Rapid assessment of injection practices in Cambodia, 2002

Background

Injection overuse and unsafe injection practices facilitate transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Anecdotal reports of unsafe and unnecessary therapeutic injections and the high prevalence of HBV (8.0%), HCV (6.5%), and HIV (2.6%) infection in Cambodia have raised concern over injection safety. To estimate the magnitude and patterns of such practices, a rapid assessment of injection practices was conducted.

Methods

We surveyed a random sample of the general population in Takeo Province and convenience samples of prescribers and injection providers in Takeo Province and Phnom Penh city regarding injection-related knowledge, attitudes, and practices. Injection providers were observed administering injections. Data were collected using standardized methods adapted from the World Health Organization safe injection assessment guidelines.

Results

Among the general population sample (n = 500), the overall injection rate was 5.9 injections per person-year, with 40% of participants reporting receipt of ≥ 1 injection during the previous 6 months. Therapeutic injections, intravenous infusions, and immunizations accounted for 74%, 16% and 10% of injections, respectively. The majority (>85%) of injections were received in the private sector. All participants who recalled their last injection reported the injection was administered with a newly opened disposable syringe and needle. Prescribers (n = 60) reported that 47% of the total prescriptions they wrote included a therapeutic injection or infusion. Among injection providers (n = 60), 58% recapped the syringe after use and 13% did not dispose of the used needle and syringe appropriately. Over half (53%) of the providers reported a needlestick injury during the previous 12 months. Ninety percent of prescribers and injection providers were aware HBV, HCV, and HIV were transmitted through unsafe injection practices. Knowledge of HIV transmission through "dirty" syringes among the general population was also high (95%).

Conclusion

Our data suggest that Cambodia has one of the world's highest rates of overall injection usage, despite general awareness of associated infection risks. Although there was little evidence of reuse of needles and syringes, support is needed for interventions to address injection overuse, healthcare worker safety and appropriate waste disposal.

[Automatic injectors in magnetic resonance imaging and computed tomography: pilot study on hygienic aspects]

PURPOSE

To evaluate hygienic conditions using automatic injectors in magnetic resonance imaging (MRI) and computed tomography (CT) during clinical routine.

MATERIALS AND METHODS

The surfaces of medical devices (e. g., control console) and the palms of the technical and medical staff were microbiologically analyzed by taking imprints before and after hygienic education. In addition, the injector syringes for contrast medium (CM) and saline were checked for microbiological contamination following multiple (MRI: 14 h; CT 8 h) and single use. Furthermore, the potential of retrograde contamination from the patient along the tube was analyzed.

RESULTS

A bacterial contamination with typical dermal bacteria was documented for the surfaces of the medical devices, the palms of the technical and medical staff, and the injection syringes following multiple use (MRI: 10/10 CM syringes, 6/10 saline syringes; CT: 8/10 CM syringes, 5/10 saline syringes). Correct hand disinfection in combination with single use of syringes avoided bacterial colonization. Retrograde bacterial contamination from the patient was not observed.

CONCLUSION

Regular hygienic teaching sessions for technical and medical staff in MRI and CT departments using automatic injectors should be mandatory. Furthermore, the multiple use of syringes should be avoided until investigations addressing the potential of bacterial contamination are performed.

Safety and efficacy of the POP technique for restoring patency to occluded PIC catheters

Peripheral-inserted central catheters (PICCs) offer a successful alternative to peripheral venipuncture for long term medication therapy. When catheters become occluded, the nurse must intervene to avoid delayed or missed treatments. Pharmacological interventions are costly and not without risks. The purpose of this exploratory study was to test a mechanical percussive POP technique to restore patency. Thirty PICC catheters were clotted with human blood and incubated for 8 hours in a 35 degrees saline bath. Using the percussive POP technique, a 10-mL syringe with 1 mL of saline restored patency in 86% of the occluded catheters. The safety and effectiveness of the POP technique in vitro was established.

