Multi-dose vials come under scrutiny

Doctors say many local healthcare institutions have been cutting down on the use of multi-dose vials, even before the hepatitis C outbreak at the Singapore General Hospital (SGH) was revealed.

This is because of the risk of infection that arises from using such vials, said infectious disease specialist Leong Hoe Nam of the Rophi Clinic at Mount Elizabeth Novena Hospital.

Typically, these small glass or plastic bottles hold several doses of liquid medication that can be shared by two or three patients .

A brand-new needle and syringe are usually used to extract the contents for each patient, so as to avoid contamination. The rubber stopper on top of each vial is usually also disinfected with an alcohol solution before use.

The vials have recently come under scrutiny as a possible source of the hepatitis C viral outbreak in a renal ward at SGH, where 22 kidney patients were diagnosed with the disease. Eight of them have since died, with four deaths possibly linked to hepatitis C.

Over the past decade, said Dr Leong, doctors have been using more single-dose vials instead, containing smaller quantities of medication. Otherwise, they use multi-dose vials kept for the same patient.

"Both single-dose and multi-dose injection medication vials are used in our public hospitals," said the Health Ministry in a statement on Wednesday night.

"Our public hospitals utilise multi-dose vials where the preparation is specifically formulated for such use, and governed by safety protocols."

Dr Ben Ng, a senior consultant at Arden Endocrinology Specialist Clinic, maintains that if the guidelines are followed, the risk of contamination is low.

He added that hospitals are likely to use them out of cost and practicality concerns.

"Cost is by far the biggest issue," said Dr Ng. "From a practical standpoint, these vials are useful to patient care as there is a huge variation in the dose needed by different people in certain illnesses such as diabetes."

According to a 2008 report by the United States Centres for Disease Control and Prevention, some 40,000 patients at an endoscopy clinic were potentially exposed to the hepatitis C virus. This was likely the result of reusing syringes and medication vials intended for one-time use.

Some hospitals are taking no chances. Dr Kelvin Loh, senior vice- president of Parkway Hospitals Singapore, said the group has "stringent clinical guidelines in place" that follow globally accepted standards.

"These include safe processes for the use of multi-dose vials," said Dr Loh, who oversees hospitals in the Parkway group such as Gleneagles and Mount Elizabeth. "Nevertheless, we have rechecked the integrity of our processes and continue to remain vigilant."

This article was first published on October 9, 2015. Get a copy of The Straits Times or go to for more stories.