Best do your homework before divvying up single dose vials (SDVs) among multiple patients – do it wrong and the results can be dangerous for your patients and expensive for you, as two clinics recently discovered.
A recent CDC report details the incidents, which took place at an Arizona pain clinic and a Delaware orthopedic clinic. In both cases, improperly sharing SDVs among multiple patients caused the spread of bacterial disease to numerous patients last spring.
Also in both outbreaks, the clinics felt pressed to share SDVs because of drug shortages, according to the CDC.
In the Arizona case, three patients with methicillin-resistant staphylococcus aureus (MRSA) required hospitalization for severe infections, including acute mediastinitis, bacterial meningitis, epidural abscess, and sepsis, after receiving injections from the pain clinic, the CDC said.
The patients all were injected with contrast (dye) for needle localization from the same vial at the clinic. A fourth patient, who got contrast from the same vial, was found dead at home six days after treatment at the clinic. “The cause of death was reported as multiple-drug overdose; however, invasive MRSA infection could not be ruled out,” the CDC reported.
In the Delaware outbreak, seven patients ended up with cases of septic arthritis or bursitis that all turned out to be methicillin-susceptible S. aureus infections traced to anesthetic joint injections they all received at the orthopedic clinic. Turns out the clinic had recently resorted to sharing a single 30 mL vial of bupivacaine among multiple patients, after a nationwide shortage of the drug.
It is possible to safely dispense a single drug vial among multiple patients, the CDC says. “However, this procedure should only be performed using a laminar-flow hood in accordance with standards in U.S. Pharmacopeia General Chapter 797 (Pharmaceutical Compounding — Sterile Preparations).”