Contamination of syringes

Abstract

Contamination of syringesTo the Editor:The recent article by Lessard etal. showed the risk to the patient of bacterial contamination with multiple use of syringes to be negligible but emphasized the risks from viral contamination.l A questionnaire was distributed to all members of anaesthesia departments of the Universities of Pittsburgh and Michigan in the general adult, paediatric and obstetric divisions (five hospitals total) to quantitate the frequency of common syringe techniques. Anonymous responses were collected and evaluated from 139 personnel: 48 anaesthetists, 48 CRNAs, 31 residents and 12 student CRNAs. Respondents indicated that they routinely, frequently, rarely or never used common syringe techniques 30.9, 41.7, 17 and 10 per cent of the time, respectively. Almost all personnel (98 per cent) reuse multiple dose vials opened by unknown persons and 75 per cent refill common syringes from multi-dose vials without discarding them subsequently. Common syringes were used by 18 per cent, when blood products were given through the IV line. In the 1950's it was recognized that reusing common syringes on multiple patients could transmit diseases and that changing needles was quite ineffective in lowering the danger of crossinfection, z'3 During needle removal from the syringe, the needle contents are aspirated up to the syringe tip before the air lock is broken at the needle hub. The lumen of intravenous lines is frequently and occultly contaminated with blood and 10 -7 to 10 -9 ml of blood can transmit hepatitis .4,5 The reuse of these needles or syringes clearly presents a danger to patients and the health care providers themselves, who may acquire hepatitis from them during use or recapping. The contamination of IV tubing can only be excluded when the IV is started and continuously observed and manipulated by one person alone. Hepatitis is transmitted via transfusion and/or operation as independent factors: 3.3 per cent of non-transfused patients acquire hepatitis from unknown sources versus 5.6 per cent of transfused patients. 6-9 Viral transmission may additionally occur when using multi-dose vials in conjunction with common syringe techniques. Hepatitis virus is stable on dry surfaces for one week and may survive longer in suitable aqueous statesJ a Bacteriological studies of multi-dose vials or syringes are not useful in documenting contamination, as contained bacteriostatic agents rapidly eliminate bacteria. II There is no evidence that bacteriostatic agents will destroy all introduced pathogenic virus and manufacturers recommend that only sterile equipment is used to enter multidose vials.Although high rates of common syringe technique utilization may not be encountered in all institutions, widespread practice is likely, in spite of recommendations to the contrary. 12 These techniques violate guidelines which exist to protect hospital workers from exposure to blood-borue infections. ~3'J4 The Center for Disease Control, however, has no specific policy regarding common syringes. Universal precaution...

Patient-to-Patient Transmission of Hepatitis C Virus during Colonoscopy

“…However, other studies have shown that the rate at which blood contaminates the intravenous tubing used for anesthesia is substantial (0.3 to 3.3 percent of cases). [21][22][23] The presence of a check valve and the changing of the needle do not affect the rate at which intravenous lines and syringes become contaminated -a point that should be emphasized, because multidose vials are very commonly used in anesthesia. [21][22][23] Moreover, because the assessment of risk factors is not a reliable predictor of which patients have chronic viral infection, the prac-tice of following strict procedures for anesthesia only in patients with known infections has little rationale and should be abandoned.…”

Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol

“…Despite the written recommendations of professional associations, such as the American Society of Anesthesiologists 28 and the American Association of Nurse Anesthetists, 29 which specifically advocate the use of aseptic techniques during the handling of medications, several authors have reported poor compliance with aseptic techniques and infection-control practices by anesthesia personnel. [30][31][32][33][34][35][36] Contamination of multidose vials, 15,37,38 use of a single syringe to administer medication to different patients, 39 assembling infusion equipment far in advance of use, 40 and contamination of syringes and catheters 38 have all been implicated in other outbreaks. Studies show that reuse of multidose vials can cause contamination of the medication in the vial 15 and that contamination can occur during the opening of a glass vial whose surface has not been disinfected.…”