Are peristaltic pumps as reliable as syringe pumps for metabolic research? Assessment of accuracy, precision, and metabolic kinetics

Syringe pumps are traditionally used to infuse tracers in metabolic research because they are perceived to be more accurate and precise than peristaltic pumps. This study evaluated the accuracy (actual v programmed infusion rate) and precision (reproducibility of infusion) of a peristaltic pump (Gemini PC 2; IMED, San Diego, CA) and a syringe pump (Model 22; Harvard Apparatus, Natick, MA) for metabolic research. In one protocol, saline delivery was measured in vitro in 5 trials at 4 flow rates: 3, 30, 150, and 300 mL/h. In the second protocol, basal glycerol rate of appearance (Ra) was determined in vivo in 5 women on 2 consecutive days. On day 1, [2-(13C)]glycerol was infused with 1 pump and [1,1,2,3,3-(2H5)]glycerol with the other. On day 2, the opposite pattern was used. The accuracy of the 2 pumps was the same (error approximately 2%). In addition, both the syringe and the peristaltic pumps were very precise, with coefficients of variation (CV) <1% at all flow rates. Glycerol Ra values were the same when tracer was infused with either a syringe or peristaltic pump on day 1 and day 2: 4.1 +/- 1.7 (syringe pump) and 4.2 +/- 1.9 (peristaltic pump) micromol. kg fat mass (FM)(-1). min(-1) on day 1; 4.2 +/- 1.2 (syringe pump) and 4.2 +/- 1.3 (peristaltic pump) micromol. kg FM(-1). min(-1) on day 2. These data demonstrate that both syringe and peristaltic pumps are very accurate and precise across a large range of flow rates. Moreover, the assessment of in vivo substrate kinetics in human subjects is the same when either pump is used to infuse isotope tracers.

Experimental determination of calibration settings for plastic syringes containing solutions of 90Y using commercial radionuclide calibrators

Calibration factors for several makes (Capintec, AtomLab, and PTW) and models of commercially available re-entrant ionization chambers ("dose calibrators") were determined for solutions of 90Y using 10 ml plastic syringes that are used in the administration of the recently approved radioimmunotherapy drug Zevalin. Effects of filling volume on chamber response were studied for the anticipated prescription volume range of 3-9 ml in those syringes. A series of syringes were prepared over that range with accurately known volumes using a "standard" solution containing 90YCl3 in 1 moll(-1) HCl and approximately 50 microg of nonradioactive YCl3 per gram of solution. The respective calibration factors for the Capintec and AtomLab chambers required to give the correct activity reading were found to be "55+/-2 x 10" and 393+/-6, where the uncertainties are expanded (k = 2) uncertainties. The results indicated no significant effect of filling volume on the calibration setting to within the uncertainty on the activity measurement for all but the PTW chamber. In that case, a variation of about 5% was observed over the filling range. A direct comparison was also made between the actual 90Y Zevalin drug and the "standard" solution, with no differences in determined calibration settings observed within the uncertainties on the activity calibration.

Transfer standard for beta decay radionuclides in radiotherapy

The measurement of the activity of therapeutic radiopharmaceuticals prior to the administration to patients is normally achieved via the use of radionuclide calibrators. An accurate measurement of the activity of pure beta-emitters is complex. Calibration problems can be solved by combining a primary calibration with a 90Y reference solution and a 90Sr/90Y transfer standard with a solid source, simulating geometric effects caused by high energetic beta radiation. The recent development of a 90Sr/90Y transfer standard for this purpose is reported.

Syringe calibration factors for the NPL Secondary Standard Radionuclide Calibrator for selected medical radionuclides

Before a radiopharmaceutical is administered to a patient, its activity needs to be accurately assayed. This is normally done via a radionuclide calibrator, using a glass vial as the calibration device. The radionuclide is then transferred to a syringe and it is now becoming common practice to re-measure the syringe and use this value as the activity administered to the patient. Due to elemental composition and geometrical differences, etc. between the glass vial and the syringe, the calibration factors are different for the two containers and this can lead to an incorrect activity being given to the patient unless a correction is applied for these differences. To reduce the uncertainty on syringe measurements, syringe calibration factors and volume correction factors for the NPL Secondary Standard Radionuclide Calibrator have been derived by NPL for several medically important radionuclides. It was found that the differences between the calibration factors for the syringes and glass vials depend on the energies of the photon emissions from the decay of the radionuclides; the lower the energy, the greater the difference. As expected, large differences were observed for 125I (70%) and only small differences for 131I. However, for radionuclides such as 99mTc and 67Ga, differences of up to 30% have been observed. This work has shown the need for the use of specifically derived syringe calibration factors as well as highlighting the complexity of the problem with regard to syringe types, procurement, etc.

