Patient Notification Events Due to Syringe Reuse and Mishandling of Injectable Medications by Health Care Personnel-United States, 2012-2018: Summary and Recommended Actions for Prevention and Response

Safe Injection, Infusion, Medication Vial, and Point-of-Care Testing Practices in Healthcare (2025)

PURPOSE STATEMENT

This position paper provides healthcare professionals (HCP) updated guidance with corresponding evidence and rationale to support safe injection, infusion, medication vial, and point-of-care testing practices in healthcare settings. It addresses the infection risks associated with these practices but does not address other safety issues such as right dose, right site, right medication, phlebotomy, or intravenous catheter care. This document updates the Association for Professionals in Infection Control and Epidemiology (APIC) 2016 position paper.

An agent-based model to simulate the transmission dynamics of bloodborne pathogens within hospitals

Mathematical models are powerful tools to analyze pathogen spread and assess control strategies in healthcare settings. Nevertheless, available models focus on nosocomial transmission through direct contact or aerosols rather than through blood, even though bloodborne pathogens remain a significant source of iatrogenic infectious risk. Herein, we propose an agent-based SEI (Susceptible-Exposed-Infected) model to reproduce the transmission of bloodborne pathogens dynamically within hospitals. This model simulates the dynamics of patients between hospital wards, from admission to discharge, as well as the dynamics of the devices used during at-risk invasive procedures, considering that patient contamination occurs after exposure to a contaminated device. We first illustrate the use of this model through a case study on hepatitis C virus (HCV) in Egypt. Model parameters, such as HCV upon-admission prevalence and transition probabilities between wards or ward-specific probabilities of undergoing different invasive procedures, are informed with data collected in Ain Shams University Hospital in Cairo. Our results suggest a low risk of HCV acquisition for patients hospitalized in this university hospital. However, we show that in a low-resource hospital, frequent device shortages could lead to increased risk. We also find that systematically screening patients in a few selected high-risk wards could significantly reduce this risk. We then further explore potential model applications through a second illustrative case study based on HBV nosocomial transmission in Ethiopia. In the future, this model could be used to predict the potential burden of emerging bloodborne pathogens and help implement effective control strategies in various hospital contexts.

An analysis of the effect of syringe barrel volume on performance and user perception

In the market, there are many types and shapes of syringes. One of the groupings of syringe types is based on barrel volume. The shape of the product design affects performance and user perception. The aim of this study is to investigate the effect of barrel volume on its performance and user perception. We performed analysis following international organization for standardization 7886 procedures on syringe with 1 mL, 3 mL, 5 mL, and 10 mL volume. In addition, a user perception test was conducted on 29 respondents using a questionnaire with the Likert chart method. This study indicates that the bigger the syringe volume, the larger the dead space and the force to operate the piston are. A larger syringe volume also raises the volume that changes due to the plunger position increase. Meanwhile, the barrel volume does not affect water and water leakage, as we did not observe any leak during the syringe tests in our experiment. In addition, the user perception test shows that the barrel's length influences the ease of device control during the injection. The volume of the barrel negatively correlated with its effect to the environment. The safety features of all syringes are similar except for the 3 mL syringe, which has a value of 0.1 points difference to other syringes.

The hypodermic syringe performance based on the ISO 7886-1:2017: A narrative review

A syringe is used to inject fluid or medicine into the patient's soft tissue. The main components of the syringe were the needle, barrel, and plunger. The use of syringes in the medical world is relatively high, and especially since the COVID-19 pandemic, the use of hypodermic syringes increased sharply due to vaccination. The syringe used must be effective and of good quality, so the International Organization for Standardization (ISO) has published test procedures and minimum specifications for hypodermic syringes. The performance of the syringe can be observed from the dead space, force piston operation, water and air leakage, and fitting position of the plunger in the barrel. This review shows that most researchers use the weighing method to measure the dead space, although some use other methods. The researchers found that most of the products met the minimum specifications of the ISO, and that the dimensions and shape of the syringe affected the dead space. Researchers have not examined other performance measures recommended by the ISO. Researchers have focused more on force injection than force piston operation, leakage after injection or back spray than air and water leakage, and reduction the friction of the plunger without considering the fitting position of the plunger in the barrel.

A public health response to a newly diagnosed case of hepatitis C associated with lapse in Infection Prevention and Control practices in a dental setting in Ontario, Canada

BACKGROUND

Haliburton, Kawartha, Pine Ridge District Health Unit (HKPRDHU) investigated an exposure in an Ontario operatory dental facility related to a newly diagnosed hepatitis C virus (HCV) infection caused by a virus with an uncommon hepatitis C genotype. Lapses in Infection Prevention and Control (IPAC) and a second epidemiologically-linked case (with the same uncommon hepatitis C genotype) were identified, prompting a broader public health response and outbreak investigation.

OBJECTIVES

a) To describe the investigation of a newly diagnosed case of hepatitis C; b) to describe the broader public health response, and c) to address a paucity in the literature related to the risk of disease transmission in dental settings due to IPAC lapses.

METHODS

A collaborative approach with two dental practices, public health partners and regulatory bodies was used. An IPAC inspection was completed to determine and mitigate the risk of blood borne infection transmission within the facilities. Appropriate protocols were followed for the IPAC investigation and public health response.

RESULTS

The investigation identified a risk of potential HCV transmission between two cases linked to the same dental facility. There were no other epi-linked cases of HCV identified. Challenges included a lack of adherence to IPAC standards in one of the dental settings and awareness in the dental community regarding HCV transmission, coordination with regulatory bodies and public health experts and low uptake of laboratory testing by patients.

CONCLUSION

Despite the unique challenges associated with the investigation, HKPRDHU conducted a successful IPAC lapse investigation and public health response. Public health units need to maintain collaborative approaches with regulated health professionals, their regulatory bodies and public health experts.

Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012-2014

OBJECTIVE

To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic.

DESIGN

Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome.

SETTING

Outpatient cardiology clinic.

PATIENTS

Patients undergoing MPI.

METHODS

Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed.

RESULTS

During 2012-2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%-99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified.

CONCLUSIONS

This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.