Multi-Dose Vials

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
       withdrawal process.  
    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    
Control #296.5