Table 1

The key findings and recommendations of the included articles (n=12) with empirical evidence on incorrect practices that lead to contamination in aseptic preparation and/or administration of medicines in hospitals and recommendations to avoid contamination according to the type of the recommendation (studies presented in alphabetical order)

StudyReasons/incorrect practices that lead to contaminationRecommendations to avoid contaminationProfessionClinical or pharmacy-based preparation or administration
 Austin and Elia10
  1.  Nurses did not clean the working surface or ampoule necks and did not use gloves

  1. Cleaning the working surface with detergents and disinfectants (eg, 70% isopropyl alcohol or ethanol) with proper technique

  2. Use of gloves

  3. Cleaning each ampoule neck and rubber septa with alcohol swab before opening

Nurses and pharmacistsClinic
 Gargiulo et al19
  1. Lack of hand hygiene, no disinfection of phial septa or intravenous ports and multiple use of syringes

  1.  Hand washing and hand disinfection

  2.  Disinfection of the intravenous ports

  1.  Lack of infection prevention in peripheral intravenous catheter use and alternative site infusions

  1.  Skin antisepsis before catheter placement

NursesClinic and home
Catheter care
 Gorski21Lack of infection prevention in peripheral intravenous catheter use and alternative site infusions
  1.  Checking and caring the catheter site daily

 Nurses Clinic and home
 Yoshida et al27
  1.  Character of ward and catheter placement time

  1. Catheter placement not more than 30 days

Nurses and pharmacistsClinic and pharmacy departments
Equipments and medicines
 Bertoglio et al11
  1.  Manually filled (filled by a nurse or a pharmacist in a hospital ward) syringes

  1.  Using of manufactured prefilled syringes

Nurses and pharmacistsClinic
 De Smet et al16
  1.  Multiple dose phials with a high nutrient content

  1. Singe use of flushing solutions with low nutrient content

 Buerke et al12
  1. Multiple use

  1.  Single use of syringes in automatic injectors

Technical and medical staffCT department (clinic)
 Nakataki et al30
  1. Improper handling

  1. Aseptic handling of infusion set needles

 Rangel-Fausto et al24
  1. Open infusion containers

  1. Use of closed infusion containers

Physicians, nurses and paramedical staffClinic
 Dolan et al18N/A
  1. Single use of syringes, disposable tubes and connectors of automatic injectors

  2. Discarding all opened phials, intravenous solutions and opened syringes

 Dolan et al18N/A
  1. Storing medications in a clean area on a clean surface

  2. Storage of needles and syringes never unwrapped

  3. Preparation of IV solutions as close as possible to administration

 N/A N/A
Working environment
 Dolan et al18 N/A
  1. Drug preparation in laminar flow hood

  2. Avoiding to contact sterile drugs or sterile areas with non-sterile objects

 N/A N/A
 Stucki et al26
  1. Environmental aspects

  1.  Working in cleanrooms when ever possible

Single operatorClinic and pharmacy department
Quality of prepared medications
 Gershman et al20
  1. No auditing for suppliers

  1. Checking suppliers to ensure that medications ordered are produced according to manufacturing regulations

N/APharmacy department
  • N/A, not available.