➤ The anesthesia supply cart should have its accessible outer surfaces
wiped clean between cases. To prevent contamination of communal
supplies, anesthesia providers should always perform HH before opening
the drawers or bins of the cart and handling the contents of the drawers
or bins. Storage of supplies on the top surface of the cart should be
avoided as much as possible and any supply items on the cart top surface
should be removed between cases to facilitate cleaning. The interior of the
supply cart should be cleaned on a periodic basis. Future innovation and
re-engineering of the storage, dispensing, and restocking of supplies in
the anesthesia work area is needed to decrease the potential for bacterial
cross contamination between cases.
➤ Provider-prepared sterile injectable drugs (eg, a drug drawn from a
vial into a syringe) are more likely to be subject to contamination than
drugs prepared in an International Organization for Standardization
(ISO) Class 5 setting, such as a pharmacy. Therefore, provider-prepared
sterile injectable drugs should be used as soon as practicable following
preparation. The package inserts for propofol that contain a preservative
typically specify that the use of propofol should commence within 12
hours of preparation. At the time of this publication, United States
Pharmacopeia (USP) Chapter recommends that the use of provider-
prepared sterile injectable drugs commence within 1 hour of preparation.
However, a draft revision of USP General Chapter suggests that a drug
from a single dose vial punctured or entered in environments with air less
clean than ISO class 5 may be used until the end of a case. If available,
commercially prefilled syringes or syringes prepared by the hospital
pharmacy in an ISO class 5 setting have a relatively long "beyond use
date."
➤ Anesthesia practitioners should minimize the time between spiking
IV bags and patient administration. Nevertheless, certain emergent
or urgent circumstances may require advanced set-up of IV fluids,
and anesthesia providers should comply with their hospital protocols.
Following spiking of an IV bag, administration should commence as soon
as possible. No specific time limit has been identified in the literature for
advance preparation of IV bags.
➤ Single-dose medication vials and flushes should be used whenever
possible. If multiple-dose medication vials must be used, they should be
used for only 1 patient and should be accessed only with a new sterile
syringe and new sterile needle for each entry. Syringes and needles are
single patient devices and syringes should never be reused for another
patient, even if the needle is changed.
