Drug Contamination from Opening Glass Ampules

Zacher, Allan N.; Zornow, Mark H.; Evans, G A

doi:10.1097/00000542-199111000-00022

Cited by 74 publications

(45 citation statements)

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“…In this context, Zachner et al found less contamination of propofol ampoules which had been swabbed with a solution of Staphylococcus epidermidis, when they were wiped with alcohol prior to opening. 27 Although it is not common practice to swab propofol ampoules in solutions containing bacteria, it should be remembered that routine anesthesia practice has repeatedly been accused of being a potential factor in the contamination of drugs. [28][29][30][31] The risk of contaminating propofol syringes would be expected to increase with the number of personnel involved in handling the drug.…”

Section: Discussionmentioning

confidence: 99%

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Lorenz

Kolbitsch

Lass‐Flörl

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Propofol is a potential vector of infection, because it contains no preservative. Thus, the manufacturer's specific recommendations for preparing injections or infusions go beyond the guidelines commonly used in our operating rooms for preparing other iv drugs. The purpose of the present study was to determine whether in the daily routine of an operating theatre a modified propofol handling technique can prevent contamination as effectively as do the manufacturer's handling recommendations. M Me et th ho od ds s: : A total of 160 consecutive neurosurgical patients were allocated to either Group I (manufacturer's handling recommendations: i.e., 1) disinfecting propofol vials and ampoules before filling syringes; 2) replacing empty syringes; 3) discarding all material at the end of surgery); or Group II (modified propofol handling protocol: i.e., 1) refilling empty syringes; 2) renewing only the infusion line to the patient). R Re es su ul lt ts s: : Total contamination rates were comparable in both groups (Group I: 14/160 (8.75%), Group II: 13/160 (8.13%) (P 2 =0.074; P=0.96). Frequency of contamination was not different between groups; either in sample 1 taken at the beginning of the procedure, (Group I: 5/80 (6.25%) vs Group II: 6/80 (7.5%); P 2 =0.098; P=0.76) or in sample 2, taken at the end, (Group I: 9/80 (11.25%) vs Group II: 7/80 (8.75%); P 2 =0.278; P=0.598). C Co on nc cl lu us si io on n: : We conclude that in the daily routine of the operating theatre following a modified propofol handling protocol prevents contamination of propofol syringes as effectively as does adhering to the manufacturer's specific handling recommendations. However, neither of the tested guidelines completely prevented contamination. Groupe I et 13/160 (8,13 %) dans le Groupe II (P 2 = 0,074; P = 0,96). La fréquence de contamination ne diffère pas d'un groupe à l'autre, pour l'échantillon 1 prélevé au début de l'opération (Groupe I : 5/80 (6,25 %) vs Groupe II : 6/80 (7,5 %); P 2 = 0,098; P = 0,76) ou l'échantillon 2 à la fin (Groupe I : 9/80 (11,25 %)vs Groupe II : 7/80 (8,75 %); P 2 = 0,278; P = 0,598 Objectif : Le propofol, ne contenant aucun agent de conservation, est un vecteur potentiel d'infection. C'est pourquoi les recommandations spécifiques du fabricant au sujet de la préparation d'injections ou de perfusions vont au delà des directives habituellement suivies dans nos salles d'opération pour la préparation d'autres médicaments intraveineux. Nous avons voulu déterminer si, en modifiant le maniement du propofol en salle d'opération, nous pouvions prévenir la contamination aussi efficacement qu'en suivant à la lettre les recom

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Section: Discussionmentioning

confidence: 99%

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Lorenz

Kolbitsch

Lass‐Flörl

et al. 2002

Can J Anesth/J Can Anesth

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“…et, troisièmement, la désinfection des ampoules ou des fioles avant l'ouverture diminue considérablement la possibilité de contamination bactérienne. 9 C'est pourquoi on commande que les fioles et les ampoules soient désinfectées avec de l'alcool isopropylique, qu'une seringue soit utilisée pour un seul patient et pendant une période ne dépassant pas six heures et que les perfusions soient réalisées en moins de 12 h après le prélèvement des fioles. [6][7][8] Néanmoins, malgré des avertissements répétés et des recommandations claires sur l'innocuité, des études de cas sont encore publiées.…”

