Multicenter Study on Environments for the Preparation of Infusions in Clinical Wards and Related Prescriptions

Preparation of infusions on clinical wards requires preventive measures against contamination. To clarify the current status of infusion preparation, a multicenter study was conducted, involving hematology and surgery wards and focusing on air cleanliness, environments for preparation, and the content of each infusion. The air cleanliness level was measured in 9 departments of 5 facilities, using a particle counter and air sampler to identify airborne particles and microbes and clarify the number of colonies per 1 m3. Environments for the preparation of infusions and infusion contents were examined in 13 departments of 9 facilities by conˆrming the sites of preparation and totaling the numbers of injection prescription sheets issued during a 10day period (a total of 7,201 prescriptions). Measurement of air cleanliness found the number of particles with a diameter of 5 mm or larger in a department ranged from 3,091×103 to 393×103/m3. Airborne microbes analysis found Staphylococcus aureus in only 3 departments, but detected humanor environment-derived CNS (coagulase negative staphylococci) and Micrococcus, Corynebacterium, and Bacillus species in all departments. Preparation tables were placed directly underneath air conditioner outlets in 9 departments (69), and interfered with staŠ tra‹c lines in 10 departments (77). Approximately 31 of the 4,089 prescription drugs, which had been subject to accidental mixture, were used for 3hour or longer infusion. Manuals for the preparation of infusions on wards were available in only 3 of the 9 facilities. Considering the low air cleanliness level in areas with preparation tables, and the ˆnding that more than 30 of prescription drugs were used for 3hour or longer infusion, the risk of bacterial contamination is likely to be high. Guidelines for the appropriate preparation of infusions on clinical wards should be established to reduce such risks. Key wordsclinical wards, preparation of infusions, airborne microbes, number of accidental mixtures, duration of infusion