Anaesthetic drug administration as a potential contributor to healthcare-associated infections: a prospective simulation-based evaluation of aseptic techniques in the administration of anaesthetic drugs

Gargiulo, Derryn; Sheridan, Janie; Webster, Craig; Swift, Simon; Torrie, Jane; Weller, Jennifer; Henderson, Kaylene; Hannam, Jacqueline A.; Merry, Alan

doi:10.1136/bmjqs-2012-000814

Cited by 26 publications

(35 citation statements)

References 54 publications

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“…In this study, the incidence of drug contamination was 2.8%, which was within the range of other reported studies (5,6,9,(12)(13)(14). However, Driver et al (2) and Wagner et al (4) studied the sterility of the anaesthetic and resuscitative drug syringes used in obstetric operating rooms and found no organisms in any syringe.…”

Section: Discussionsupporting

confidence: 84%

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Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres

Rueangchira-urai¹,

Rujirojindakul²,

Geater³

et al. 2017

Turk J Anaesth Reanim

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Objective: The aim of this study was to determine the incidence of bacterial and fungal contamination in anaesthetic and vasopressor drugs before and after use in operating theatres. Methods:A cross-sectional study was conducted in the operating theatres of a university hospital. We collected 945 samples of three different drugs, namely, propofol, vecuronium and ephedrine, from 20 operating rooms and refrigerators where the unused drugs were stored. Each drug was divided into two groups, the pre-use group and the post-use group. The pre-use drugs were cultured before the patient received the drug. The post-use drugs were cultured after the patient had received the drug or after the drugs had been transferred to other syringes. The culture results were reported as either positive or negative.Results: Out of the 945 drug samples, 26 (2.8%, 95% confidence interval=1.8%-4.0%) gave a positive culture. Of the 317 propofol samples, 20 (6.3%) were found to have bacterial contamination, 11 in the pre-use group and 9 in the post-use group. Of the 318 ephedrine samples, 6 (1.9%) were found to be positive on culture, one in the pre-use group and five in the post-use group. Vecuronium gave no positive cultures. All organisms were non-pathogenic, and no fungal contamination was found. Conclusion:The incidence of bacterial contamination in anaesthetic and vasopressor drugs was 2.8%. Anaesthetic teams must be aware of contamination issues in anaesthetic drugs that have been prepared for later use and, in order to reduce the risk of contamination, they must improve the methods of administering drugs to patients.Keywords: Anaesthetic drug, contamination, operating room, sterility Abstract Address for Correspondences: Panthila Rujirojindakul

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Section: Discussionsupporting

confidence: 84%

“…Most of these studies were conducted in laboratory settings (6)(7)(8), and not in real operating room conditions (2,4,9), i.e. analysing drugs stored in syringes (2,4,5,10) or in multidose vials (3,11).…”

Section: Introductionmentioning

confidence: 99%

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres

Rueangchira-urai¹,

Rujirojindakul²,

Geater³

et al. 2017

Turk J Anaesth Reanim

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“…The remaining studies (n=6) had been conducted among various healthcare professionals or not conducted among personnel at all 12 18 19 20 24 26. These 12 key studies had been carried out in different environments: 8 of the studies were conducted in clinical10 11 12 16 19 21 24 30 and 1 in pharmaceutical20 environments. Two of the studies compared clinical and pharmaceutical environments 26 27.…”

Section: Resultsmentioning

confidence: 99%

“…The most common of these incorrect practices were: incorrect aseptic techniques (five studies);10 19 27 29 30 multiple use of syringes (one study),12 phials and ampoules (two studies)16 19 and environmental aspects (one study) 26…”

Section: Resultsmentioning

confidence: 99%

Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

et al. 2016

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Objective Many patient deaths have been reported because of administration of contaminated intravenous medicines due to incorrect aseptic techniques. Our aim was to review the literature for (1) incorrect practices in aseptic drug preparation and administration and (2) recommendations for safer practices in hospitals. Methods A systematic literature search was conducted in PubMed covering [2007][2008][2009][2010][2011][2012][2013][2014][2015]. Studies were included if they concerned aseptic medicine preparation and administration in hospitals by different healthcare professionals, assessed incorrect practices and made recommendations for safer aseptic preparation and administration.Results 26 studies were included of which 19 were original articles. 12 of the studies concerned description of incorrect practices that led to contamination. The studies reported 11 incorrect practices that increased the risk of contamination of parenteral medicines. The most reported incorrect practices were multiple use of phials and syringes (2/12 studies) and lack of overall disinfection during the aseptic preparation and administration (3/12 studies). 22 practices were recommended to avoid contamination, which were classified into six categories: equipment and medicines (7); disinfection (6); working environment (3); storing (3); catheter care (2) and quality of prepared medicines (1). The results indicate that pharmacists prepared syringes with less contamination than nurses because of the pharmacist's aseptic skills and environmental aspects in pharmacy units. Conclusions The review discusses many appropriate and enhanced practices in aseptic drug preparation and administration. As the change for the better in contamination rates of administered medicines seems to be challenging to achieve in hospitals, better and possibly international procedures for safe parenteral practices need to be developed.

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“…Despite aseptic training of clinicians, there remains the risk of microbial contamination [41]. Therefore, we propose that citric acid solutions should be aseptically prepared in single-use syringes either by hospitals with aseptic compounding capabilities or commercial compounding companies.…”

Section: Discussionmentioning

confidence: 98%

An Investigation into the Stability and Sterility of Citric Acid Solutions Used for Cough Reflex Testing

Falconer

Lau

et al. 2014

Dysphagia

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Citric acid is used in cough reflex testing in clinical and research settings to assess reflexive cough in patients at risk of swallowing disorders. To address a lack of knowledge in this area, this study investigated the stability and sterility of citric acid solutions. Triplicate solutions of citric acid (0.8 M) in isotonic saline were stored at 4 ± 2 °C for up to 28 days and analysed by high-performance liquid chromatography. Microbiological sterility of freshly prepared samples and bulk samples previously used for 2 weeks within the hospital was determined using a pour plate technique. Microbial survival in citric acid was determined by inoculating Staphylococcus aureus, Escherichia coli, or Candida albicans into citric acid solution and monitoring the number of colony-forming units/mL over 40 min. Citric acid solutions remained stable at 4 °C for 28 days (98.4 ± 1.8 % remained). The freshly prepared and clinical samples tested were sterile. However, viability studies revealed that citric acid solution allows for the survival of C. albicans but not for S. aureus or E. coli. The microbial survival study showed that citric acid kills S. aureus and E. coli but has no marked effect on C. albicans after 40 min. Citric acid samples at 0.8 M remained stable over the 4-week testing period, with viable microbial cells absent from samples tested. However, C. albicans has the ability to survive in citric acid solution if inadvertently introduced in practice. For this reason, in clinical and research practice it is suggested to use single-use aliquots prepared aseptically which can be stored for up to 28 days at 4 °C.

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Anaesthetic drug administration as a potential contributor to healthcare-associated infections: a prospective simulation-based evaluation of aseptic techniques in the administration of anaesthetic drugs

Cited by 26 publications

References 54 publications

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres

Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

An Investigation into the Stability and Sterility of Citric Acid Solutions Used for Cough Reflex Testing

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