Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014

Administration of propofol, the most frequently used intravenous anesthetic worldwide, has been associated with several iatrogenic infections despite its relative safety. Little is known regarding the global epidemiology of propofol-related outbreaks and the effectiveness of existing preventive strategies. In this overview of the evidence of propofol as a source of infection and appraisal of preventive strategies, we identified 58 studies through a literature search in PubMed, Embase, and Lilacs for propofol-related infections during 1989–2014. Twenty propofol-related outbreaks have been reported, affecting 144 patients and resulting in 10 deaths. Related factors included reuse of syringes for multiple patients and prolonged exposure to the environment when vials were left open. The addition of antimicrobial drugs to the emulsion has been instituted in some countries, but outbreaks have still occurred. There remains a lack of comprehensive information on the effectiveness of measures to prevent future outbreaks

Risk for Death among Children with Pneumonia, Afghanistan

In Afghanistan, childhood deaths from pneumonia are high. Among 639 children at 1 hospital, the case-fatality rate was 12.1%, and 46.8% of pneumococcal serotypes detected were covered by the 13-valent vaccine. Most deaths occurred within 2 days of hospitalization; newborns and malnourished children were at risk. Vaccination could reduce pneumonia and deaths

Molecular evolution, diversity and adaptation of H7N9 viruses in China during 2013-2017

The substantial increase in prevalence and emergence of antigenically divergent or highly pathogenic influenza A(H7N9) viruses during 2016–17 raises concerns about the epizootic potential of these viruses. We investigated the evolution and adaptation of H7N9 viruses by analyzing available data and newly generated virus sequences isolated in Guangdong Province, China, during 2015–2017. Phylogenetic analyses showed that circulating H7N9 viruses belong to distinct lineages with differing spatial distributions. Hemagglutination inhibition assays performed on serum samples from patients infected with these viruses identified 3 antigenic clusters for 16 strains of different virus lineages. We used ancestral sequence reconstruction to identify parallel amino acid changes on multiple separate lineages. We inferred that mutations in hemagglutinin occur primarily at sites involved in receptor recognition or antigenicity. Our results indicate that highly pathogenic strains likely emerged from viruses circulating in eastern Guangdong Province during March 2016 and are associated with a high rate of adaptive molecular evolution

