van Grafhorst Janneke P, Foudraine Norbert A, Nooteboom Fleur, Crombach Wil H J, Oldenhof Nico J J, van Doorne Hans
Department of Clinical Pharmacy, St. Maartens Gasthuis, Venlo, The Netherlands.
Crit Care Med. 2002 Apr;30(4):833-6. doi: 10.1097/00003246-200204000-00019.
To determine the risk of bacterial contamination of the infusate in a simulation model of syringes prepared for continuous intravenous drug administration by intensive care unit nurses. Widely accepted standard procedures in the intensive care unit were compared with syringes prepared by pharmaceutical technicians working under standard aseptic conditions according to national guidelines.
Prospective study.
Intensive care units of four general teaching hospitals and two university hospitals.
We examined 650 syringes prepared from 10-mL ampules and 100 syringes prepared from rubber-compound-capped 50-mL vials by intensive care unit nurses of six hospitals. Also, 100 syringes from 10-mL ampules and 100 syringes from rubber-compound-capped 50-mL vials were prepared by pharmaceutical technicians.
Turbidity of syringes after culturing for 7 days at 37 degrees C was used as the criterion for possible bacterial contamination, which was proved with subsequent Gram staining.
A median contamination rate of 22% (range, 7% to 44%) was observed for the syringes prepared from 10-mL ampules by intensive care unit nurses, compared with only 1% for the syringes prepared from ampules by technicians (p <.001). In >75% of all contaminated syringes, Gram-positive cocci were identified. At least 12% of all prepared syringes proved to be contaminated with staphylococci species. The contamination rate of syringes prepared from vials was much lower: 2% in the intensive care unit and 0% at the department of clinical pharmacy.
In the intensive care unit, standard procedures for preparing syringes for intravenous administration of drugs lack vigorous aseptic precautions, leading to a high contamination rate of the infusate. This risk is increased when ampules instead of 50 mL-vials are used to prepare the syringes.
在由重症监护病房护士准备用于持续静脉给药的注射器模拟模型中，确定输注液的细菌污染风险。将重症监护病房广泛接受的标准操作程序与根据国家指南在标准无菌条件下工作的药剂师准备的注射器进行比较。
前瞻性研究。
四家综合教学医院和两家大学医院的重症监护病房。
我们检查了六家医院的重症监护病房护士用10毫升安瓿制备的650支注射器和用橡胶复合盖50毫升小瓶制备的100支注射器。此外，药剂师还用10毫升安瓿制备了100支注射器，用橡胶复合盖50毫升小瓶制备了100支注射器。
将注射器在37℃培养7天后的浑浊度作为可能细菌污染的标准，随后通过革兰氏染色进行验证。
重症监护病房护士用10毫升安瓿制备的注射器的污染率中位数为22%（范围为7%至44%），而药剂师用安瓿制备的注射器的污染率仅为1%（p<.001）。在所有受污染的注射器中，超过75%鉴定出革兰氏阳性球菌。所有制备的注射器中至少12%被证明被葡萄球菌属污染。从小瓶制备的注射器的污染率要低得多：重症监护病房为2%，临床药学部为0%。
在重症监护病房，用于静脉给药的注射器的标准制备程序缺乏严格的无菌预防措施，导致输注液的污染率很高。当使用安瓿而不是50毫升小瓶来制备注射器时，这种风险会增加。
