"Injection Safety Checklist"

Injection Safety Checklist is a 1-page legal document that was released by the U.S. Department of Health and Human Services - Centers for Disease Control and Prevention and used nation-wide.

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INJECTION SAFETY
CHECKLIST
The following Injection Safety checklist items are a subset of items that can be found in the CDC Infection Prevention Checklist for
Outpatient Settings: Minimum Expectations for Safe Care.
The checklist, which is appropriate for both inpatient and outpatient settings, should be used to systematically assess adherence
of healthcare providers to safe injection practices. Assessment of adherence should be conducted by direct observation of
healthcare personnel during the performance of their duties.
Practice
If answer is No, document plan
Injection Safety
Performed?
for remediation
Proper hand hygiene, using alcohol-based hand rub or
Yes No
soap and water, is performed prior to preparing and
administering medications.
Injections are prepared using aseptic technique in a clean
Yes No
area free from contamination or contact with blood, body
fluids, or contaminated equipment.
Needles and syringes are used for only one patient (this
Yes No
includes manufactured prefilled syringes and cartridge
devices such as insulin pens).
The rubber septum on a medication vial is disinfected
Yes No
with alcohol prior to piercing.
Medication vials are entered with a new needle and a
Yes No
new syringe, even when obtaining additional doses for
the same patient.
Single-dose or single-use medication vials, ampules, and
Yes No
bags or bottles of intravenous solution are used for only
one patient.
Medication administration tubing and connectors are
Yes No
used for only one patient.
Multi-dose vials are dated by healthcare when they are
first opened and discarded within 28 days unless the
manufacturer specifies a different (shorter or longer) date
Yes No
for that opened vial.
Note: This is different from the expiration date printed on the vial.
Multi-dose vials are dedicated to individual patients
Yes No
whenever possible.
Multi-dose vials to be used for more than one patient are
kept in a centralized medication area and do not enter
the immediate patient treatment area (e.g., operating
Yes No
room, patient room/cubicle).
Note: If multi-dose vials enter the immediate patient treatment
area, they should be dedicated for single-patient use and
discarded immediately after use.
The One & Only Campaign is a public health effort to eliminate
For the latest news and updates,
follow us on Twitter @injectionsafety
unsafe medical injections. To learn more about safe injection
and Facebook/OneandOnlyCampaign.
practices, please visit OneandOnlyCampaign.org.
This material was developed by CDC. The One & Only Campaign is made possible by a partnership between the CDC Foundation and Lilly USA, LLC.
INJECTION SAFETY
CHECKLIST
The following Injection Safety checklist items are a subset of items that can be found in the CDC Infection Prevention Checklist for
Outpatient Settings: Minimum Expectations for Safe Care.
The checklist, which is appropriate for both inpatient and outpatient settings, should be used to systematically assess adherence
of healthcare providers to safe injection practices. Assessment of adherence should be conducted by direct observation of
healthcare personnel during the performance of their duties.
Practice
If answer is No, document plan
Injection Safety
Performed?
for remediation
Proper hand hygiene, using alcohol-based hand rub or
Yes No
soap and water, is performed prior to preparing and
administering medications.
Injections are prepared using aseptic technique in a clean
Yes No
area free from contamination or contact with blood, body
fluids, or contaminated equipment.
Needles and syringes are used for only one patient (this
Yes No
includes manufactured prefilled syringes and cartridge
devices such as insulin pens).
The rubber septum on a medication vial is disinfected
Yes No
with alcohol prior to piercing.
Medication vials are entered with a new needle and a
Yes No
new syringe, even when obtaining additional doses for
the same patient.
Single-dose or single-use medication vials, ampules, and
Yes No
bags or bottles of intravenous solution are used for only
one patient.
Medication administration tubing and connectors are
Yes No
used for only one patient.
Multi-dose vials are dated by healthcare when they are
first opened and discarded within 28 days unless the
manufacturer specifies a different (shorter or longer) date
Yes No
for that opened vial.
Note: This is different from the expiration date printed on the vial.
Multi-dose vials are dedicated to individual patients
Yes No
whenever possible.
Multi-dose vials to be used for more than one patient are
kept in a centralized medication area and do not enter
the immediate patient treatment area (e.g., operating
Yes No
room, patient room/cubicle).
Note: If multi-dose vials enter the immediate patient treatment
area, they should be dedicated for single-patient use and
discarded immediately after use.
The One & Only Campaign is a public health effort to eliminate
For the latest news and updates,
follow us on Twitter @injectionsafety
unsafe medical injections. To learn more about safe injection
and Facebook/OneandOnlyCampaign.
practices, please visit OneandOnlyCampaign.org.
This material was developed by CDC. The One & Only Campaign is made possible by a partnership between the CDC Foundation and Lilly USA, LLC.