5.5 Single-use equipment and preventing contamination of medication:

5.5.1 Single use equipment: 

The reuse of disposable (single-use) equipment is not recommended. There are insufficient data on the safety of this practice for anesthesia equipment. Quality assurance programs and policies need to be formulated by departments that reuse disposable equipment to ensure that disinfection/sterilization is adequate and that the function and integrity of the product are not compromised.

Reuse of most disposable equipment will require sterilization or disinfection of the items. The chemical disinfection or sterilization processes may damage or weaken the integrity of the single-use (disposable) item making it unsafe to reuse. Reuse of disposable devices shifts all responsibility (and liability) from the original manufacturer to the individual user. Although there is some evidence that certain disposable medical devices may be reused safely after disinfection or sterilization, there are insufficient data on disposable anesthesia equipment. 

5.5.2 Preventing contamination of medication: 

Safe handling of parenteral medications is required to prevent nosocomial infections in patients undergoing anesthesia or sedation. While contamination of medications or fluids can occur from extrinsic or intrinsic sources, some preparations are more likely to support the growth of microorganisms. 

• Preservative-free ampoules, vials and prefilled syringes are single-patient, single-dose items. The labels of all rubber-stopped vials should be checked for the presence of preservative agents because some vials are single-dose preparations. 
• The ampoule, vial or prefilled syringe should be opened at the time of use. 
• Use aseptic technique, including use of an alcohol swab or appropriate disinfectant, to cleanse the vial's rubber septum before entering. 
• Cleanse the neck of glass ampoules with an alcohol swab and let dry before opening. 
• Sterile needles and syringes should always be used to aspirate the contents of an ampoule or vial. 
• Single-use ampoules and vials should be discarded after the contents have been drawn up, and the prefilled syringe should be discarded after use is completed. 

5.5.2.3 Use of syringes 

• Syringes and needles are sterile, single-patient use items. 
• Medications from a syringe must not be administered to multiple patients even if the needle on the syringe is changed. 
• After entry into or connection with a patient's intravenous (IV) infusion, the syringe and needle should be considered contaminated and used only for that patient. 
• After use or at the latest, at the end of each patient's anesthetic, all used syringes and needles should be discarded immediately in an appropriate puncture-resistant container. 
• Unused syringes, needles and related items should be stored in a clean area to avoid contamination by contaminated syringes and equipment. 

5.5.2.4 Use of multi dose vials 

• If aseptic technique is used consistently, an uncontaminated multidose vial may be used until the manufacturer's expiration date. 
• If suspected or visible contamination has occurred or if sterility is questionable, the vial should be discarded. 
• Each time a multidose vial is entered; aseptic technique should be used, including cleansing the rubber stopper with alcohol and using a sterile needle and syringe. 

5.5.2.5 Use of infusions 

• All infusions (fluids and containers) and administration sets (IV tubings and connections) are single-patient use. 
• Aseptic technique should be used when preparing IV infusion and administration sets, and entry into or breaks in the tubing should be minimized. 
• Check all containers of parenteral fluids for visible turbidity, leaks, cracks, particulate matter and the manufacturer's expiration date before use. Use single-dose vials for parenteral additives or medications whenever possible. 
• Stopcocks, injection ports and other portals of access to sterile fluids should be maintained with sterile technique. Stopcocks should be kept free of blood and covered by a sterile cap or syringe when not in use. IV injection ports should be cleaned with an appropriate disinfectant prior to entry.