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Improved aseptic technique can reduce variable contamination rates of ward-prepared parenteral doses

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Summary

Aseptic techniques are required to manipulate central venous lines and prepare intravenous doses. This study aimed to examine whether different aseptic techniques affect the contamination rates of intravenous doses prepared on hospital wards. Syringes of tryptic soy broth test media prepared by one pharmacy operator and five nurses were assessed for contamination. The pharmacy operator achieved lower contamination than the nurses (0.0% vs 6.9%; Fisher's exact test, P < 0.001). Contamination differed significantly between nurses (∼2–17% of syringes; binary logistic regression, P = 0.018). In conclusion, appropriate training and experience in aseptic techniques should be embedded into routine clinical practice to reduce contamination rates.

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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