What are we injecting with our drugs?

Glass particulate adulterated in single dose ampoules: A patient safety concern

AIMS AND OBJECTIVES

To determine the amount, size and characteristics of glass particulate contamination inside single-dose ampoules.

BACKGROUND

Glass particulate contamination in an ampoule when opened can cause adverse effects on critically ill patients.

DESIGN

Crossectional descriptive study.

METHODS

Eight hundred 10-ml sterile water ampoules were inspected for glass particulate contamination upon opening. Ampoules were opened by nurses following their usual practices. Glass particulates were inspected by stereomicroscope. Further examination was conducted using a scanning electron microscope (SEM) to determine the size and amount of the particulates in the 20 positive and 20 negative samples from stereomicroscope inspection. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for preparing this manuscript.

RESULTS

Seven hundred and ninety-eight ampoules were inspected, as 2 ampoules were broken. Glass particulates were detected in 65% of the ampoules (519/798). The size of glass particulates from 20 positive and 20 negative samples, ranged from 8 to 172 microns and 8 to 102 microns, respectively. The glass particulates were detected most at sized ≤ 50 microns in both positive and negative samples with the mean number of 47.8 ± 20.4 and 27.8 ± 21.8 particulates, respectively.

CONCLUSION

Glass particulate contamination occurred while opening medication in glass ampoules. A safety tool is needed to prevent glass particulates from contaminating injection treatments.

RELEVANCE TO CLINICAL PRACTICE

Many critically ill patients and neonates need intravenous injections for treatment. Almost all medication solutions are stored in glass ampoules. Nursing personnel should be aware while drawing medication solutions from glass ampoules. Using filtered needles and leaning the ampoules can help reduce the number of glass particulates that pass into the solutions being drawn into the syringes.

Safety concerns with glass particle contamination: improving the standard guidelines for preparing medication injections

Background

Glass ampoules are widely used to contain injection medications because of their properties. However, the existing literature reports that glass particle contamination is found in opening glass ampoules. To date, nursing practice standards on this issue have not gained attention in terms of the manual breaking methods generally used for opening ampoules in a clinical setting that can minimize the risk of glass particle contamination and, therefore, increase patient safety.

Objective

This study aimed to compare manual breaking methods commonly used to open ampoules in clinical practice that affected the number of glass particles and to identify the factors influencing glass particle contamination.

Methods

We used a comparative research design to evaluate the manual breaking methods for opening medication ampoules among 56 registered nurses from diverse clinical areas in a university hospital. Each participant broke 12 ampoules in two sizes using six methods, each method combined with wrapping material and one breaking direction. We measured the number of glass particles in five sizes for each method and the factors influencing glass particle contamination.

Results

In total, 449 of 672 ampoules were contaminated with glass particles. Breaking the ampoule with a cotton ball (partial ampoule neck wrapping) from an outward direction resulted in the fewest glass particles, while breaking the ampoule with a gauze pad (entire ampoule neck wrapping) from an inward direction resulted in the most glass particles. Breaking method, ampoule size and clinical experience significantly influence glass particle contamination (P < 0.05).

Conclusions

The method (wrapping technique and breaking direction) that nurses use to break ampoules affects the number of glass particles. Therefore, improving the standard guidelines for preparing medication injections and training in breaking methods for opening ampoules is essential.

Challenges in reducing the risk of infection when accessing vascular catheters

Injection safety is essential to reduce the risk of healthcare-associated infections (HAIs) when accessing vascular catheters. This general review evaluates the contamination of vascular catheter access ports and associated HAIs in acute care settings, focusing on open lumen stopcocks (OLSs) and disinfectable needleless closed connectors (DNCCs). PubMed was searched from January 2000 to February 2021. OLS intraluminal surfaces are frequently contaminated during patient care, increasing the risk of HAIs, and neither an isopropyl alcohol (IPA) pad nor a port-scrub device can reduce contamination effectively. In contrast, DNCCs can be disinfected, with most studies indicating less intraluminal contamination than OLSs and some studies showing decreased HAIs. While the optimal DNCC design to reduce HAIs needs to be determined, DNCCs alone or stopcocks with a DNCC bonded to the injection port should replace routine use of OLSs, with OLSs restricted to use in sterile fields. Compliance with disinfection is essential immediately before use of a DNCC as use of a non-disinfected DNCC can have equivalent or greater risk of HAIs compared with use of an OLS. The recommendations for access port disinfection in selected national and international guidelines vary. When comparing in-vitro studies, clinical studies and published guidelines, consensus is lacking; therefore, additional studies are needed, including large randomized controlled trials. IPA caps disinfect DNCCs passively, eliminate scrubbing and provide a contamination barrier; however, their use in neonates has been questioned. Further study is needed to determine whether IPA caps are more efficacious than scrubbing with disinfectant to decrease HAIs related to use of central venous, peripheral venous and arterial catheters.