Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: an update

Austin, P.; Hand, Kieran; Elia, Marinos

doi:10.1016/j.jhin.2015.04.007

Cited by 21 publications

(30 citation statements)

References 33 publications

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“…Our review found differences in contamination rates between different healthcare workers in preparing medicines as has been found in the previous systematic reviews (Austin and Elia5 and and Austin et al 7). We also found many incorrect aseptic techniques and practices that should be avoided and many good techniques and practices that should be used instead.…”

Section: Discussionsupporting

confidence: 82%

“…The new safer techniques and practices, for example, disinfection and hygiene aspects, should be implemented and taught to healthcare practitioners, particularly to nurses. As the change for the better in contamination rates of administered medicines seems to be challenging to achieve in hospitals,7 better and possibly international procedures for safe parenteral practices need to be developed.…”

Section: Discussionmentioning

confidence: 99%

“…The contamination rates were higher when medicines were prepared in hospital wards rather than in a pharmaceutical environment 5. The same authors updated the systematic review and meta-analysis in 2015 to cover the evidence published in 1950–2014 7. The first systematic review found the overall contamination rates for doses prepared in clinical environments to be 5% for individual doses and 2% for doses prepared as part of a batch 5.…”

Section: Introductionmentioning

confidence: 99%

“…The above-mentioned two systematic reviews by Austin and Elia5 7 compared the contamination rates between the different environments, but they did not focus on the different aseptic techniques applied to the preparation of parenteral medicines. The aseptic techniques can differ in many ways, for example, by practices related to working area, personal hygiene, reagents and media and handling.…”

Section: Introductionmentioning

confidence: 99%

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Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

et al. 2016

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Objective 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. Methods A systematic literature search was conducted in PubMed covering [2007][2008][2009][2010][2011][2012][2013][2014][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.Results 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. Conclusions 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.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

et al. 2016

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“…Furthermore, several countries have published national guidelines, such as the Dutch Hospital Patient Safety Program or the epic-3 guideline for the UK [15,16]. In a meta-analysis, Austin et al found a contamination rate of 3.7% for the clinical environment and 0.5% for the pharmacy environment [17]. Austin et al included 34 studies, but 22 (65%) of those were published before 2000.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of microbial contamination of parenteral medication prepared in a clinical versus pharmacy environment

Larmené-Beld

Frijlink

Taxis

2019

Eur J Clin Pharmacol

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Purpose Preparation of parenteral medication in hospitals is a complex process with a risk of microbial contamination of the product, especially when inappropriately prepared. Contaminated parenteral medications can cause severe complications to patients and increase morbidity in hospitals. The aim of this literature review is to systematically evaluate the contamination rate of parenteral medications in hospitals prepared in a pharmacy environment and a clinical environment. Methods A literature search of PubMed and EMBASE from 2000 to 2018 was performed. Two different environments where preparation may be carried out were defined. Point estimates and 95% confidence intervals for contamination rates were calculated for each environment of medication preparation. The meta-analysis was performed using a random effects model. Results The contamination rates in the clinical environment (n = 13 studies) varied between 1.09 and 20.70%. In the pharmacy environment (n = 5), all contamination rates were 0.00% except for one study (0.66%). The point estimates (random effect model) for the overall contamination rate of doses prepared in the clinical environment was 7.47% (5.16-9.79%), and 0.08% for doses prepared in the pharmacy environment. The point estimates (random effect model) for the overall contamination rate of doses prepared by nursing/ medical staff was 7.85% (5.18-10.53%), and 0.08% for doses prepared by pharmacy staff. Conclusions Significantly higher contamination rates were found for the preparation of parenteral medication in the clinical environment compared to pharmacy environment. In accordance with recent guidance, the almost 100-fold higher changes of contamination when reconstitution is performed in the clinical environment should urge hospitals to review their reconstitution process and apply risk-reducing measures to improve patient safety of parenteral therapy.

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Taneja

Deb

Maheshwari

et al. 2018

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Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: an update

Abstract: Please cite this article as: Austin PD, Hand KS, Elia M, Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: an update, Journal of Hospital Infection (2015),

Cited by 21 publications

References 33 publications

Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

Incorrect aseptic techniques in medicine preparation and recommendations for safer practices: a systematic review

A systematic review and meta-analysis of microbial contamination of parenteral medication prepared in a clinical versus pharmacy environment

Package Types for Different Dosage Forms

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