Bacterial Contamination in Solution Aspirated from Non-Sterile Packaged Fentanyl Ampoules: A Laboratory Study (Report)
Anaesthesia and Intensive Care 2009, July, 37, 4
Anaesthesia and Intensive Care
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Injecting a drug breaches a patient's immunological defences and risks the development of iatrogenic infection. In the case of intrathecal injection, bacterial meningitis is a rare but potentially devastating complication (1-3). Anaesthetists attempt to maintain a "chain of asepsis" when performing neuraxial anaesthesia (4-6). Common aseptic measures include wearing sterile gown and gloves, the use of sterile equipment and work area, decontamination of the patient's skin and the wearing of a hat and mask to minimise airborne contamination of the work area. It is desirable to use drug ampoules which are presented in sterile packaging, as these can be placed in the anaesthetist's sterile work area and handled directly by the anaesthetist. Drug ampoules which are not sterile-wrapped require a careful drawing-up technique to ensure maintenance of the aseptic chain. Typically, an assistant will 'crack open' the ampoule and hold it, while the anaesthetist inserts a drawing-up needle and aspirates its contents. The potential exists to contaminate the drawing-up needle through contact with the non-sterile neck of the ampoule. In addition, tiny glass shards, which theoretically could carry bacteria, may fall inside the ampoule as it is opened (7-10). The potential for bacterial contamination when using non-sterile packaged ampoules has led to recommendations such as decontamination of the neck of the ampoule with alcohol before opening (4,11), in-hospital autoclaving (12), ethylene oxide sterilisation of ampoules (13) and the use of antibacterial filters in the aspiration process (4,7,8). The efficacy and safety of these techniques is largely unknown. The aim of this laboratory study was to determine the extent of bacterial contamination in solutions drawn up from non-sterile packaged ampoules by anaesthetists using different techniques. We hypothesised that cleaning the neck of the ampoule with an alcohol swab or aspirating through a 0.22 micron filter might reduce the incidence of contamination.
- Category: Health & Fitness
- Published: 01 July 2009
- Publisher: Australian Society of Anaesthetists
- Print Length: 14 Pages
- Language: English