Medication Preparation Questions

1. How should I draw up medications?
   Parenteral medications should be accessed in an aseptic manner. This includes using a new sterile syringe and sterile needle to draw up medications while preventing contact between the injection materials and the non-sterile environment. Proper hand hygiene should be performed before handling medications and the rubber septum should be disinfected with alcohol prior to piercing it.
2. Where should I draw up medications?
   Medications should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Examples of contaminated items that should not be placed in or near the medication preparation area include: used equipment such as syringes, needles, IV tubing, blood collection tubes, needle holders (e.g., Vacutainer® holder), or other soiled equipment or materials that have been used in a procedure. In general, any item that could have come in contact with blood or body fluids should not be in the medication preparation area.
3. Is it acceptable to leave a needle or other device inserted in the septum of a medication vial for multiple medication draws?
   No. A needle or other device should never be left inserted into a medication vial septum for multiple uses. This provides a direct route for microorganisms to enter the vial and contaminate the fluid.
4. Is it acceptable to use a syringe (that has not been used on a patient) to draw up and mix contents from multiple medication vials?
   The safest practice is to always enter a medication vial with a sterile needle and sterile syringe.There has been at least one outbreak attributed to healthcare personnel using a common needle and syringe to access multiple multi-dose vials for the purpose of combining their contents into a single syringe [14].If one vial becomes contaminated, this practice can spread contamination to the others, prolonging presence of the pathogen and increasing the potential for disease transmission. Syringe reuse in this fashion may also have been a factor in additional outbreaks [9].

   While it is not recommended to use the same needle and syringe to enter more than one medication vial because of the risks described above, there are circumstances where more than one vial may need to be entered with the same syringe and needle (e.g., when reconstituting medications or vaccines).  In these circumstances, aseptic technique must be followed and reconstitution should be performed in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed.

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