Accepted answer
42 days is 1.5 times the twenty-eight days conventionally allowed for a preserved multi-dose vial once it has been entered. That convention assumes a preservative. Sterile water for injection has none, which makes it a single-entry preparation — its clock runs in hours after piercing, and 42 days is 1008 of them. So the twenty-eight-day arithmetic never applied, and 1.5 times a figure that was never yours is not a reassurance. Growth at the densities that matter is not visible, so inspection is not the check people take it for. Date the vial at first entry and mark the punctures on the label; both cost nothing and both are the evidence you will want later.
Bacteriostatic water is water for injection containing roughly 0.9 per cent benzyl alcohol as a preservative, and its purpose is to suppress microbial growth in a vial opened repeatedly.
Opened vials accumulate bioburden with every pierce, and benzyl alcohol suppresses the growth of the organisms that get in but does not prevent them getting in.
On the detail: a vial that has been sitting out at room temperature is not sterile and bacteriostatic water does not make it so.
Benzyl alcohol efficacy in suppressing common skin and environmental bacteria is well-established and published.
Worth noting that some people have reactions to benzyl alcohol, which is worth knowing if you are going to inject.
The practical summary: use bacteriostatic water for multi-withdrawal, store refrigerated, and respect the 28-day limit.
edited 6 Jan 2025 by micron22 — clarified the distinction between purity and content