Barrier protection capacity of flip-top pharmaceutical vials

The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure’s possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.

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“…Hilliard et al [188] reported contamination of the diaphragm in two out 12 vials, despite an intact dust plastic cover.…”

Section: Reviewmentioning

confidence: 99%

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Merani

Hunyor

2015

Int J Retin Vitr

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“…Although this was an expected finding because stoppers of flip-top vials are not designed to be sterile and should be scrubbed with alcohol prior to access, in a survey of 878 anesthesiologists, 52% of respondents believed that the vial stoppers were sterile under the flip-top caps. 109 A survey performed among anesthesia providers in New Zealand found that almost 80% of respondents said they rarely or never wiped the intravenous line injection port with alcohol before injection. Furthermore, 54% of anesthesia providers failed to wipe the multi-dose vial septum with alcohol before use.…”

Section: Evidence For Infectious Sources In the Anesthesia Work Areamentioning

confidence: 99%

“…Hilliard et al 109 investigated flip-top drug vials and confirmed that the surface of the stopper of flip-top vials is frequently not sterile. Although this was an expected finding because stoppers of flip-top vials are not designed to be sterile and should be scrubbed with alcohol prior to access, in a survey of 878 anesthesiologists, 52% of respondents believed that the vial stoppers were sterile under the flip-top caps 109 . A survey performed among anesthesia providers in New Zealand found that almost 80% of respondents said they rarely or never wiped the intravenous line injection port with alcohol before injection.…”

Section: Introductionmentioning

confidence: 99%

Infection prevention in the operating room anesthesia work area

Munoz-Price

Bowdle

Johnston

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…1 Researchers studied microbial contamination of medication vial diaphragms after one of the following: routine handling (ie, removal of the dust cover with clean hands before sampling), exposure of the vial with dust cover in place to an Escherichia coli-contaminated aerosol, or submersion of the vial with dust cover in place into an E coli-contaminated liquid. 13 Two (17%) of 12 access diaphragms tested positive for contaminants after routine handling and removal of caps. There was no bacterial growth for any vial diaphragms after exposure to aerosolized E coli for 30 minutes and 24 hours.…”

Section: Retrieval and Preparationmentioning

confidence: 99%

“…The researchers recommended disinfecting medication vial stoppers before accessing the contents. 13 Each time clinicians withdraw medications from vials, they should use a new sterile access device (eg, needleless device, blunt needle). 1 Limiting the use of sharps can reduce the risk of injury and exposure among health care personnel.…”

Section: Retrieval and Preparationmentioning

confidence: 99%

Guidelines in Practice: Medication Safety

Speth

2023

AORN Journal

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Medication errors are preventable events that health care professionals, consumers, and medication manufacturers report to the US Food and Drug Administration. The agency receives more than 100,000 medication‐related reports each year, and some reports involve patient death. A variety of sources provide perioperative nurses with information on interventions and practices to prevent medication errors, including the US Pharmacopeia, The Joint Commission, medication manufacturers’ instructions for use, safety data sheets, and the updated AORN “Guideline for medication safety.” This article provides an overview of the guideline and discusses recommendations for organizational oversight, procurement and storage, retrieval and preparation, labeling, and hazardous medications. It also includes a scenario that illustrates perioperative nursing practices for administering an antineoplastic medication intraoperatively. Perioperative nurses should review the guideline in its entirety and implement recommendations in operative or procedural settings.

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Barrier protection capacity of flip-top pharmaceutical vials

Cited by 8 publications

References 18 publications

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review

Infection prevention in the operating room anesthesia work area

Guidelines in Practice: Medication Safety

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