Evolution of fibrin glue applicators

Fibrin glue (FG) is used worldwide as a potent surgical tool, which establishes hemostasis in wounds and also bonds tissue. The standard FG applicator is based on a dual-syringe system. This review, based mainly on the patent literature, describes the development of the quasi-standard dual syringe system as well as the rise of other FG applicator designs based on mechanical force (ratchet systems), Bernoulli gas flow, positive gas pressure, or electro-servo devices. The packaging of commercial FG components is reviewed within the context of "loading" the FG applicators and the need to minimize the number of needles required to access the packaged (vials) components. Parameters such as internal clogging, homogeneity of spray, the requirement for gas or vacuum house lines, the number of parts that must be handled, and the time required to assemble the applicator, load it, and have it ready for use are also discussed. A rating system is proposed that permits one to use such parameters to rank the various applicator designs, relative to the dual-syringe system. Hopefully, this review will stimulate the design of better FG applicators and packaging required for elective surgery, emergency treatments, and tissue engineering in the 21st century.

Statistical evaluation of stability data: criteria for change-over-time and data variability

In a recently issued ICH Q1E guidance on evaluation of stability data of drug substances and products, the need to perform a statistical extrapolation of a shelf-life of a drug product or a retest period for a drug substance is based heavily on whether data exhibit a change-over-time and/or variability. However, this document suggests neither measures nor acceptance criteria of these two parameters. This paper demonstrates a useful application of simple statistical parameters for determining whether sets of stability data from either accelerated or long-term storage programs exhibit a change-over-time and/or variability. These parameters are all derived from a simple linear regression analysis first performed on the stability data. The p-value of the slope of the regression line is taken as a measure for change-over-time, and a value of 0.25 is suggested as a limit to insignificant change of the quantitative stability attributes monitored. The minimal process capability index, Cpk, calculated from the standard deviation of the regression line, is suggested as a measure for variability with a value of 2.5 as a limit for an insignificant variability. The usefulness of the above two parameters, p-value and Cpk, was demonstrated on stability data of a refrigerated drug product and on pooled data of three batches of a drug substance. In both cases, the determined parameters allowed characterization of the data in terms of change-over-time and variability. Consequently, complete evaluation of the stability data could be pursued according to the ICH guidance. It is believed that the application of the above two parameters with their acceptance criteria will allow a more unified evaluation of stability data.

Legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: A comparative study of Denmark, Norway and Sweden

BACKGROUND

Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies.

METHODS

Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers.

RESULTS

A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment.

CONCLUSION

Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.

Needlestick-prevention devices. Disposable syringes and injection needles

Needlestick-prevention devices (NPDs) are an essential tool for protecting healthcare workers from injuries that could result in exposure to bloodborne pathogens. More than a dozen NPD varieties are available. They generally take the same form as conventional (nonsafety) sharps but incorporate some type of safety design--for example, a shield or a needle-retracting mechanism. In this Evaluation, we focus on protective devices that are used in place of conventional syringes and injection needles--namely, disposable protective syringes and needle guards. We tested 14 products from 8 suppliers. We give Preferred ratings to three products, all of which are needle-retracting syringes. When used correctly, these devices provide the best protection available. However, their primary safety advantage--preremoval activation--can be negated if the user chooses to activate the safety mechanism after removing the needle from the patient. For many facilities, one of the seven models we rate Acceptable might be a better choice. We caution that our ratings should not be the sole basis of a purchase decision. Staff members need to conduct a hands-on assessment of the available products to identify those that best meet their needs. We also stress that any NPD--even one we rate Not Recommended--is preferable to using no protective device at all.

