From the Department of Anaesthesiology (D.A.G., S.J.M., T.G.S., J.T., C.S.W., A.F.M.), School of Pharmacy (J.S.), Department of Molecular Medicine and Pathology (S.S.), Centre for Medical and Health Sciences Education (C.S.W.), University of Auckland, Grafton, Auckland, New Zealand; and Department of Anaesthesia and Perioperative Medicine (S.J.M., T.G.S., J.T., A.F.M.), Auckland City Hospital, Grafton, Auckland, New Zealand.
Anesthesiology. 2016 Apr;124(4):785-94. doi: 10.1097/ALN.0000000000001041.
The aseptic techniques of anesthesiologists in the preparation and administration of injected medications have not been extensively investigated, but emerging data demonstrate that inadvertent lapses in aseptic technique may be an important contributor to surgical site and other postoperative infections.
A prospective, open, microbiological audit of 303 cases in which anesthesiologists were asked to inject all bolus drugs, except propofol and antibiotics, through a 0.2-µm filter was performed. The authors cultured microorganisms, if present, from the 0.2-µm filter unit and from the residual contents of the syringes used for drawing up or administering drugs. Participating anesthesiologists rated ease of use of the filters after each case.
Twenty-three anesthesiologists each anesthetized up to 25 adult patients. The authors isolated microorganisms from filter units in 19 (6.3%) of 300 cases (3 cases were excluded), including Staphylococcus capitis, Staphylococcus warneri, Staphylococcus epidermidis, Staphylococcus haemolyticus, Micrococcus luteus/lylae, Corynebacterium, and Bacillus species. The authors collected used syringes at the end of each case and grew microorganisms from residual drug in 55 of these 2,318 (2.4%) syringes including all the aforementioned microorganisms and also Kocuria kristinae, Staphylococcus aureus, and Staphylococcus hominus. Participants' average rating of ease of use of the filter units was 3.5 out of 10 (0 being very easy and 10 being very difficult).
Microorganisms with the potential to cause infection are being injected (presumably inadvertently) into some patients during the administration of intravenous drugs by bolus during anesthesia. The relevance of this finding to postoperative infections warrants further investigation.
麻醉师在准备和给药时的无菌技术尚未得到广泛研究，但新出现的数据表明，无菌技术的疏忽可能是手术部位和其他术后感染的一个重要因素。
对 303 例病例进行了前瞻性、开放性、微生物学审核，要求麻醉师通过 0.2-µm 过滤器注射所有推注药物，但丙泊酚和抗生素除外。作者从 0.2-µm 过滤器单元和用于抽取或给药的注射器的残留内容物中培养微生物，如果存在的话。参与的麻醉师在每次病例后对过滤器的易用性进行了评分。
23 名麻醉师每人麻醉了多达 25 名成年患者。作者从 300 例中的 19 例（3 例被排除在外）过滤器单元中分离出微生物，包括头状葡萄球菌、华纳葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、微球菌/lylae、棒状杆菌和芽孢杆菌。作者在每个病例结束时收集了用过的注射器，并从这 2318 个注射器中的 55 个（2.4%）中培养出了微生物，包括上述所有微生物以及克氏库克菌、金黄色葡萄球菌和人葡萄球菌。参与者对过滤器单元易用性的平均评分为 3.5（0 为非常容易，10 为非常困难）。
在麻醉期间静脉内给药时，通过推注将具有潜在感染能力的微生物（推测是无意中）注入一些患者体内。这一发现与术后感染的相关性需要进一步研究。
