Contamination Of Syringes Research Articles

Impact of Syringe and Needle Reuse on the Clinical Outcomes of Patients With Type 2 Diabetes: A 12-Week Randomized Clinical Trial.

To evaluate the clinical and laboratory outcomes of patients with type 2 diabetes by comparing the no reuse or reuse of syringes and needles for insulin injection. Adults with type 2 diabetes who had reused syringes and needles at least three times were randomly instructed either to not reuse or to reuse insulin syringes and needles five times. The primary outcomes assessed were glycemic control, pain scores, and skin complications (ecchymosis, lipohypertrophy, nodules, infection) at baseline and 4, 8, and 12 weeks after the intervention. Secondary outcomes included treatment adherence, quality of life, microbiological contamination of syringes and needles, needle quality, and insulin injection technique. Among the 71 participants (mean ± SD age 59.7 ± 8.8 years), 59% were women with a median duration of diabetes of 18 years (interquartile range 10-25 years) and a mean BMI of 31.7 ± 6.7 kg/m2. The group that reused syringes and needles experienced an increase in lipohypertrophy/nodules (0.16 ± 0.08, P = 0.040) but did not experience worsening pain or glycemic control, even when the syringes and needles were inserted into the skin with great effort. There was no difference in the total number of skin complications, quality of life, or microbiological contamination. Both groups improved treatment adherence, with a greater increase in the reuse group. The reuse of syringes and needles is associated with a modest increase in lipohypertrophy/nodules but does not have a short-term impact on glycemic control in patients with type 2 diabetes.

Bacterial Contamination of Syringes and Fluids in Diagnostic and Interventional Neuroangiography.

(1) Background: Bacterial contamination has been shown to occur during angiographies, although data on its frequency and relevance are sparse. Our aim was to evaluate the incidence of bacterial contamination of syringes used under sterile conditions during neuroangiographies. We sought to differentiate between contamination of the outside of the syringes and the inside and to detect the frequency, extent and germ spectrum of bacterial contamination. (2) Methods: We prospectively collected 600 samples from 100 neuroangiographies. Per angiography, fluid samples from the three routinely used syringes as well as the syringes themselves were analyzed. We analyzed the frequency and extent of contamination and determined the germ spectrum. (3) Results: The majority of samples (56.9%) were contaminated. There was no angiography that showed no contamination (0%). The outer surfaces of the syringes were contaminated significantly more frequently and to a higher extent than the inner surfaces. Both the frequency and extent of contamination of the samples increased with longer duration of angiographic procedures. Most of the bacterial species were environmental or skin germs (87.7%). (4) Conclusions: Bacterial contamination is a frequent finding during neuroangiographies, although its clinical significance is believed to be small. Bacterial contamination increases with longer duration of angiographic procedures.

Nosocomial outbreaks of aseptic meningitis: A public health concern

Nosocomial outbreaks of aseptic meningitis: A public health concern

Air contamination, syringe contamination, and cross-contamination when using an automatic compounding device for sensitizing drugs

Abstract Objectives To measure cross-contamination between batches of different sensitizing drugs, contamination on the outside of compounded syringes, and drug concentrations in environmental air when using an automated compounding device. Methods One batch of piperacillin/tazobactam syringes followed by one batch of meropenem syringes were compounded daily for three consecutive days by one operator. For each batch two hundred syringes were filled. During each batch, three stationary air samples (two inside and one outside the compounding device), and one personal air sample were collected. At the end of the compounding process, the outside of 40 syringes was tested for drug contamination by wipe sampling. The drug compounded was checked for cross-contamination with the other drug compounded in the previous batch. Liquid chromatography tandem mass spectrometry was used for the analysis of piperacillin and meropenem. Results Piperacillin was measured in environmental air inside the device (8.1–335 ng/m3), outside the device (5.2–21 ng/m3), and in the personal air samples of the operator (15 and 155 ng/m3) during two batches. Meropenem was not detected during meropenem compounding. Piperacillin was found in the air samples of the operator during two batches (12 and 15 ng/m3). Meropenem was not detected in any of the air samples. The drug compounded was found on the outside of the syringes for all batches (piperacillin: 1.35–30 ng/cm2; meropenem: 0.07–0.65 ng/cm2). Piperacillin was detected on the syringes in all meropenen batches (0.56–11 ng/cm2), and meropenen in two piperacillin batches (0.07 and 0.46 ng/cm2). The drug solutions show no cross-contamination with the other drug for any of the batches. Conclusions Cross-contamination was not found and the drug concentrations in environmental air were below the Occupational Exposure Limit of 0.1 mg/m3. The automatic compounding device meets the criteria for a safe compounding of sensitizing drugs for patient and operator.

An Easily Overlooked Contamination of Syringes in Newborn Screening by Tandem Mass Spectrometry.

Background: Tandem mass spectrometry becomes a common and important test in newborn screening, but potential contamination of the equipment has largely been ignored.Methods: The source of contamination through Biosan quality control samples was examined prospectively, and further confirmed by retrospective analysis of patient samples.Results: We found that the source of contamination came from a syringe in the Biosan quality control samples. Furthermore, we found that a large number of indicators in the patient sample were interfered by syringe contamination in our center, and also in two other newborn screening centers, but the affected indicators were different in different screening centers.Conclusion: Syringe contamination will affect the detection of patient samples by tandem mass spectrometry and should be monitored carefully and immediately.

