Single-Use Vials -- The Debate Continues
Single-Use Vials -- The Debate Continues
Waste, cost, and "common sense" continue to rationalize healthcare providers' use of single-use vials of injectable medications for more than 1 patient. Following publication of Single-Use Vials: Cost, Safety, and Availability on Medscape, many readers responded with comments either supportive of or in opposition to the Centers for Disease Control and Prevention (CDC) position statement about appropriate use of single-use vials.
This position statement restated the CDC's long-standing position that vials labeled by manufacturers as "single-dose" or "single-use" (or even "single-unit" -- all mean the same thing) should be used only once, for a single patient, to protect against life-threatening infections. These single-dose/single use medication vials typically lack antimicrobial preservatives and can become contaminated during entry, serving as a source of infection if the vial contents are used on subsequent patients.
So, what did healthcare providers have to say?
Is the practice of re-entering a single-use vial acceptable, "if proper basic injection practices are employed," or is it simply "an appalling breach in safe healthcare delivery that puts patients at risk"? Both of these views were expressed by readers. In aggregate, however, most of those who joined the discussion supported using single-use vials as intended -- 1 patient, 1 dose, and 1 time.
An internal medicine physician wrote, "Patients deserve better than multiple uses from a single-dose container. Infections caused by a healthcare provider using poor technique [are] malpractice, and worse, a betrayal of trust placed in a provider by the patient." A medical student adds, "I absolutely agree. We are here to save lives and maintain the highest quality of life possible. There is no reason good enough to risk infection."
"Single-use vials don't contain preservatives," commented an oncologist. "Puncturing a vial, drawing out half the contents, and placing it back on the shelf for the next day is a recipe for bacterial growth."
Many agree that the potential consequences just aren't worth the risk, regardless of cost or availability. A pediatric nurse writes, "Some people maintain that limiting single-dose vials to one-time use is costly and unnecessary. What is the cost of a new vial of medication compared with the cost of hospitalization, blood cultures, and multiple antibiotics to treat the infection? It's a no-brainer. If it says 'single-use,' it's exactly that."
It is easy to see why clinicians are frustrated. A critical care nurse complained, "My hospital is supplied with 10-mL vials of folic acid with a concentration of 5 mg/mL. The dose that we use is only 1 mg; therefore, if we follow policy we would use only 0.2 mL of that 10 mL and throw the rest away. That kind of waste on a daily basis really bothers me."
A gastroenterologist described the impact on clinical practice. "During shortages of propofol and midazolam, we have to do cases with less than adequate sedation or even put off any elective cases for weeks."
For many, it seems that the frustration is magnified by the conviction that reusing single-use vials does not, in fact, endanger patients.
Clinicians Are Still Talking About Single-Use Vials
Waste, cost, and "common sense" continue to rationalize healthcare providers' use of single-use vials of injectable medications for more than 1 patient. Following publication of Single-Use Vials: Cost, Safety, and Availability on Medscape, many readers responded with comments either supportive of or in opposition to the Centers for Disease Control and Prevention (CDC) position statement about appropriate use of single-use vials.
This position statement restated the CDC's long-standing position that vials labeled by manufacturers as "single-dose" or "single-use" (or even "single-unit" -- all mean the same thing) should be used only once, for a single patient, to protect against life-threatening infections. These single-dose/single use medication vials typically lack antimicrobial preservatives and can become contaminated during entry, serving as a source of infection if the vial contents are used on subsequent patients.
So, what did healthcare providers have to say?
Single-Use Means Single Use, Period
Is the practice of re-entering a single-use vial acceptable, "if proper basic injection practices are employed," or is it simply "an appalling breach in safe healthcare delivery that puts patients at risk"? Both of these views were expressed by readers. In aggregate, however, most of those who joined the discussion supported using single-use vials as intended -- 1 patient, 1 dose, and 1 time.
An internal medicine physician wrote, "Patients deserve better than multiple uses from a single-dose container. Infections caused by a healthcare provider using poor technique [are] malpractice, and worse, a betrayal of trust placed in a provider by the patient." A medical student adds, "I absolutely agree. We are here to save lives and maintain the highest quality of life possible. There is no reason good enough to risk infection."
"Single-use vials don't contain preservatives," commented an oncologist. "Puncturing a vial, drawing out half the contents, and placing it back on the shelf for the next day is a recipe for bacterial growth."
Many agree that the potential consequences just aren't worth the risk, regardless of cost or availability. A pediatric nurse writes, "Some people maintain that limiting single-dose vials to one-time use is costly and unnecessary. What is the cost of a new vial of medication compared with the cost of hospitalization, blood cultures, and multiple antibiotics to treat the infection? It's a no-brainer. If it says 'single-use,' it's exactly that."
It is easy to see why clinicians are frustrated. A critical care nurse complained, "My hospital is supplied with 10-mL vials of folic acid with a concentration of 5 mg/mL. The dose that we use is only 1 mg; therefore, if we follow policy we would use only 0.2 mL of that 10 mL and throw the rest away. That kind of waste on a daily basis really bothers me."
A gastroenterologist described the impact on clinical practice. "During shortages of propofol and midazolam, we have to do cases with less than adequate sedation or even put off any elective cases for weeks."
For many, it seems that the frustration is magnified by the conviction that reusing single-use vials does not, in fact, endanger patients.