| Summary: | A research report submitted to the Faculty of Health Sciences, University of
the Witwatersrand, Johannesburg, in partial fulfilment of the requirements
for the degree
of
Master of Medicine in the branch of Anaesthesiology
Johannesburg, 2013 === Background: Microbial contamination of multi-dose vials is one of the
mechanisms by which transmission of pathogens to patients can occur in
anaesthesia. Common practice at Chris Hani Baragwanath Academic Hospital
(CHBAH) is to use boluses of a self-prepared, multi-dose phenylephrine
solution (referred to as the solutions) to treat hypotension, due to the
vasodilatory effects of a spinal anaesthetic, in stable patients undergoing a
caesarean section.
Aims: The aims of this study were to determine if there was microbial
contamination of the solutions used at CHBAH and to evaluate if appropriate
labelling and aspiration practices were adhered to with regard to the solutions
A sample was collected and the labelling data was documented from the solutions found
in the obsteric theatres at CHBAH over a period of three months. The samples were
sent to a laboratory for microbial investigation.
Microbial contamination was identified in seven of 110 (6.36%) samples collected from
the solutions. The name of the solution was indicated on all 110 (100%) containers and
the concentration of the solution was indicated on 106 (96.36%) containers. The date
the solution was prepared was indicated on 82 (74.55%) containers and the time the
solution was prepared was indicated on 63 (57.27%) containers. Only nine (8.18%) of
the healthcare workers that prepared the solutions confirmed it by placing a signature on
the container. Labelling data was written directly on all 110 (100%) containers and a
spike device was used in 71 (64.54%) containers.
This study demonstrated microbial contamination of the solutions and that safe injection
practices were not adhered to when intravenous medications were prepared and
administered. This is important at CHBAH since a large proportion of South African
patients are immunocompromised and susceptible to opportunistic infections.
Inappropriate labelling of medications is a cause of medication administration errors and
this may have serious legal implications for the anaesthetist.
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