Anesthesia Workspace Cleanliness and Safety: Implementation of a Novel Syringe Bracket Using 3D Printing Techniques.

Purpose Wide variability persists in the preparation and storage of common anesthetic medications despite the recognition of anesthesia workspace standardization as a national quality improvement priority. Syringe contamination and medication swaps continue to pose significant hazards to patient safety. Methods We assessed differences in practice related to the availability of commonly prepared anesthetic medications. Using baseline provider surveys (n = 87) and anesthesia workspace audits (n = 80), we designed a custom syringe organization device using 3D printing techniques to serve as a cognitive aid and organizational tool. We iteratively tested and then deployed this device in all 60 operating rooms at a single institution, and then, repeated postintervention surveys (n = 79) and workspace audits (n = 75) one year after introduction. Results Implementation was associated with significant improvements in provider-reported medication availability during coverage and handoff situations (43.7% versus 76.2% reporting 95% confidence preintervention versus postintervention, p < 0.001). This was substantiated by audits of the anesthesia workspace which demonstrated reduced variability in the location (p < 0.001) and availability (p < 0.001) of key medications. Provider confidence in the cleanliness of syringes was also improved (p=0.01). A high degree of acceptance and compliance with the intervention was reported, with 80.4% of syringes observed to be stored in the device one year after implementation and approximately 95% of respondents reporting positive measures of usability and convenience. Conclusion Use of a simple organizational device for syringes in the anesthesia workspace has numerous safety benefits. 3D printing offers improvements in adaptability and affordability compared with prior approaches.

Improving Aseptic Technique During the Treatment of Pediatric Septic Shock

Rapid fluid resuscitation is used to treat pediatric septic shock. However, achieving fluid delivery goals while maintaining aseptic technique can be challenging. Two methods of fluid resuscitation—the commonly used push-pull technique (PPT) and a new fluid infusion technique using the LifeFlow device (410 Medical, Inc; Durham, NC)—were compared in a simulated patient model. PPT was associated with multiple aseptic technique violations related to contamination of the syringe barrel. This study confirms the risk of PPT-associated syringe contamination and suggests that this risk could be mitigated with the use of a protected syringe system, such as LifeFlow.

Microbial contamination of syringes during preparation: The direct influence of environmental cleanliness and risk manipulations on end-product quality

The direct influence of environmental cleanliness and risk manipulations on prepared syringes was evaluated. Media-fill testing was used to estimate potential microbial contamination. Syringes were prepared in three different environments using four different uncontrolled high-risk manipulations. The three environments included an International Organization for Standardization (ISO) class 5 horizontal laminar-airflow hood in an ISO class 6 cleanroom (in accordance with United States Pharmacopeia [USP] chapter 797), an ISO class 7 drug preparation area of an operating room, and an uncontrolled decentralized pharmacy in a ward. For each combination of environment and manipulation, 100 syringes were filled by a single operator. The four high-risk manipulations used included simple filling of syringes with trypticase soy broth, three-second contact by the ungloved fingers of the operator with the hub of the syringe, three-second contact between an object and the hub of the syringe, and exposure of the filled syringes to ambient air for 10 minutes. Of the 1500 syringes prepared in three different environments, none produced within the cleanroom contained microorganisms, 6% were contaminated in the operating room, and 16% were contaminated in the ward (p < 0.0001). Certain high-risk manipulations were associated with a significant increase in the contamination of the surrogate syringes, including exposure to nonsterile ambient air and nonsterile objects or fingers (p < 0.0001). High contamination rates were measured when the hub of syringes touched nonsterile environmental surfaces and fingers, whereas the drawn-air manipulation was associated with a lower risk of contamination. Working within a properly operating unidirectional airflow primary engineering control in an ISO class 5 cleanroom in accordance with USP chapter 797 requirements was demonstrated to be the best way to avoid bacterial or fungal contamination of injectable drugs directly resulting in patient infections.

Epidemiologic Investigation of a 2007 Outbreak of Serratia marcescens Bloodstream Infection in Texas Caused by Contamination of Syringes Prefilled With Heparin and Saline

This retrospective cohort study found that syringes prefilled with heparin flush solution caused an outbreak of Serratia marcescens bloodstream infection at an outpatient treatment center in Texas in 2007. The epidemiologic study supported this conclusion, despite the lack of microbiologic evidence of contamination from environmental and product testing. This report underscores the crucial contributions that epidemiologic studies can make to investigations of outbreaks that are possibly product related.

