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
- Derryn A Gargiulo1,
- Janie Sheridan2,
- Craig S Webster3,
- Simon Swift4,
- Jane Torrie1,5,
- Jennifer Weller3,5,
- Kaylene Henderson1,5,
- Jacqueline Hannam1,
- Alan F Merry1,5
- 1Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- 2School of Pharmacy, University of Auckland, Auckland, New Zealand
- 3Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- 4Department of Molecular Medicine and Pathology, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand
- 5Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
- Correspondence to Professor Alan F Merry, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92-019, Auckland 1142, New Zealand;
Contributors DG conceived the original idea and subsequent updates of the methods, contributed to the setup of the equipment, obtained the data, carried out the analyses and interpretation, and wrote the initial draft and subsequent revisions. AM expanded the original idea for this substudy. JT, JW, KH and JH were involved with the development of the cases, and the procurement and setup of the equipment. AM and JW were the principal investigators on the VASER study and oversaw all aspects of its conduct, including those related to this substudy. SS contributed to the microbiological analyses. All the authors contributed to the revisions of the paper, had full access to all of the data and can take responsibility for its integrity.
- Accepted 30 April 2012
- Published Online First 16 June 2012
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, https://www.anzctr.org.au/registry/trial_review.aspx?ID=308128; note that the work presented here is a subset of the registered trial and its outcomes were not included in this registration.
- healthcare-associated infections
- safety management
- patient harm
- healthcare quality improvement
- infection control
- nosocomial infections
- human factors
- human error
- crisis management
- duty hours/work hours
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 http://www.icmje.org/coi_disclosure.pdf 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.