Assessment of Infection Control Practices for
Interventional Techniques: A Best Evidence
Synthesis of Safe Injection Practices and Use of
Single-Dose Medication Vials
Authors: Manchikanti Laxmaiah 
Published: March 2021

Background: It is universally accepted 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 practices by health care professionals in various clinical settings. This
resulted in development of multiple guidelines based on case reports; however, these case reports
are confounded by multiple factors without causal relationship to a single factor. Even then, singledose vials used for multiple patients have been singled out and became the focus of infection control
policies resulting in inordinate expenses for practices without improving patient safety. The cost of
implementation of single dose vial policy in Interventional Pain Management for drugs alone may cost
$750 million, whereas with single use radional gloves may exceed $1 billion per year.
Study Design: Best evidence synthesis.
Objective: To critically appraise and synthesize the literature on infection control practices for
interventional techniques, including safe injection and medication vial utilization.
Methods: The available literature on infection control practices was reviewed. Due to the nature of
the studies involved, with the majority being case reports, and a few prospective evaluations, quality
assessment and clinical relevance criteria were not applied.
Data sources included relevant literature identified through searches of PubMed and EMBASE from
1966 through June 2012, literature from the Centers for Disease Control and Prevention (CDC),
the U.S. Food and Drug Administration (FDA), and manual searches of the bibliographies of known
primary and review articles.
Outcome Measures: The primary outcome measure was correlating infection to a breach of
standards in infection control practices. The secondary objective was to assess the contribution of
single-dose vials independently for infection.
Results: A total of 60 reports met inclusion criteria, with 16 reports related to pain management and
other procedures, of which 9 reports were attributed to issues related to interventional techniques.
Based on an estimated 37 infections occurring during 200 million interventional techniques from 1997
through 2011, the rate of infection is speculated to be one infection for every 5 million interventional
pain management procedures. However, if 10 times more infections are estimated, the infection rate
appears to be one infection for every 500,000 interventional pain management procedures.
The evidence is good for infection related to a breach of infection control practices. There is good
evidence that contamination of multi-dose or single-dose vials can contribute to infection.
There was poor evidence that the use of single-dose vials on multiple patients with appropriate
infection control practices cause infection in interventional pain management.
Limitations: The limitations of this comprehensive best evidence synthesis include the paucity of
literature and dependence of governmental agencies on their literature without applying Institute of
Medicine (IOM) criteria for guideline synthesis