Performance of a device to minimise radiation dose to the hands during radioactive syringe calibration

The preparation of syringes for routine applications in nuclear medicine, and in particular the calibration procedure, is associated with high radiation exposure to the hands. To reduce this radiation burden, our group developed a modified calibration procedure based on a device that we refer to as the ActivoFix, which allows syringes to be drawn up inside the dose calibrator. This study investigated the performance of the new device as compared to the usual procedure of syringe calibration with regard to the absorbed radiation dose to the hands (fingertips and middle finger bases), the precision of the calibration procedure and the time required to calibrate syringes. Fourteen experienced nuclear medicine technologists drew up syringes from an initial eluate of 8.2 GBq using the conventional technique and the new calibration procedure. All technologists had to calibrate syringes with 50 MBq, 250 MBq and 650 MBq. This sequence was repeated four times using the conventional technique and then the new procedure. The equivalent dose to the hands was measured with thermoluminescent dosimeters. The exact amount of radioactivity in the syringe and the time needed for the calibration procedure were also recorded. The reduction in equivalent dose using the new device compared with the routine procedure ranged from 8.3- to 19.6-fold (mean 14.3-fold) for the fingers of the dominant hand and from 13.6- to 40.3-fold (mean 27-fold) for those of the non-dominant hand (total mean 21.3-fold). For small volumes, time could be saved with the ActivoFix, whereas for greater volumes time was lost. The device produced less variability in calibrating doses at 250 MBq and 650 MBq. Following the ALARA principle, the new device can be recommended for syringe calibration in nuclear medicine because the use of the ActivoFix-based procedure reduces finger dose by an average factor of 21, improves the precision of calibration and reduces the filling time for small volumes.

Ensuring injection safety during measles immunization campaigns: more than auto-disable syringes and safety boxes

Measles immunization campaigns are effective elements of a comprehensive strategy for preventing measles cases and deaths. However, if immunizations are not properly administered or if immunization waste products are not safely managed, there is the potential to transmit bloodborne pathogens (e.g., human immunodeficiency virus and hepatitis B and hepatitis C). A safe injection can be defined as one that results in no harm to the recipient, the vaccinator, and the surrounding community. Proper equipment, such as the exclusive use of auto-disable syringes and safety boxes, is necessary, but these alone are not sufficient to ensure injection safety in immunization campaigns. Equally important are careful planning and managerial activities that include policy and strategy development, financing, budgeting, logistics, training, supervision, and monitoring. The key elements that must be in place to ensure injection safety in measles immunization campaigns are outlined.

Injection practices and sharp waste disposal by general practitioners of Murree, Pakistan

OBJECTIVE

To describe the injection and sharp waste disposal practices of general practitioners of Murree, Pakistan.

METHODOLOGY

In-depth interviews of all general practitioners available between 10th to 20th July 2000 were conducted. Practitioners were interviewed about injection administration and disposal of waste due to injections and other sharp material.

RESULTS

Twenty general practitioners out of 25 were interviewed. All claimed using disposable syringes only once. None of them was disposing off syringes in sharp containers in the clinic. Of 20, 12 (60%) were throwing syringes at open places and 5 (25%) in municipal waste bins. Most of the injections by general practitioners were administered for fever, body aches, diarrhea and respiratory tract infection.

CONCLUSION

Sharp waste disposal is not safe in Murree. Improper disposal of sharp waste needs development of cost effective methods that are applicable at a small scale. Larger studies are required to quantify the gravity of the problem.

Nonlinear model for offline correction of pulmonary waveform generators

Pulmonary waveform generators consisting of motor-driven piston pumps are frequently used to test respiratory-function equipment such as spirometers and peak expiratory flow (PEF) meters. Gas compression within these generators can produce significant distortion of the output flow-time profile. A nonlinear model of the generator was developed along with a method to compensate for gas compression when testing pulmonary function equipment. The model and correction procedure were tested on an Assess Full Range PEF meter and a Micro DiaryCard PEF meter. The tests were performed using the 26 American Thoracic Society standard flow-time waveforms as the target flow profiles. Without correction, the pump loaded with the higher resistance Assess meter resulted in ten waveforms having a mean square error (MSE) higher than 0.001 L2/s2. Correction of the pump for these ten waveforms resulted in a mean decrease in MSE of 87.0%. When loaded with the Micro DiaryCard meter, the uncorrected pump outputs included six waveforms with MSE higher than 0.001 L2/s2. Pump corrections for these six waveforms resulted in a mean decrease in MSE of 58.4%.