The Prevalence of Propofol Contamination in the Tygerberg Theatre Complex

Thesis (MMed)--Stellenbosch University, 2020.ENGLISH ABSTRACT: Propofol is a widely used intravenous anaesthetic agent. Soon after its introduction into the market, propofol-related postoperative infections were reported. It was determined that the emulsion supports growth and manufacturers provided strict aseptic guidelines with regards to propofol usage, but it has been shown that clinicians in South Africa do not adhere to these guidelines. The primary objective of our observational study was to determine the prevalence of contamination of syringes containing propofol (Fresenius’ Propoven® 1%, Fresenius Kabi, Sweden) in the Tygerberg Hospital Theatre Complex. Samples of syringes containing propofol were collected from various randomised operating theatres over a period of 15 days and specimens cultured and tested for growth of organisms. The secondary objective was to differentiate between contamination occurring in e mergency and elective surgery operating theatres and investigate the difference in propofol contamination when used by junior versus more senior anaesthetists. We demonstrated an unacceptably high propofol contamination prevalence of 41.8% (95% CI: 32.5%, 51.6%). Coagulase negative staphylococcus (CONS) was the most prevalent organism. Overall, 58.18% of samples demonstrated no growth after 2 days. Regarding our secondary objective, there was no statistically significant difference regarding the prevalence of propofol contamination of samples taken from the emergency and elective operating theatres (p = 0.95; risk ratio 1.02; 95% CI: 0.55; 1.89). Propofol syringes handled by senior versus junior anaesthetists revealed a similar result (p = 0.65; risk ratio 0.90; 95% CI: 0.58; 1.41). CONS are often contaminants and the bulk of organisms we cultured are non-pathogenic in healthyhosts but can be lethal in immunocompromised patients. Presence of commensals is also a warning that any other pathogens (including viruses) that may be present on the anaesthetist’s hands or in the environment may also contaminate the propofol. The presence of human commensals as well as environmental organisms in the propofol syringes are avoidable and a zero-contamination rate should be aspired to in all interactions with patients.AFRIKAANSE OPSOMMING: Propofol word tans algemeen as intraveneuse narkosemiddel gebruik. Propofol verwante postoperatiewe infeksies is egter gou nadat die middel bekendgestel is gerapporteer. Organismes kan groei in die emulsie en die vervaardigers het streng aseptiese riglyne vir die gebruik van propofol daargestel. Dit blyk egter dat praktisyns in Suid-Afrika nie die riglyne volg nie. Die primêre doel van ons beskrywende studie was om die prevalensie van kontaminasie van spuite met propofol (Fresenius Propoven® 1%, Fresenius Kabi, Swede) in die Tygerberg Hospitaal Teaterkompleks te bepaal. Monsters van spuite met propofol is versamel van verskeie gerandomiseerde operasieteaters oor ‘n periode van 15 dae. Die monsters is gekweek en evalueer vir die groei van organismes. Die sekondêre doel was om te onderskei tussen kontaminasie in teaters waar nood en elektiewe chirurgie uitgevoer word en om te bepaal of daar ‘n verskil in propofol kontaminasie is tussen junior en meer senior narkose personeel. Ons het ‘n onaanvaarbare hoë prevalensie van propofol kontaminasie van 41.8% (95% CI: 32.5%, 51.6%) gevind. Koagulase negatiewe stafilokokki was die mees prevalente organisme. Geen groei is gevind in 58.18% van die monsters na 2 dae. Wat betref ons sekondêre doel, was daar geen statisties beduidende verskil in die prevalensie van propofol kontaminasie in die monsters geneem in die nood en elektiewe teaters nie (p = 0.95; risk ratio 1.02; 95% CI: 0.55; 1.89). Daar was ook geen verskil in monsters van spuite gebruik deur junior en meer senior narkose personeel nie (p = 0.65; risk ratio 0.90; 95% CI: 0.58; 1.41). Koagulase negatiewe stafilokokki is dikwels kontaminante en die meeste van die organismes wat onsgekweek het is nie patogenies in normale gashere nie. Dit kan egter dodelik wees in pasiënte wat imuunkompromiseerd is. Kontaminasie met kommensale organismes dien as a waarskuwing dat enige patogene (insluitend virusse) op die narkotiseur se hande of in die omgewing in die propofol mag land. Die teenwoordigheid van menslike kommensale organismes sowel as omgewings organismes in die propofol spuite is voorkombaar. Daar moet gestreef word na geen kontaminasie in alle interaksies met pasiënte.Master

The difference in the frequency of dreams in men and women undergoing gastrointestinal endoscopy under intravenous anesthesia with propofol

