Article Text

other Versions

Anaesthetic drug administration as a potential contributor to healthcare-associated infections: a prospective simulation-based evaluation of aseptic techniques in the administration of anaesthetic drugs


Objective To evaluate the possibility that anaesthetists are administering potentially pathogenic micro-organisms to their patients.

Design Prospective microbiological and observational study in a realistic simulated setting.

Participants Ten anaesthetists supported by 10 anaesthetic technicians.

Primary outcome measure The presence or absence of organisms cultured from sterile intravenous bags used to collect drugs injected during the simulated cases and from the needles and the contents of the syringes used. The authors also observed the aseptic techniques used.

Results Organisms were isolated from five of 38 (13%) bags from five of 20 simulated cases anaesthetised by four of 10 anaesthetists, 10 of 197 (5%) syringes and six of 17 (35%) needles. None of the anaesthetists washed their hands prior to entry, used the hand gel provided, disinfected the phial septa before drawing up drugs or disinfected the intravenous ports on the intravenous administration set before use. One was seen to recap a needle left on a syringe for possible reuse. Three participants were observed to place equipment such as stethoscopes, drug charts and pens on top of their inuse drug trays.

Conclusion The administration of intravenous drugs during anaesthesia may be an important factor in the genesis (or potentially the prevention) of healthcare-associated infection. These observations suggest room for improvement in the aseptic techniques of at least some anaesthetists when preparing and administering intravenous drugs. Confirmation of these findings in clinical settings is needed.

Study registry number (for the VASER study) Australian New Zealand Clinical Trials Registry: Ref: ACTRN 12609000530224,; note that the work presented here is a subset of the registered trial and its outcomes were not included in this registration.

  • Anaesthesia
  • healthcare-associated infections
  • safety management
  • simulation
  • patient harm
  • healthcare quality improvement
  • infection control
  • nosocomial infections
  • human factors
  • human error
  • checklists
  • crisis management
  • duty hours/work hours

Statistics from


  • Funding This substudy was supported by the New Zealand Pharmacy Education and Research Fund (NZPERF). The VASER study was supported by grants from the Australian and New Zealand College of Anaesthetists and the Auckland Medical Research Foundation. These funders were not involved in the study design; in collection, analysis and interpretation of data; in writing the report; or in the decision to submit the article for publication.

  • Competing interests All authors have completed the Unified Competing Interest form at and declare that: AM is a director of, and AM and CW are shareholders in Safer Sleep LLC which markets the drug administration and automated record keeping system used in this study. AM is Head of the School of Medicine, University of Auckland, which promotes simulation training of health. DG, JS, SS, JT, JW, KH and JH have no relevant interests to declare.

  • Patient consent Consent was obtained from participants.

  • Ethics approval This study was approved within the provisions of the wider VASER study by the Northern Y Regional Ethics, New Zealand. Approval number is NYT/09/01/005.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.