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Diseases & Topics

Injection Safety

Since 2008, more than 116,000 patients in the United States have been notified of potential exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), due to lapses in basic infection control practices. Many of these lapses involved healthcare providers reusing syringes, resulting in contamination of medication vials or containers that were then used on subsequent patients. Over the past nine years, 61 outbreaks of viral hepatitis related to healthcare in the United States were reported to CDC. The majority of these outbreaks (95%) occurred in non-hospital settings. Four of these outbreaks have occurred in North Carolina. (See the CDC article, Healthcare-Associated Hepatitis B and C Outbreaks (≥ 2 cases) Reported to the Centers for Disease Control and Prevention (CDC) 2008-2017). External link

SHARPPS Program! Formerly known as the HAI Program, the Surveillance of Healthcare-Associated Infections and Resistant Pathogens Patient Safety (SHARPPS) Program is the new name chosen to better reflect the broader scope of work conducted on a daily basis.  The SHARPPS Program conducts surveillance, provides guidance, education, and training, and assists with outbreak investigations relevant in all types of healthcare settings. 

.0206 What Physicians Must Know

NC Rule .0206 requires all healthcare organizations that perform invasive procedures to have a designated, trained employee to direct infection control policies and attend a state-approved course on infection control. Dr. Zack Moore, State Epidemiologist, recently participated in a video discussing the importance of NC Rule .0206. View the video to learn more on this state law.

Drug Diversion: Potential for Disease Transmission

Drug diversion is the act of illegally obtaining prescription medications by a healthcare worker for his or her own use. This can result in several types of patient harm, including:

  • Substandard care delivered by an impaired healthcare provider,
  • Denial of essential pain medication or therapy, or
  • Risk of infection (e.g., with hepatitis C virus or bacterial pathogens) if a provider tampers with injectable drugs

Diversion involving injectable medications or injection equipment has been linked to multiple outbreaks of bacterial and viral infections nationwide, including six outbreaks between 2004 and 2014 that collectively resulted in more than 100 infections and 30,000 potential exposures. DPH has formed partnerships with professional licensing boards, local and state law enforcement, DEA and others to combat this growing problem and protect the citizens of North Carolina.

Learn more about drug diversion on the CDC website.

View the memo from the North Carolina Division of Public Health regarding Drug Diversion by healthcare workers.

One Needle, One Syringe, Only One Time. Safe Injection Practices Coalition.

To prevent outbreaks associated with unsafe injections, the N.C. Division of Public Health has partnered with the CDC and the Safe Injection Practices Coalition (SIPC) to raise awareness about safe injection practices through the One & Only Campaign. External link The One & Only Campaign is an educational effort targeting patients and healthcare providers with the message of One Needle, One Syringe, Only One Time – for each and every injection.

Healthcare providers: Safe injection practices are not optional. Injection safety is part of Standard Precautions, evidence-based infection prevention practices that apply to all patients in any setting in which healthcare is delivered, even home-based care. These practices should be the same for all patients, regardless of suspected or confirmed infection status.

Doctors, nurses, other healthcare providers and anyone providing injections should never reuse a needle or syringe from one patient to another or to withdraw medication from a vial. Both needle and syringe are single-use devices and must be discarded once they have been used. Reusing syringes or medication vials, even if the needle is changed, can transmit disease.

All healthcare providers are urged to carefully review their injection practices, and those of their staff, to ensure proper procedures are being followed. Resources for providers are available on the One & Only Campaign External link website and the CDC Injection Safety External link website.

Patients: Patients need to be aware that unsafe injection practices can be a serious threat to their health. Healthcare providers should never reuse a needle or syringe from one patient to another or to withdraw medication from a vial.

The One & Only Campaign External link website has materials and resources to help you begin conversations with your providers about what steps they are taking to keep you safe.

Injection Safety Concerns for Diabetics: Blood glucose testing and insulin administration can also expose people to bloodborne viruses when supplies are shared between people. Healthcare providers and patients should know these three simple rules for safe diabetes care:

  1. Fingerstick devices should never be used for more than one person.
  2. Glucometers should be assigned to a single person and not be shared whenever possible. If they must be shared, they should be cleaned and disinfected after every use, per manufacturer's instructions, to prevent carry-over of blood and infectious agents.
  3. Insulin pens should be assigned to only one person and labeled appropriately. They should never be used for more than one person, even when the needle is changed.

More information about safe diabetes care can be found on the CDC External link website.


  • Injection Safety webinar: Presented by Dr. Zack Moore, State Epidemiologist. Provided by Duke University Health System Department of Clinical Education and Professional Development. Continuing education available for physicians.

For Additional Information