Cilj: Usporediti učestalost snova za vrijeme intravenske anestezije propofolom između muškaraca i žena. Odrediti ima li razlike u demografskim osobinama, trajanju anestezije, potrošnji propofola i vrijednostima arterijskog tlaka, pulsa i bispektralnog indeksa između ispitanika koji su sanjali i onih koji nisu. Ispitanici i metode: U ovoj prospektivnoj opservacijskoj studiji sudjelovalo je 95 uzastopnih pacijenata podvrgnutih kolonoskopiji u KBC-u Osijek, od toga 40 muškaraca i 55 žena. Svi su potpisali informirani pristanak za dobrovoljno sudjelovanje u istraživanju. Demografski su podaci zabilježeni prije indukcije anestezije. Količina propofola za vrijeme zahvata titrirana je individualno s ciljem nestanka refleksnog odgovora na bolnu stimulaciju uz očuvano spontano disanje. Arterijski tlak, puls i bispektralni indeks bilježeni su u određenim intervalima. Nakon buđenja brojkom je procijenjen pacijentov izraz lica, nakon čega je pitan o pojavi snova i jesu li bili ugodni. Rezultati: Snove je imalo 40 ispitanika, 20 muškaraca i 20 žena. Nije bilo statistički značajne razlike u pojavi snova između muškaraca i žena. Nije bilo razlike niti u demografskim osobinama, trajanju anestezije, potrošnji propofola, vrijednostima pulsa i bispektralnog indeksa između onih koji su imali snove i onih koji nisu. Sistolički arterijski tlak nakon buđenja bio je značajno niži u onih koji su imali snove (105,3 sa SD 17,9 naspram 114,4 sa SD 22,8 mmHg; t-test, P = 0,038). Statistički je značajna razlika u ispitivačevoj ocjeni izraza lica između onih koji su sanjali i onih koji nisu (1,7 sa SD 1,0 naspram 1,0 sa SD 1,3; t-test P = 0,005). Zaključak: Pacijenti koji su sanjali budili su se sa zadovoljnijim izrazom lica i nižim sistoličkim arterijskim tlakom od onih koji nisu. Nije bilo drugih statistički značajnih razlika među skupinama.Objectives: The aim of this study was to compare the incidence of dreaming between men and women after propofol anesthesia. We also investigated differences in demographic characteristics, duration of anesthesia, propofol dose, arterial blood pressure levels, pulse and bispectral index between those who have had dreams and those who have not. Participants and methods: Total of 95 patients undergoing gastrointestinal endoscopy at University Hospital Osijek participated in this prospective observational study, there were 40 men and 55 women. Written informed consent was obtained from all participants. Demographic characteristics were noted before anesthesia. Propofol dose was titrated individually until a patient was unresponsive to painful stimuli while maintaining spontaneous breathing. Arterial blood pressure, pulse and bispectral index were monitored in typical intervals. On the emergence from anesthesia, patient's face expression was rated numerically by the examiner. Afterwards, the patients were asked whether their dreams had been pleasant or not. Results: The presence of dreams was registered in 40 patients; 20 men and 20 women. There were no significant differences in demographic characteristics, duration of anesthesia, propofol dose, pulse and bispectral index values between dreamers and non-dreamers. Systolic arterial pressure was significantly lower at the moment of emergence in those who have had dreams (105.3 with SD 17,9 vs. 114.4 with SD 22.8 mmHg, t-test, P=0,038). There was a significant difference between the observer’s rating of facial expressions in the group with pleasant dreams and in non-dreamers (1.7 with SD 1.0 vs. 1.0 with SD 1.3; t-test, P=0.005). Conclusion: Patients who have had dreams emerged from anesthesia with significantly more pleasant face expression and lower systolic blood pressure than those who haven’t. There were no other significant differences between the groups

Análisis de errores con medicamentos en pacientes ingresados en salas de cirugía y recuperación posanestésica de un hospital de alta complejidad en Bogotá, Colombia

Medication errors represent one of the main causes of incidents and adverse events during the perioperative period. Therefore, this study analyzes errors before, during, and after the administration of general anesthesia for abdominal surgery at a high-complexity hospital in Bogota, Colombia. A descriptive cross-sectional study was conducted with 390 patients between January and September 2019. Of the 3,677 medication administrations, some type of error was made in 60% of cases, mostly in emergency surgeries. The pharmacological group with the most errors was general anesthetics, with 32%. All identified errors constituted situations with harm potential, indicating the need to promote the standardization of activities involving the use of medications and a culture of healthcare safety in order to avoid adverse events.Los errores con medicamentos representan una de las principales causas de incidentes y eventos adversos durante el periodo perioperatorio por lo que en este estudio se analizaron los errores antes, durante y después de la administración de anestesia general para la realización de cirugía abdominal en un hospital de alta complejidad en Bogotá, Colombia. Se realizó un estudio descriptivo de corte transversal en 390 pacientes entre los meses de enero a septiembre de 2019. De las 3.677 administraciones de medicamentos, en el 60% se incurrió en algún tipo de error, mayoritariamente en cirugías de urgencia. El grupo farmacológico con más errores fue el de los anestésicos generales con un 32%. Todos los errores identificados se configuraron como situaciones con potencial de daño lo que indica la necesidad de promover la estandarización de actividades durante la utilización de medicamentos y la cultura de seguridad asistencial para evitar que ocasionen eventos adversos

Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014

Administration of propofol, the most frequently used intravenous anesthetic worldwide, has been associated with several iatrogenic infections despite its relative safety. Little is known regarding the global epidemiology of propofol-related outbreaks and the effectiveness of existing preventive strategies. In this overview of the evidence of propofol as a source of infection and appraisal of preventive strategies, we identified 58 studies through a literature search in PubMed, Embase, and Lilacs for propofol-related infections during 1989–2014. Twenty propofol-related outbreaks have been reported, affecting 144 patients and resulting in 10 deaths. Related factors included reuse of syringes for multiple patients and prolonged exposure to the environment when vials were left open. The addition of antimicrobial drugs to the emulsion has been instituted in some countries, but outbreaks have still occurred. There remains a lack of comprehensive information on the effectiveness of measures to prevent future outbreaks