However, a national drug shortage disrupted this supply and prompted the use of 30 mL SDVs for multiple patients, with staff drawing from the same vial until it was empty and occasionally storing it overnight for use the following day. The infected patients required an average hospital stay of six days to combat the infection.


Many documented lapses in basic infection control practices involved healthcare providers reusing syringes when giving patients medication, or when drawing up medication from vials meant for only one use. Known outbreaks indicate that several procedures put patients most at risk such as the administration of sedatives and anesthetics for surgical, diagnostic, and pain management procedures; the administration of IV medications for chemotherapy, imaging studies, cosmetic procedures, and alternative medicine therapies (e.g., contrast medium); and the use of saline from an IV administration bag to flush IV lines and catheters. The following practices are dangerous and have resulted in disease transmission: using the same syringe to administer medication to more than one patient, even if the needle was changed or the injection was administered through an intervening length of intravenous (IV) tubing; accessing medication with a syringe that has already been used to administer medication to a patient, then reusing the contaminated medication for another patient; using medications packaged as single-dose or single-use for more than one patient; and failing to use aseptic technique when preparing and administering injections.


See the CDC Report