Standardized colour coding for syringe drug labels: a national survey

A standardised colour code for user-applied syringe labels for anaesthetic drugs exists in the USA, Australia, New Zealand and Canada. In the UK, there is none. Consequently, an assortment of colour codes for syringe labels is available in the UK. We conducted a postal survey of the 285 College Tutors of the Royal College of Anaesthetists to establish their local syringe drug labelling system and their views on a national, standardised colour code. We found that that 96% of departments currently use coloured syringe drug labels. Of these, 98% use the 'Medilabel' scheme. The College Tutors felt that a standardised colour code for labels is required (94%), that the Association of Anaesthetists or the Royal College of Anaesthetists should be involved in the choice of scheme (76%) and that the scheme chosen should be international (65%). There was a majority feeling that the opinions expressed were representative of other members of the College Tutors' departments. We conclude that a national standard for drug labels is required and that a choice will have to be made between the 'international' scheme and the currently dominant Medilabel scheme.

Calibration of a liquid I-125 source in a syringe

The calibration of a liquid I-125 source in an older standard dose calibration system is presented. The calibration factor agrees well with factors established by the NIST for newer dose calibration systems. The determination of the source activity is necessary to accurately calculate the time required to deliver the prescribed dose.

[Potential advantages a new syringe pump system]

OBJECTIVES

To evaluate what could be the benefit in terms of alarm suppression, of a new syringe pumps system, which allows automatic relay without alarms.

PATIENTS AND METHODS

We have prospectively recorded the nature and the mode of relay of all syringe pumps for administration of drugs to patients in two ICU. The perfusion regimen was studied in 61 patients over the complete duration of their stay in two ICU. Alarms were also recorded in one ICU room, over 13 days consecutive. The records were processed off-line with an automatic detection-recognition system in order to assess the origin of each alarm. Accordingly, the amount of alarm corresponding to monitor, ventilator and syringe pumps was computed.

RESULTS

We found that syringe pumps, which would provide automatic relays without alarm, would suppress 17% of alarms in ICU and automatize 65% of the relay procedures, which are usually performed often in emergency, on response to the end of perfusion alarm.

CONCLUSION

New syringe pumps allow both reduction of alarms in ICU and a better management of nurse workload. Indeed syringe relay can be planned in advance.

Accuracy and precision of intraocular injection volume

PURPOSE

To assess the accuracy and precision of methods in clinical use for intraocular drug injection.

DESIGN

Experimental laboratory investigation.

METHODS

A total of 800 injections were performed using 20 different 1-ml syringes at intended volumes of 0.10 ml and 0.05 ml. The volume of each injection was calculated from mass of water delivered onto an analytic balance.

RESULTS

The mean measured volume delivered was less than the intended volume for every syringe (P <.001 for each syringe at each volume). A total of 7% and 22% of injections differed by 20% or more from the intended volumes of 0.10 ml and 0.05 ml, respectively. Overdelivery of volume was uncommon.

CONCLUSION

Clinically relevant materials and methods used for intraocular injection of drugs systematically underdelivered the intended volume.

Intravascular administration sets are accurate and in appropriate condition after 7 days of continuous use: an in vitro study

BACKGROUND

The ideal duration of intravascular administration set use is unknown. Studies have compared the infective implications of 1--7 days of use. The Centers for Disease Control recommend at least 3 days usage. No previous study has evaluated the accuracy of volume delivery or integrity of administration sets after prolonged use.

AIM

To evaluate the accuracy and condition of intravascular administration sets used continuously for 7 days.

DESIGN

Prospective, randomized, experimental study in the laboratory setting.

METHODS

Four administration sets were randomly assigned to deliver 2 mL/hour (IMEDreg syringe set 2280--0000), 20, 50 or 100 mL/hour (IMEDreg infusion sets 2210--0500) of crystalloid solution continuously for 7 days through an IMEDreg Geminireg four channel infusion pump (PC4). At study commencement and daily for 7 days, a 4-hour volume measurement and an inspection for leaks/erosion of administration sets occurred for each administration set (total measurements = 32).

RESULTS

Mean volume outputs over 4 hours were 7.84 mL (2 mL/hour), 80.66 mL (20 mL/hour), 205.35 (50 mL/hour) and 406.37 (100 mL/hour). These differed significantly from the programmed volumes (P=0.00--0.01). Usage duration did not influence performance (F=0.866, P=0.55). Accuracy of volume delivery differed significantly with pump speed (F=106.933, P < 0.001) exhibiting increased volume to 50 mL/hour then a reduction at 100 mL/hour. Differences were within manufacturer specifications (+/-5%) and were clinically acceptable. All administration sets remained in appropriate condition displaying no leakage or erosion.

