Single-Use Vials: Are They Really One-Time Only Use?

If you use injectable estrogen or testosterone, we’re pretty sure that you’ve run into the single-use vial dilemma.

The FDA says a vial can only be used once.

The pharmacy says a vial can only be used once.

But, damn, meds can be expensive and hard to get, and why would we want to contribute to non-recyclable waste more than is necessary, anyway? (Aside – have you seen how people are upcycling vials into earrings and other jewelry? FUN!)

Can you use that single-use vial for more than one injection? Is it safe?

The main risk of reusing a vial is contamination of the product. A contaminated product can increase your risk of infection or injecting an unwanted substance, which can cause other problems and infections. However, this risk can be minimized with sterile technique and the use of preservatives.

Historically, hormones have been available in 1mL, 5 mL, or 10 mL vials.

The 1 mL vials often did not have any preservative in the solution, so they were only approved for one-time use. Larger vials contained preservatives, so could be used for more than one dose.

Many 1 mL vials now come with preservatives and you may now be told to use a vial more than once!

The first rules of infection and contamination control are security of the seal and keeping sterile products sterile and disinfected surfaces disinfected.

As soon as anything breaks the seal of the stopper, the risk of unwanted materials (whether other chemicals or infection risks like bacteria) contaminating the vial increases, and those risks increase each time the seal is punctured. Thinner or more brittle stoppers may become increasingly damaged with multiple punctures, and the rubber might no longer be able to protect the contents of the vial from contamination.

Vocab!

Sterile – the material is free from bacteria or other microorganisms.

Clean – the material is free from surface dirt, dust, or impurities. Clean is not necessarily sterile.

Disinfected – the material has been cleaned, usually with a chemical, to kill any bacteria on the surface. Disinfected might not be sterile.

But, how does this play out in actual use?

Clinical experience and community knowledge tells us that using good technique when prepping and doing your injections and good storage practices lower contamination risks. We can’t say that you’re safe from infection if you practice good technique. We do encourage you to speak to your prescriber about your risks and benefits.

IMPORTANT NOTE: vials with preservatives are intended to be thrown out 28 days after first use.

Check the label!

A vial marked single-use only may have preservatives. Check the label and ingredients (see examples below):

Each mL contains:

testosterone cypionate, 200 mg. Also contains benzyl benzoate, 0.2 mL; benzyl alcohol added as preservative, 9.45 mg; in cottonseed oil, 560 mg.

Note: compounded injectables might not have preservatives. Check with your compounding pharmacy!

So let’s talk about good sterile technique!

Resources on how to inject:

• Our self-injection handout.
• Dr. Kevin Hatfield’s injection video.
• Tips For Less Painful Injections
• Fenway Health’s Self-Injection Guide.
• Getting Nerdy About It: WHO Best Practices for Injections and Related Procedures Toolkit – Best Practices for Injections

The most important points are:

• Clean surfaces and disinfect injection surfaces (vial stopper, your injection site.)
• Wash your hands.
• Don’t let the needle or the rubber stopper of the vial touch contaminated surfaces.
• Don’t re-use needles.

In More Detail

1. Make sure your space is clean. A quick tip is to lay a paper towel (inside surface up) on the available surface then put your supplies on the towel.
2. Gather your supplies and inspect them for damage and expiration dates.
   • If anything is damaged, replace with new ones.
   • Alcohol pads – 2 of ’em! Or fresh and clean cotton balls and 60% – 70% isopropyl alcohol.
   • Your vial of hormones
   • Syringe, drawing needle, and injecting needle (don’t open yet!)
     • We like18 – 21 gauge needles for drawing and 23 – 25 gauge needles for injecting (if they’re in individual packaging, you can remove them from the packaging, but don’t take the caps off the needles yet.)
   • Bandage
   • Sharps container
3. Before you open anything, wash your hands well.
   • soap and water, rub rub rub for 30 seconds, rinse, dry off with paper towel, turn off the water with a towel instead of your hands.
4. Once your hands are washed, open your supplies, but don’t uncap your needles yet.
5. Wipe the rubber stopper of your vial with one of the alcohol swabs and let it air dry.
6. Uncap the drawing needle and draw your injection, then remove the drawing needle and replace it with your capped injection needle. Place the drawing needle in your sharps container.
7. Swab the skin where you’re going to inject with the second alcohol swab and let air dry.
8. Uncap the injection needle and proceed with your injection. Do not let the needle touch anything between uncapping and the injection itself. Recap the needle after your injection.
9. Extra points contamination control:
   • After your injection, wipe the injection spot again with the alcohol swab, then apply your bandaid if needed.
   • Wipe the top of your vial with alcohol again.
10. Dispose of everything (needles into sharps!)
11. Wash your hands again.

Storage Tips For Single-Use and Multi-Use Vials:

• Keep at room temperature (between 68°F and 77°F or between 20°C and 25°C.)
• Keep vial away from light.

Other Resources and Studies on Single-Use and Multiple-Use Vials

CDC Safe Injection Practices

1. Baniasadi S, Dorudinia A, Mobarhan M, Karimi Gamishan M, Fahimi F. Microbial contamination of single- and multiple-dose vials after opening in a pulmonary teaching hospital. Braz J Infect Dis. 2013 Jan-Feb;17(1):69-73. doi: 10.1016/j.bjid.2012.09.005. Epub 2013 Jan 5. PMID: 23294643; PMCID: PMC9427349.
2. Tabor A, Shalemariam Z, Alemu Y, Gorems K. Bacterial contamination of single and multiple-dose parenteral injection vials after opening and antibiotic susceptibility of isolates at Jimma Medical Center, Jimma, Southwest Ethiopia. Infect Prev Pract. 2023 Jun 10;5(3):100290. doi: 10.1016/j.infpip.2023.100290. PMID: 37457638; PMCID: PMC10339008.
3. Ripoll Gallardo A, Meneghetti G, Ragazzoni L, Kroumova V, Ferrante D, Ingrassia PL, Ruzza P, Dell’Era A, Boniolo E, Koraqe G, Faggiano F, Della Corte F. Multiple withdrawals from single-use vials: a study on sterility. Int J Pharm. 2015 May 15;485(1-2):160-3. doi: 10.1016/j.ijpharm.2015.03.010. Epub 2015 Mar 9. PMID: 25769293.
4. McGoldrick M. Infection prevention: single- and multidose vial management. Home Healthc Now. 2015 Mar;33(3):171-2. doi: 10.1097/NHH.0000000000000206. PMID: 25738277.

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