Glass ampoules: risks and benefits

The occupational hazards of anesthesiologists: A literature review and evidence-based approach to prevention

BackgroundAn occupational hazard is any workplace condition that poses a risk to an employee's health. Occupational hazards are ubiquitous in the field of anesthesiology and often go underappreciated. These hazards warrant careful assessment and strategic preventative planning.ObjectiveThis narrative literature review examines the occupational hazards encountered by anesthesiologists and discusses evidence-based techniques to mitigate these risks. Facilitating the health and safety of anesthesia professionals protects not only the providers themselves but also enhances patient care by reducing the possibility of medical errors due to occupational fatigue, stress, and injuries.MethodsA targeted search of PubMed and other databases (SCOPUS, Web of Science) was used to review the literature. Safety standard handbooks by the International Atomic Energy Agency, The Pan American Health Organization, The World Health Organization, and Food and Agriculture of the United Nations, were also consulted to provide the current guidelines for hazards discussed. Articles and information were included if they provided information about the occupational hazards of anesthesiologists or evidence-based prevention techniques for mitigating the hazards.ResultsThe occupational hazards are classified into physical, chemical, and biological categories. Evidence-based preventive measures are proposed and examined for each category.ConclusionThis paper examines the challenges faced by anesthesiologists by categorizing the physical, chemical, and biological occupational hazards. Each identified hazard is accompanied by evidence-based strategies to mitigate its impact. By illuminating these issues, increased awareness among healthcare professionals, policymakers, and the public can foster a collective effort to improve the safety of the work of anesthesia providers.

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.

Flexor tendon laceration of the hand from opening a glass ampoule

Sharps and needlestick injuries are serious work-related injuries to the hand in healthcare workers (HCWs). We present two cases of HCWs with hand injuries from opening a medicinal glass ampoule. The index finger (IF) was involved in both cases, with an associated flexor tendon injury, presenting as inability to flex the proximal and distal interphalangeal joints. Sensation was intact, and radiographs showed no foreign body.The surgical repair of the flexor tendon injury was carried out using the Wide-awake Local Anaesthesia No Tourniquet technique. The quality of the repair was tested intraoperatively. Physiotherapy involved gradual progression of finger flexion from 30% to 50% to full range of motion. At 36 and 42 months follow-up, they regained the IF range of motion and returned to work.Flexor tendon injuries from opening medicinal glass ampoules are rare but can be devastating, with a long rehabilitation process after surgical repair.

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.

Atropine and glycopyrrolate do not support bacterial growth-safety and economic considerations

STUDY OBJECTIVE

Evaluation of bacterial growth in atropine and glycopyrrolate.

DESIGN

Laboratory investigation.

SUBJECTS AND MEASUREMENTS

Standard microbiological methods were used to evaluate the impact of atropine and glycopyrrolate on the growth of Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. Bacterial count was checked at 0, 1, 2, 3, 4, 6, and 24 hours.

MAIN RESULTS

Atropine or glycopyrrolate did not support the growth of the above bacteria at any examined time at room temperature. Glycopyrrolate killed all of the examined strains (P < .05), whereas in atropine, only the clinical isolates of Staphylococcus and Acinetobacter were killed (P < .05).

CONCLUSIONS

Drawing up atropine or glycopyrrolate at the beginning of the operating list and use within 24 hours if needed are a safe practice and do not pose infection hazard. We can also reduce hospital costs if we do not throw away these unused syringes following each case.

Applying the Theory of Planned Behaviour to understand nurse intention to follow recommendations related to a preventive clinical practice

The use of filter needles reduces the number of particles found in parenteral solutions after the opening of glass ampoules and has been recommended by many authors. Even so, nurses do not use filter needles unilaterally in their practice. In order to understand the psychosocial determinants of nurse intention to follow recommendations related to the use of filter needles in the preparation of parenteral medication, we conducted a cross-sectional study in a large university medical centre in the province of Quebec (Canada). We developed a questionnaire based on Ajzen’s Theory of Planned Behaviour and distributed it to all nurses ( n = 364) from eight care units. A total of 242 questionnaires were completed and returned (response rate of 66.5%). Attitude towards the behaviour and perceived behavioural control predicted nurse intention to use filter needles according to recommendations. Three specific beliefs related to these variables – ease of use, enjoyment and reason – explained 50.3% of the variance in nurse intention to use filter needles. The results of this study support the use of the Theory of Planned Behaviour as a theoretical basis that can help identify important avenues to inform behaviour change strategies regarding healthcare professional adoption of guidelines to improve patient safety.

Applying Theory to Understand and Modify Nurse Intention to Adhere to Recommendations regarding the Use of Filter Needles: An Intervention Mapping Approach

The manipulation of glass ampoules involves risk of particle contamination of parenteral medication, and the use of filter needles has often been recommended in order to reduce the number of particles in these solutions. This study aims to develop a theory-based intervention to increase nurse intention to use filter needles according to clinical guideline recommendations produced by a large university medical centre in Quebec (Canada). Using the Intervention Mapping framework, we first identified the psychosocial determinants of nurse intention to use filter needles according to these recommendations. Second, we developed and implemented an intervention targeting nurses from five care units in order to increase their intention to adhere to recommendations on the use of filter needles. We also assessed nurse satisfaction with the intervention. In total, 270 nurses received the intervention and 169 completed the posttest questionnaire. The two determinants of intention, that is, attitude and perceived behavioral control, were significantly higher after the intervention, but only perceived behavioral control remained a predictor of intention. In general, nurses were highly satisfied with the intervention. This study provides support for the use of Intervention Mapping to develop, implement, and evaluate theory-based interventions in order to improve healthcare professional adherence to clinical recommendations.