Multi-dose vials contain preservatives to inhibit the growth
of microorganisms and must meet certain standards formulated
by the United States Pharmacopoeia to ensure that the
preservatives remain effective for the shelf life of the
product. Additionally, multidose vials are sized based upon
the anticipated number of punctures and potential for
contamination of the contents.
Studies have shown that bacterial contamination of used
multidose vials, even those tested beyond their label shelf
life is zero to negligible (Christensen et al., 1992; Melnyk
et al., 1993; Moi & Thronton, 1991).
While there may be safeguards in place to inhibit the growth
of bacteria cross contamination in the form of blood borne
pathogens between patients can occur due to improper
technique. Research has shown that HIV and Hepatitis B and C
could be transmitted from a contaminated multidose vial (Arrington
et al., 1990; CDC, 1993; Druce et al., 1995; Plott et al.,
Another consideration in the shelf life of a substance in a
multidose vial is the effect of air upon the chemicals.
Epinephrine is degraded by exposure to oxygen therefore
manufacturers recommend that solutions containing epinephrine
be used 'as soon as possible.'
Therefore the following will occur in this organization:
1. Only one vial of a particular medication will be open
at one time in each exam room and procedure room
2. Solutions will be examined prior to use and discarded
if any visible changes such as discoloration or
particulate matter are noted.
3. The stopper will be cleaned with 70% alcohol before
any device (eg. needle or spike) is inserted into the
vial. Avoid touching the stopper during the
4. MOST IMPORTANTLY, only sterile syringes and needles
will be utilized to draw up medications
from multidose vials.
5. When the vial is opened it is dated with an
expiration date. The date of expiration is 28 days
after the opening of the medication.
Approved By Governing Board