1. 2011;14;425-434Infection Control Practices (Safe Injection and Medication Vial Utilization) for Interventional Techniques: Are They Based on Relative Risk Management or Evidence?
   Prospective Evaluation
   Bert Fellows, MA, Bradley W. Wargo, DO, Yogesh Malla, MD, and Laxmaiah Manchikanti, MD.

BACKGROUND: Recently, multiple regulations and recommendations for safe infection control practices and safe injection and medication vial utilization have been implemented. These include single dose and multi-dose vials for a single patient and regulations. It is a well known fact that transmission of bloodborne pathogens during health care procedures continues to occur because of the use of unsafe and improper injection, infusion, and medication administration. Multiple case reports have been published illustrating the occurrence of infections in interventional pain management and other minor techniques because of lack of safe injection practices, and noncompliance with other precautions. However, there are no studies or case reports illustrating the transmission of infection due to the use of single dose vials in multiple patients when appropriate precautions are observed. Similarly, the preparation standards for simple procedures such as medial branch blocks or transforaminal epidurals have not been proven to be essential. Further, the effectiveness or necessity of surgical face masks and hats, etc., for interventional techniques has not been proven.

OBJECTIVE: To assess the rates of infection in patients undergoing interventional techniques.

STUDY DESIGN: A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009.

STUDY SETTING: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.

METHODS: All patients presenting for interventional techniques from May 2008 to December 2009 are included with documentation of various complications related to interventional techniques including infection.

RESULTS: May 2008 to December 2009 a total of 3,179 patients underwent 12,000 encounters with 18,472 procedures.

A total of 12 patients reported suspicion of infection. All of them were evaluated by a physician and only one of them was a superficial infection due to the patient’s poor hygienic practices which required no antibiotic therapy.

LIMITATIONS: Limitations include the nonrandomized observational nature of the study.

CONCLUSION: There were no infections of any significance noted in approximately 3,200 patients with over 18,000 procedures performed during a 20-month period in an ambulatory surgery center utilizing simple precautions for clean procedures with the use of single dose vials for multiple patients and using safe injection practices.