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Multidose medication vial sterility: an in-use study and a review of the literature
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 863 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 ob-gyn wards (p less than 0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p less than 0.05), and insulin MDV were more regularly dated (p = 0.001). The percentage of undated MDV declined significantly by month during the 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.
Insights
Multiple-dose medication vials (MDV) showed no bacterial contamination in a 3-month hospital study. Current guidelines support dating vials upon opening and discarding when empty or expired, unless contamination is suspected.
Area of Science:
- Microbiology
- Infectious Disease Prevention
- Hospital Pharmacy
Background:
- Multiple-dose medication vials (MDV) are crucial for administering various medications.
- Concerns exist regarding bacterial contamination and infection transmission from opened MDVs.
- Current practices suggest discarding MDVs after 24 hours or single use, potentially increasing waste.
Purpose of the Study:
- To evaluate the microbial safety of in-use multiple-dose medication vials (MDVs) in a hospital setting.
- To assess the duration of use and adherence to dating protocols for MDVs.
- To provide evidence-based recommendations for MDV handling and disposal guidelines.
Main Methods:
- Cultured 1,223 weekly samples from 863 in-use MDVs over three months.
- Included medications: xylocaine, insulin, heparin, immunizations, and miscellaneous agents.
- Analyzed duration of use, dating practices, and departmental variations.
Main Results:
- No bacterial contamination was detected in any of the cultured MDV samples.
- The median duration of MDV use was 9.5 days, with a mean of 18 days (range: 1-402 days).
- Adherence to dating protocols improved significantly over the study period.
Conclusions:
- Current hospital guidelines for dating MDVs upon opening and discarding when empty or expired (unless contamination is suspected) are supported by these findings.
- The study demonstrates the safety of prolonged MDV use when appropriate handling procedures are followed.
- Optimized MDV management can reduce waste and maintain patient safety.