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Many vaccines, including the current vaccines for COVID-19, come in small bottles with more than one dose inside.
These are known as multiple-dose, or “multi-dose” vials, and can be used to vaccinate more than one patient.
Multi-Dose Vials and Infection Control
Multi-dose vials are more likely to become contaminated compared to single-dose vials, and therefore require important injection safety actions.
“Multi-dose vials are more likely to get dirty because you’re putting a needle into that bottle many times to pull out each dose for each separate vaccine,” said Dr. Abigail Carlson, an infectious diseases physician with the Centers for Disease Control & Prevention (CDC), as part of CDC Project Firstline’s Inside Infection Control video series.
If the vial gets dirty, contaminated, or past the beyond-use date, it will have to be thrown away because it can harm patients.
“Don’t underestimate how big of a problem this can be, and how much we need to avoid it,” Dr. Carlson said.
For example, if a multi-dose vial is contaminated by a used needle or syringe and isn’t thrown away, every patient who gets an injection from that vial after the contamination occurs could get sick or die from diseases that spread this way, like hepatitis or HIV.
“Every year in the US, patients get contaminated medication or contaminated vaccines from multi-dose vials, and they can get sick and die,” Dr. Carlson said. “But it doesn’t have to happen – and that’s why [injection safety] steps are so important.”
If a contaminated multi-dose vial is used to administer vaccines, everyone who got a dose from that vial must be notified and tested to determine if they were infected.
If you suspect a multi-dose vial is contaminated, remove it from use immediately and notify public health authorities if anyone might have been exposed to contaminated contents.
Preparing and Safely Using Multi-Dose Vaccine Vials
Always prepare a multi-dose vial it in a space that is clean and away from patients. Preparing multi-dose vials in a separate space helps ensure they are handled correctly and decreases the chance for mistakes.
Do not bring the multi-dose vial into patient care spaces, as this increases the chance that someone might mistakenly put a used needle or syringe into the vial and contaminate it.
Using multi-dose vials safely begins with cleaning your hands.
Before touching any vials, clean your hands with alcohol-based hand sanitizer or soap and water. This keeps germs on your hands from getting onto the vial, especially the top area where the needle will enter.
Once your hands are clean, identify a multi-dose vial and check the label to make sure the vaccine is not expired or beyond its use date. If it is, do not use it.
“You don’t want to use a vaccine that has expired because it could be weaker than a non-expired vaccine,” Dr. Carlson said. “You don’t want to give a vaccine to patients that may not protect them.”
Also, check to see if the vaccine looks the way it’s supposed to look. You can check the instructions from the vaccine maker to find out what the vaccine is supposed to look like.
If the vaccine doesn’t look right or you are unsure, do not use it.
Remember, always use a brand-new, sterile needle and a brand-new, sterile syringe for every vaccine dose.
“If you are not sure if the needle or syringe has been used before, get a new one,” Dr. Carlson said.
Next, disinfect the top part of the vial, where you will stick the needle in, by rubbing it with a sterile alcohol prep pad and letting it dry.
This step kills any bacteria, funguses, and viruses on the top of the vial, so the needle won’t push them into the vial when you insert it.
The first time you “access the vial,” or stick a needle into the vial, write the time and date on the label.
“One you access the vial, the clock starts running, and you only have a certain amount of time to use that vaccine on other patients,” Dr. Carlson said.
If you get to the end of the vial and there is an extra full dose of vaccine left in it, you can use that dose on another patient if you are still within the time that it can be used.
However, if there is some vaccine left, but not enough for a full dose, throw the vial away. Never “pool” or mix vaccines from different vials to try to make one full dose, because it increases the risk of vaccine contamination and patients can get sick.
Finally, follow the vaccine maker’s instructions for how to store vaccine.
What Can You Do to Promote Infection Control in Your Healthcare Setting?
Access more information about infection prevention and control in healthcare by visiting resources from CDC Project Firstline.
Project Firstline creates resources, including videos and shareable images, web buttons, posters, and print materials. They also have facilitator toolkits to help workers lead trainings even if they are not an infection control expert.
Salud America! at UT Health San Antonio is working with the National Hispanic Medical Association to bring Project Firstline infection control educational content to healthcare workers, so they are equipped with the knowledge they need to protect themselves, their facilities, and their patients (Latinos and all communities) from infectious disease threats in healthcare settings.
You can read these articles:
- What is Project Firstline?
- What’s a Virus?
- How Does Infection Control Work on COVID-19 Variants Like Omicron?
- Contact Time: What is It and How Does it Impact Infection Control?
- The Surprising Difference Between Cleaning and Disinfection
- What’s a Respiratory Droplet and Why Does It Matter?
- Why Do Cleaning and Disinfection Matter in Healthcare?
- We Need to Talk about Hand Hygiene Again
- What is the Goal of Infection Prevention and Control in Healthcare Settings?
- The Intersection of Infection Prevention and Control and Healthcare Equity
“Healthcare teams in hospitals, nursing homes, and other care settings are the front lines against the spread of infection,” said Dr. Amelie G. Ramirez, director of Salud America! at UT Health San Antonio. “CDC’s Project Firstline is bolstering those efforts by developing evidence-based tools that can be delivered in a variety of ways to make infection control learning convenient and accessible for busy healthcare staff.”
Editor’s Note: This article is part of a collaboration between Salud America!, the National Hispanic Medical Association, and the CDC’s Project Firstline. To find resources training materials, and other tools to bolster knowledge and practice of infection control, visit Project Firstline and view Salud America!’s infection control content.