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Summary The bacterial contamination of preserved blood continues to take place in the most efficiently run transfusion services throughout the world though fatalities due to this cause are probably not more than 1 in 500,000 bottles collected. The reason that this frequency is not greater is due to effective control by means of technical safeguards in the preparation of equipment and the collection and storage of the blood. The principles of this control are outlined. A further deterrent to the gross contamination of stored blood lies in the bacteriostatic and bacteriocidal properties of fresh blood. Where outbreaks of fatalities from transfused blood have taken place, it is usually due to more than one factor being involved. Résumé La contamination bactérielle du sang conservé est inévitable, même dans les services de transfusion les mieux organisés, quoique les accidents mortels causés par elle ne se produisent environ qu'avec 1 sur 500 000 unités de sang transfusées. Cette basse fréquence est dûe aux précautions techniques prises dans la préparation de l'apareillage pour les prises de sang, lors de la prise elle‐même et durant la conservation du sang, Les principes sur lesquels ces précautions sont basées sont discutés. Le pouvoir bactériostatique et bactéricide du sang frais représente une sauvegarde de plus contre la contamination. En genéral, ce n'est que quand plusieurs facteurs de sauvegarde sont en jeu qu'il se produit une accumulation d'accidents mortels. Zusammenfassung Die bakterielle Verunreinigung von Konservenblut ist nach wie vor auch in den best organisierten Transfusionszentren ein bedeutsames Problem, obschon bei 500 000 Transfusionen mit lediglich einem tödlichen Zwischenfall zu rechnen ist. Die Zwischenfallshäufigkeit ist klein, solange die Herstellung der Transfusionsgerate und der Konsemen strikte überwacht wird. Die Kontrollmethoden werden besprochen. Die bakteriostatischen und bakteriziden Eigenschaften des frischen Blutes wirken einer massiven bakteriellen Verunreinigung entgegen. Gehläfte schwere Zwischenfälle sind meistens auf mehrere Ursachen zurückzuführen.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). M edication discrepancies are common in medicine, posing an ongoing threat to safe patient care. Discrepancies can be defined as any difference between the physician's records and the medications that the patient actually takes, including related dose and frequency. In clinical practice, medication discrepancies are common, occurring in 34% to 95% of patients newly admitted to hospitals. 1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy. 4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases. These patients are often treated with a large number of drugs 5 and are cared for by multiple physicians. This is certainly true in advanced CKD, in which care can become fragmented because of the large number of collaborating care providers and suboptimal communication.The relationship between medication discrepancies and subsequent hospitalizations has been rarely studied in advanced CKD. 6 There are clear reasons to believe that such a relationship would exist. Patients with advanced CKD probably have a high rate of hospitalizations. Improper use of medications could lead to hospitalizations through adverse effects of misused drugs, medical complications, and diminution of anticipated efficacy. In the current study we have analyzed the relationship between the number medication discrepancies in advanced CKD and the risk for hospitalizations over up to a year of follow-up. RESULTSWe enrolled 713 patients with stage 4 to 5 CKD into the baseline cohort, with characteristics displayed in Table 1. The population skewed toward older age, with 62.7% being >65 years. There was a minor underrepresentation of Hispanic patients; comprising only 9% of patients. The vast majority of patients were hypertensive and approximately 50% had diabetes mellitus. During the 1-year assessment period, 23 patients died and 33 patients reached end-stage renal disease. A further 5 patients were lost to follow-up.A total of 392 patients (55.0% of the study population) had at least 1 medication discrepancy. The median number of discrepancies per patient (in patients with at least 1 discrepancy) was 2, (interquartile range, 1-4). A total of 646 patients (90.6%) had 0-5 discrepancies, 56 (7.8%) had 6-10 discrepancies, and 11 (1.5%) had more than 10 discrepancies. Types of discrepancies included patients taking a medication not on the nephrologist's list, patients not taking a medication on the nephrologist's list, different doses, and different dose frequencies. Medication...

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