CONCLUSION

There were small inaccuracies found between programmed and delivered volumes, however, there was no deterioration in performance over time. This suggests that inaccuracies were because of normal pump performance rather than the administration sets. Administration sets retain acceptable accuracy and condition after 7 days continuous use. Further research should assess the infective and other impacts of prolonged usage.

Prevalence of safer needle devices and factors associated with their adoption: results of a national hospital survey

OBJECTIVES

In this study, we collected and analyzed the first data available on the extent of the adoption of safer needle devices (engineered sharps injury protections [ESIPs]) by U.S. hospitals and on the degree to which selected factors influence the use of this technology.

METHODS

We gathered data via a telephone survey of a random sample of 494 U.S. hospitals from November 1999 through February 2000.

RESULTS

Although 83% of the sample reported some ESIP adoption, adoption was inconsistent across types of devices. All of the appropriate units in 52% of the facilities had adopted needleless intravenous delivery systems, but the hospitals used other types of ESIPs less often. A respondent's perception that the cost of ESIPs would not be a problem for the hospital was the best predictor of adoption of ESIPs in the facility, explaining 8% of the variance. Other predictors of adoption included the size of the hospital and the presence or absence of state legislative activity on the needlestick issue.

CONCLUSIONS

Smaller hospitals may require special encouragement and assistance from outside sources to adopt expensive risk-reduction innovations such as ESIPs. Although use of ESIPs is the mandated and preferred way to protect workers from needlesticks, complete adoption of this technology will depend on the support of the social systems in which it is used and the people who use it.

Modifications to the hand-held Gene Gun: improvements for in vitro biolistic transfection of organotypic neuronal tissue

Transfection and subsequent expression of DNA in living neuronal tissue is problematic and no technique has emerged that is completely non-damaging, efficient and reproducible. The Bio-Rad hand-held Gene Gun has overcome some of these problems by exploiting a biolistic method in which small gold particles carrying plasmid DNA are propelled into neurons whilst causing minimal detectable cell damage. In its current configuration, however, the Bio-Rad Gene Gun is optimised for transfecting cells in dispersed cultures, and therefore delivers particles superficially over a relatively wide area. Here we report modifications to the Bio-Rad Gene Gun that both enhance its accuracy by restricting its target area, and increase the depth penetration achieved by gold particles, thereby allowing smaller and deeper tissues to be transfected. These alterations make the modified Gene Gun more applicable for in vitro transfection of organotypic cultures and enhance its potential utility for in vivo gene delivery. Moreover, the modified configuration operates successfully at lower gas pressures, thereby reducing even further the degree of cell damage incurred during transfection.

Aseptic efficacy of prefilled syringes in a polluted environment

INTRODUCTION

To evaluate the aseptic efficacy of prefilled syringes compared with ampules when used in a polluted environment similar to that at a disaster site.

METHODS

The researchers tested epinephrine, 0.1%, atropine sulfate, 0.05%, and lidocaine hydrochloride solutions, 2% (Group A) as well as lidocaine hydrochloride, 10%, sodium bicarbonate, 8.4%, and glucose solutions, 50% (Group B), that frequently are used for intravenous injection and intravenous infusion respectively in Disaster Medicine. Each of these solutions in 10 prefilled syringes (PFSs) and 10 ampules was placed in a box of contaminated soil along with needles and empty syringes for ampules. In the box, each was taken out of its package, all syringes were connected with a needle, and empty syringes were filled with a solution. After this procedure, all syringes were taken out of the box to check their contents for bacterial contamination.

RESULTS

No bacterium was observed in any of the 10 PFS samples of Group A and B solutions. In contrast, out of 10 ampule samples, six of the 10 samples containing epinephrine, nine of the 10 containing atropine sulfate, all 10 samples containing lidocaine hydrochloride, 2%, and all of the ampule samples containing Group B solutions tested positive for bacteria. A statistically significant difference was observed between the PFS and ampule samples in all six solutions.

CONCLUSION

Results indicate that, in environments with airborne contaminants, the use of prefilled syringes may be useful for preventing bacterial contamination of the medicine inside.