Microbiologic Contamination of Automatic Injectors at MDCT: Experimental and Clinical Investigations

It is mandatory to teach antiseptic skills to staff who use contrast agent injectors. The purpose of this study was to evaluate in an experimental setting and in clinical routine the risk of microbiologic contamination of the syringes of injectors used to administer contrast agent and saline solution for MDCT. Microbiologic contamination of CT injector syringes over multiple uses for several injections was investigated in an experimental setup simulating the clinical setting. Each refill and injection operation was performed by the same technician, who processed a contrast agent for administration in a neighboring room as in clinical CT routine. Multiple administrations of nutritive medium and a chaser bolus were performed with the injection syringes. Simultaneously with each syringe replacement and filling operation, the filling and injection operation was simulated with a separate injection system under normal clinical conditions. Hygienic conditions in the CT department also were evaluated. For microbiologic analysis of devices and of palms of staff, imprints were obtained during clinical routine at the beginning of the study and at follow-up. Throughout the study, the staff participated in continuing education on hygienic behavior, such as hand disinfection and wearing of sterile gloves. In addition, clinical injector syringes were checked for microbiologic contamination. In the experimental setup, the first four samples of each simulation experiment were sterile, and the subsequent probes were found to be contaminated with typical dermal bacteria, such as staphylococci. In the CT department, contamination with skin and oral flora was found on surfaces of devices and on palms. No imprint of surfaces or palms was contaminated with nosocomial or fecal pathogens. Because even optimization of environments does not prevent contamination of syringes, multiple uses of syringes for more than one patient should be prohibited owing to the risk of septic complications.

Air bubble barrier to syringe contamination

Air bubble barrier to syringe contamination

Modified syringe design prevents plunger-related contamination—results of contamination and flow-rate tests

The usual mechanism for syringe contamination is spread of micro-organisms along the inside of the barrel. Two or more full strokes of the plunger will inevitably transport a contaminant from the inside wall into the sterile compartment. We modified syringes by replacing the plunger with a modified version that has an additional central O-ring seal. Conventional and modified syringes were tested for their susceptibility to contamination using standard microbiological and radioisotope methods, and the flow-rate stability of the modified syringe design was assessed in a model with commercially available infusion pumps. Although conventional syringes consistently became contaminated with the second full excursion of the plunger, no contamination was observed in modified syringes, even after 100 aspiration/injection cycles. With respect to flow-rate stability, the new syringe design complies with DIN (German Institute for Standardization) standards.

Contamination of medicine injection paraphernalia used by registered medical practitioners in south India: an ethnographic study

While considerable attention has been directed at the important role of intravenous drug use in the spread of human immunodeficiency virus (HIV) and hepatitis B, little research to date has been conducted on the role of medicine injections in disease transmission. This is the case despite the fact that (a) the number of medicine injections is several orders of magnitude greater than injections of illegal drugs and (b) the networks of people potentially affected by contaminated medicine injection paraphernalia is far wider. In this article we examine the medicine injecting practices of a random sample of 40 registered medical practitioners (RMP) who have not had formal training in allopathic medicine (do not have MBBS or MD degrees) in Tamil Nadu, India. Attention is drawn to: (a) the lack of vigilance practitioners exercise in maintaining hygienic needles and syringes, (b) their perceptions of what constitutes acceptable hygienic procedure and (c) how patients respond in contexts where they are able to purchase disposable needles and syringes directly from practitioners or from the open market prior to visiting a practitioner. Study results are a cause for alarm and indicate widespread contamination of injection paraphernalia as well as common reuse of disposable needles. The study was confined to RMPs and the researchers strongly suggest that future studies of MBBS trained doctors practising in the public and private sectors be carried out. A structured observation instrument developed to record needle and syringe contamination during the process of injection administration is provided.

Titrated intravenous opioids from the same syringe: an infection risk?

OBJECTIVE: (1) To compare the rate of contamination of syringes prepared under laminar flow conditions in pharmacy with those prepared by nurses in the emergency department; (2) to determine whether...

Risk of cross-infection related to the multiple use of disposable syringes

The rate of blood contamination of IV tubings used in anaesthesia practice was investigated. Only IV tubings started in the operating room were studied. First, 300 tubings of three different types were tested at the three distal injection sites. The contamination rate was 3.3 per cent at the injection site closest to the IV catheter and 0.3 per cent at the furthest. The presence of a check-valve did not affect the contamination rate. Second, 300 third injection sites fixed at a level equal to or above the IV catheter were tested. None of them was contaminated. Finally, in order to evaluate whether changing the needle alone could prevent the contamination of syringes, injections were made into a tubing where blood was flowing. Thirty-four per cent of the syringes tested positive for blood. We conclude that IV tubings have a significant contamination rate in usual practice. This rate decreases as the distance from the IV catheter increases. The use of the third site fixed at a level equal to or above the IV catheter carries a lower risk of contamination. Changing the needle alone is a useless procedure to prevent cross-contamination.

MYCOBACTERIUM FORTUITUM IN ABSCESSES OF MAN.

Myco. fortuitum was isolated from subcutaneous abscesses of two patients who had been inoculated with B.C.G. and one patient who had iron injections. The organisms were resistant to a wide range of anti-tuberculous drugs. They were highly virulent for mice in which they produced symptoms of spinning disease. It is thought that the infections originated from contamination of syringes or skin.

Syringe contamination following intramuscular and subcutaneous injections.

Syringe contamination following intramuscular and subcutaneous injections.

Contamination of syringes used for skin tests

Contamination of syringes used for skin tests