During medication preparation, there are MULTIPLE STEPS THAT CAN BE PRONE TO ERROR or CAUSE CONTAMINATION OF THE VIAL OR SYRINGE. Such examples include:

1 medication TRAY OR CART/TROLLEY have MORE THAN ONE INJECTION for different patients; 2 health care worker PICK UP WRONG SYRINGE OR MEDICATION VIAL for a patient if it is mislabeled or not labelled at all; 3 if injections NOT PREPARED WITH GOOD STERILE TECHNIQUE (for example they can become contaminated from a dirty environment, like the medication tray); 4 COTTON BALLS used for disinfecting should not be PRESOAKED; nor should presoaked cotton balls or swabs be stored in containers.