Suvikas-Peltonen Eeva, Hakoinen Suvi, Celikkayalar Ercan, Laaksonen Raisa, Airaksinen Marja
Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland.
Eur J Hosp Pharm. 2017 May;24(3):175-181. doi: 10.1136/ejhpharm-2016-001015. Epub 2016 Oct 12.
Many patient deaths have been reported because of administration of contaminated intravenous medicines due to incorrect aseptic techniques. Our aim was to review the literature for (1) incorrect practices in aseptic drug preparation and administration and (2) recommendations for safer practices in hospitals.
A systematic literature search was conducted in PubMed covering 2007-2015. Studies were included if they concerned aseptic medicine preparation and administration in hospitals by different healthcare professionals, assessed incorrect practices and made recommendations for safer aseptic preparation and administration.
26 studies were included of which 19 were original articles. 12 of the studies concerned description of incorrect practices that led to contamination. The studies reported 11 incorrect practices that increased the risk of contamination of parenteral medicines. The most reported incorrect practices were multiple use of phials and syringes (2/12 studies) and lack of overall disinfection during the aseptic preparation and administration (3/12 studies). 22 practices were recommended to avoid contamination, which were classified into six categories: equipment and medicines (7); disinfection (6); working environment (3); storing (3); catheter care (2) and quality of prepared medicines (1). The results indicate that pharmacists prepared syringes with less contamination than nurses because of the pharmacist's aseptic skills and environmental aspects in pharmacy units.
The review discusses many appropriate and enhanced practices in aseptic drug preparation and administration. As the change for the better in contamination rates of administered medicines seems to be challenging to achieve in hospitals, better and possibly international procedures for safe parenteral practices need to be developed.
有报道称，由于无菌技术不正确导致静脉注射药物受污染，许多患者死亡。我们的目的是回顾文献，以了解（1）无菌药物配制和给药中的错误操作，以及（2）医院更安全操作的建议。
在PubMed上进行了一项系统的文献检索，涵盖2007年至2015年。如果研究涉及不同医疗保健专业人员在医院进行的无菌药物配制和给药，评估错误操作并提出更安全的无菌配制和给药建议，则纳入研究。
纳入了26项研究，其中19项为原创文章。12项研究涉及导致污染的错误操作描述。这些研究报告了11项增加注射用药物污染风险的错误操作。报告最多的错误操作是多次使用药瓶和注射器（12项研究中的2项）以及无菌配制和给药过程中缺乏全面消毒（12项研究中的3项）。推荐了22项避免污染的操作，分为六类：设备和药品（7项）；消毒（6项）；工作环境（3项）；储存（3项）；导管护理（2项）和配制药品质量（1项）。结果表明，由于药剂师的无菌技术和药房的环境因素，药剂师配制的注射器污染较少。
该综述讨论了无菌药物配制和给药中的许多适当和改进的操作。由于在医院中似乎难以实现给药污染率的改善，因此需要制定更好的、可能是国际性的安全注射操作程序。
