A recent alert sent by Children's Hospital of Pittsburgh of UPMC to some patients' families about a potential risk of infection from injections had come with a notice that the hospital is changing to a new injection procedure.

That change -- to provide fresh needles, syringes and tubing with every injection -- is a small part of a nationwide effort to prevent the spread of disease.

A hospital statement last week said its leadership had recently discovered that "a non-standard of care technique for Botox injection to correct spasticity has been in use in our ambulatory center." It explained that the technique used new sterile needles and tubing but would reuse "a common syringe for injection into more than one patient." The use of a common syringe has been stopped, the hospital said.

In 2007, the Centers for Disease Control and Prevention issued injection safety guidelines calling for all-new needles, tubing and syringes, following an investigation of four large outbreaks of hepatitis B and C virus.

The guidelines noted the investigation found "The primary breaches in infection control practice that contributed to these outbreaks were 1) reinsertion of used needles into a multiple-dose vial or solution container (e.g., saline bag) and 2) use of a single needle/syringe to administer intravenous medication to multiple patients."

The CDC cited a survey at that time that found that a small percentage (1 percent to 3 percent) of health care workers in the United States reused the same needle and/or syringe on multiple patients.

After the Children's Hospital matter became widely known, Allegheny County Health Director Bruce Dixon explained that the procedure at Children's -- in which an injection is made with a "butterfly" needle attached to catheter tubing, which taps into a syringe containing medication -- did not, in his opinion, risk spreading infection from patient to patient by using a previously used syringe.

The tubing, which he described as being 6 inches long or more, would prevent infectious viruses or other pathogens from passing from the injection site back into the syringe, Dr. Dixon said.

"The chances of getting contaminants back into the syringe is almost near zero," he said.

Marian Michaels, infectious disease specialist at Children's, said last week that the young patients involved were being treated for spasticity, a tightening of muscle, most often as a symptom of cerebral palsy. She added, "It can also be from other kinds of brain injury. Sometimes the muscles also become tight, the nerves and muscles don't work properly."

Dr. Michaels said that reusing a single syringe in more than one patient has been in practice "at least as far back as 2005." She said at least 250 Children's patients are potentially at risk of contracting a bloodborne illness from another patient from the practice.

"We're still examining how far back and how many patients," Dr. Michaels explained, adding that "the same syringe wouldn't have been used on more than two or three patients at the most, not 20."

She said habit may have contributed to the continuing practice.

"I think what happens sometimes these procedures are just done the same way again and again. It was a nurse who noticed and said, 'Can I throw this syringe away?' and someone said, 'No, no, it's such a precious commodity; we'll use it on the next patient.'

"It was really because a nurse picked up on this and asked is there any risk [in reusing syringes]," Dr. Michaels said. While the risk of infection is low, she explained, the hospital wants to take action wherever it can to make a difference.

The nurse's question brought the issue to people's attention, Dr. Michaels said. "It got to the leadership and to us in infectious diseases and infections control. It's a little risk but there is a risk and we can stop that procedure."

Efforts to promote the one needle, one syringe guidelines continue nationwide with the Safe Injection Practices Coalition, which includes patient advocacy organizations, foundations, provider associations and industry partners and the CDC.

The coalition on May 26 launched a 10-minute video for healthcare providers that demonstrates the procedure for safe injection practices.

"One infection due to unsafe injection practices is unacceptable," said Dr. Michael Bell, deputy director for infection control at CDC and narrator of the video. "Every health care provider has the responsibility to ensure that all injections given to patients are safe, and we hope that this video will help make that happen."

The video is part of the One & Only Campaign, a health education and awareness initiative developed by the coalition.

Children's Hospital concluded its statement last week with a commitment to follow the safe injection guidelines, ending its earlier injection method:

"The technique does not meet today's standards of infection control. We believe that any risk posed by this technique is very small and to our knowledge, there have been no infections resulting from its use. We have immediately changed this technique to ensure that there is zero risk to patients.

"We have thoroughly reviewed patient records, determined some patients may have been affected and have began contacting those families to offer screening and counseling. We regret this unfortunate situation and offer our apologies to the families impacted."

Dr. Dixon supported the hospital's followup, saying, "Children's is being proper in notifying people." He said standard practice is now replacing all three pieces -- needle, tubing and syringe -- for every patient.

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