Section: Le Propofol Et Le Risque De Transmission D'infectionunclassified

“…[6][7][8] These recommendations are based on the knowledge of the following scientific evidence: first propofol supports bacterial growth, 1 second the number of bacteria increases rapidly with time 1 and third disinfection of ampules or vials before opening considerably decreases the likelihood of bacterial contamination. 9 Hence recommendations state that vials and ampules are to be disinfected with isopropyl alcohol, syringes must be used for a single patient and within six hours, and infusions must be completed within 12 hr after the vial has been spiked. [6][7][8] Yet, in spite of repeated warnings and clear safety recommendations, case reports have kept on appearing in the literature.…”

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confidence: 99%

Propofol and the risk of transmission of infection

Trépanier

Lessard

2003

Can J Anesth/J Can Anesth

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“…Zacher et al demonstrated that wiping the ampoule neck with alcohol prior to opening significantly reduced bacterial contamination of propofol ampoules. 43 This is of particular importance when preparing propofol infusions for TCI or total intravenous anaesthesia (TIVA), or for sedation during critical care, where the solution may be administered over several hours. The second major contributor related to the duration of propofol infusions in the intensive care unit (ICU) whereby participants were prepared The page number in the footer is not for bibliographic referencing www.tandfonline.com/ojaa 30 EDTA (ethylenediaminetetraacetic acid) can retard the 24-h growth of microorganisms 10-fold thereby reducing the microbial growth potential in propofol to that of a non-lipid medication.…”

Section: Discussionmentioning

confidence: 99%

A survey of propofol injection practices reveals poor knowledge of and unsatisfactory adherence to the SASA Guidelines for Infection Control

Breedt

Coetzee

Kluyts

et al. 2017

Southern African Journal of Anaesthesia and Analgesia

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Background: Propofol lipid emulsion supports bacterial growth and various outbreaks of postoperative infection are attributed to extrinsic contamination. This study's objectives were to ascertain propofol administration practices among South African anaesthesiologists and to determine the influence of the 2014 South African Society of Anaesthesiologists (SASA) Guidelines for Infection Control in Anaesthesia. Methods: A total of 1 598 SASA members were invited to participate anonymously and 634 replies were received. Using a riskscoring system developed from 13 questionnaire items, 542 respondents who administer propofol infusions were stratified into Low-, Moderate-, High-and Very High-Risk groups. Results: The majority (65%) of the 542 participants who administer propofol infusions were classified as Moderate Risk, 29% as Low Risk and 6% as High and Very High Risk. Some 61% were aware of the SASA Guidelines, of whom 47.3% had studied them. The median risk-score of the Studied Guidelines group was significantly smaller (p < 0.001). They included a greater proportion who were categorised as low risk (58% vs. 45%) and a lower proportion who were moderate risk (38% vs. 51%). Proportions of high-risk individuals did not differ. Of the total 634 respondents, 247 used rubber-stoppered vials of whom 28% had studied the SASA Guidelines; 20% of the Studied Guidelines group often/always shared vial contents between patients versus 12% of those who had not studied them (p = 0.13). Conversely, 40% (studied group) versus 13.6% (not-studied group) often/always wiped the diaphragm and seldom/never shared vial contents between patients (p < 0.0001). In all, 25% of the total 634 respondents often/ always pre-prepared multiple propofol syringes; 5.0% diluted propofol and often/always pre-prepared syringes. Conclusion: Penetration of the SASA Guidelines was low. Differences in unsafe practices among anaesthesiologists who had read the guidelines were statistically significant but clinically inconsequential. This highlights a need for greater publicity, emphasising their practical importance.

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Drug Contamination from Opening Glass Ampules

Cited by 74 publications

References 0 publications

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Propofol and the risk of transmission of infection

A survey of propofol injection practices reveals poor knowledge of and unsatisfactory adherence to the SASA Guidelines for Infection Control

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