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Multidose Medication Vial Sterility: An In-Use Study and a Review of the Literature

Published online by Cambridge University Press:  02 January 2015

Robert Longfield*
Affiliation:
Hospital Infection Control, Infections Diseases Division, Department of Internal Medicine, Naval Hospital, and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Jenice Longfield
Affiliation:
Hospital Infection Control, Infections Diseases Division, Department of Internal Medicine, Naval Hospital, and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
L. Patrick Smith
Affiliation:
Hospital Infection Control, Infections Diseases Division, Department of Internal Medicine, Naval Hospital, and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
K. Craig Hyams
Affiliation:
Hospital Infection Control, Infections Diseases Division, Department of Internal Medicine, Naval Hospital, and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
M. Elena Strohmer
Affiliation:
Hospital Infection Control, Infections Diseases Division, Department of Internal Medicine, Naval Hospital, and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
*
Hospital Epidemiologist, Naval Hospital, Bethesda, MD 20814

Abstract

Contaminated multiple-dose medication vials (MDV) have been implicated in transmission of bacterial infections. It has been suggested that MDV be discarded after 24 hours or even after a single use. At our hospital, we cultured 1,223 weekly samples from 864 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. The duration of use was 9.5d (median), 18d (mean), and 1-402d (range) with 13% of vials in-use for more than 30 days. The mean duration of use was significantly shorter for medicine wards, emergency room, and outpatient clinics than for surgery and obgyn wards (p<0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p<0.05), and insulin MDV were more regularly dated (p=0.001). The percentage of undated MDV declined significantly by month during die study (p=0.003). These results lend support to our current guideline that MDV should be dated upon opening and that, unless visible or suspected contamination occurs, vials are discarded either when empty or at the manufacturer's expiration date.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1984

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References

1.Nakashima, AK, Highsmith, AK, Allen, JR, et al: Serratia marcescens joint infections following intraarticular injections. Read before the 83rd Annual Meeting of the American Society for Microbiology, New Orleans, March 1983.Google Scholar
2.Kothari, T, Reyes, MP, Brooks, N, et al: Pseudomonas cepacia septic arthritis due to intraarticular injections of methylprednisolone. Can Med Assoc J 1977;116:12301232.Google ScholarPubMed
3.Corbett, JJ, Rosenstein, BJ: Pseudomonas meningitis related to spinal anesthesia. Neurology 1971;21:946950.CrossRefGoogle ScholarPubMed
4.Steere, AC, Tenney, JH, Mackel, DC, et al: Pseudomonas species bacteremia caused by contaminated normal human serum albumin. J Infect Dis 1977;135:729735.CrossRefGoogle ScholarPubMed
5.Gremillion, DH, Mursch, SB, Lerner, CJ: Injection site abscesses caused by Mycobacterium chelonei. Infect Control 1983;4:2528.CrossRefGoogle ScholarPubMed
6.Yangco, BG, Germain, BG, Deresinski, SC: Case report: Fatal gas gangrene following intraarticular steroid injection. Am J Med Sci 1982; 283(2):9497.CrossRefGoogle Scholar
7.Kohan, S, Carlin, H, Whitehead, R: A study of contamination of multiple-dose medication vials. Journal of the American Hospital Association 1962;38:7882.Google Scholar
8.Heller, WM: Time limits on the use of opened multiple-dose vials. Am J Hosp Pharm 1980;37:1610.Google ScholarPubMed
9.Ravnik, A, Yatsco, J : A study of the sterility of multiple-dose injectables after repeated withdrawals. Am J Hosp Pharm 1962;19:469471.Google Scholar
10.Bothe, J: Study shows contamination in multiple-dose vials. American Organization of Registered Nurses Journal 1973;17:111114.Google ScholarPubMed
11.Young, JA, Collette, TS, Brehm, WF: Sterility of multiple-dose vials after repeated use. Am Surg 1958;24:811814.Google ScholarPubMed
12.Rosenzweig, AL: Potential health hazards in the multiple-dose vial. Journal of the American Hospital Association 1964;38:7174.Google ScholarPubMed
13.Ridgeway, JF, McAuliff, WK: The sterility of multiple-dose vials is challenged. Hospital Management 1967;104:6772.Google Scholar
14.Corley, CE, Manos, JP, Thomas, JD: Multiple dose vials: A source of contamination? J SC Med Assoc 1968; 461464.Google Scholar
15.Petty, WC, Heggers, JP, Shelton, DF, et al: Viral and bacterial contamination of multiple-dose drug vials kept in anesthesia machines. Anesthesiology 1969;30:465468.CrossRefGoogle ScholarPubMed
16.Olson, OT, Aslund, B, Sandell, E: Studies on in-use microbial contamination of multiple-dose vials. Acta Pharm Suec 1978; 15(6):401405.Google ScholarPubMed
17.Bawden, JC, Jacobson, JA, Jackson, JC, et al: Sterility and use patterns of multiple-dose vials. Am J Hosp Pharm 1982;39:294297.Google ScholarPubMed
18.Sheth, NK, Post, GT, Wisniewski, TR, et al: Multidose vials versus single dose vials: A study in sterility and cost effectiveness. J Clin Microbiol 1983;17:377379.CrossRefGoogle Scholar
19.Highsmith, AK, Greenhood, GP, Allen, JR: Growth of nosocomial pathogens in multiple-dose parenteral medication vials. J Clin Microbiol 1982; 15(6): 10241028.CrossRefGoogle ScholarPubMed