Short reportImproved aseptic technique can reduce variable contamination rates of ward-prepared parenteral doses
Introduction
Catheter-related sepsis (CRS) is a widespread problem that affects patients managed on intravenous therapy in hospital and in the community. CRS contributes to bacteraemia, infective morbidity, line removal, hospital admissions and death.
Aseptic techniques are required to manipulate central venous lines and prepare doses for intravenous administration, but poor techniques may lead to contaminated doses and infected lines. It is not always easy to link contaminated doses directly with CRS, but, for example, administration of contaminated parenteral nutrition has repeatedly been reported to lead to deaths: 13 in Johannesburg, South Africa in 19901 and another eight in 1992;2 two in Manchester, England in 1994;3, 4 six in Bloemfontein, South Africa in 2004;5 three in Mainz, Germany in 2010;6 and nine in Alabama, USA in 2011.7
Intravenous dose preparation can be undertaken in pharmacy aseptic services operating to defined standards, or in clinical environments such as hospital wards. Variable training and practice in the use of aseptic techniques may differ between healthcare workers (e.g. nurses and aseptic pharmacy operators) leading to different risks of CRS.
This study, which formed part of a local service development, aimed to test whether different techniques used by nurses and aseptic pharmacy operators can affect the variable contamination rates of doses prepared on wards.
Section snippets
Methods
One pharmacy operator and five nurses, each trained in aseptic techniques according to the requirements of their respective professions, participated in the study. The pharmacy operator was experienced in the techniques whereas the nurses were not. The infusate drawn up to make the flushes was a growth medium (certified sterile) in order to enhance detection of contaminants. Each operator was requested to use the aseptic techniques they had been formally trained to implement. The syringes were
Results
In total, 778 syringes were prepared over eight months, during 18 sessions taking 1130 min (Table I).
Discussion
The results indicate that the pharmacy operator was able to prepare more syringes, more quickly, and with significantly less contamination than the nurses, who achieved rates consistent with other reports.10
The most likely reason for the differences in contamination rates between the pharmacy operator and the nurses concerns their respective training and experience, which was associated with different operational procedures. For example, the pharmacy operator, but not the nurses, wore gloves
Acknowledgements
The authors wish to thank Southampton Hospital Pharmacy Centralised Intravenous Additive Service for supporting this study as part of a service development, and all the nurses involved. The authors also wish to thank Steve McKenzie in Clinical Trials, the pharmacy operator, and Rebecca Ballard in the Pharmacy Quality Assurance Service for independently assessing the test samples.
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Cited by (18)
Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: An update
2015, Journal of Hospital InfectionCitation Excerpt :The analysis involved 16,552 doses from 34 studies (33 records8,12–43). Of these, 4309 doses from 18 studies (18 records14,15,17,18,21,22,24,27–32,35–37,40,43) had been prepared as individual lots and 12,243 doses from 16 studies (16 records8,12,13,16,19–21,23,25,26,33,34,38,39,41,42) had been prepared as part of a batch. When all the data were combined there was a significantly higher frequency of contamination of doses prepared as individual lots than as part of a batch [4.4% (95% CI: 2.5%, 7.6%; N = 4309 doses) (I2 = 90.77%; P < 0.001) vs 1.3% (95% CI: 0.5%, 3.0%; N = 12,243 doses) (I2 = 96.68; P < 0.001); P = 0.022].
PROCEDURE FOR RAPID DETERMINATION OF CANDIDA SPECIES IN DRUGS
2023, One Health and Risk ManagementSuitability in compounding sterile preparations: An observational study in a referral hospital
2022, Journal of Pharmacy and Pharmacognosy ResearchPersonnel knowledge of intravenous admixtures: a survey in a government hospital
2021, Pan African Medical JournalCompounding parenteral products in pediatric wards—effect of environment and aseptic technique on product sterility
2021, Healthcare (Switzerland)