Background Single-use vials should be used clinically only for one dose for one patient and then discarded or reused under strictly controlled conditions. Certain conditions may justify repacking of single-use vials into smaller doses each intended for a single patient. This process must be performed under aseptic conditions by properly trained operators.
Purpose To demonstrate the necessity for aseptic technique and conditions and preparation by the pharmacy.
Materials and Methods For a period of six months 15 patients were prescribed Bergman’s solution 500 ml to which was added 5 ml pentoxiphylin and 12 ml lidocaine 2% (50 ml vials divided between 4 patients) in the orthopaedic department. This infusion was prepared in the nursing room, by the nurses without suitable aseptic conditions. For the next six months pharmacists prepared this infusion in the hospital pharmacy aseptic facility. 17 patients in the orthopaedic department got this solution.
Results The nurses used each 50 ml vial of lidocaine for several patients until the vial was used. The vial was saved for use the following day after initial entry. Within days of application 8 patients required antibiotics and prolonged hospitalisation. Microbiological tests showed MRSA infection. One of the nurses forgot to wash hands before preparing the infusion for 3 patients, one used the same needle for both drugs for 4 patients, and one accidentally touched the needle in 1 patient. In the next six months the hospital pharmacy prepared 17 infusions for 17 patients in the aseptic facility. All patients finished their treatment in very good condition without any complications.
Conclusions Nurses’ rooms and training are unsuitable for reusing single dose vials for several patients. Subdividing must follow highly controlled environmental conditions, with training and qualifications of personnel and procedures for reuse, which are met by the hospital pharmacy and pharmacists in our hospital.
No conflict of interest.
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