Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland.

On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and compounding environment on the wards. These results can be used for updating the guidelines and for training nurses involved in compounding.

Performance of the Alere i influenza A&B assay and mariPOC test for the rapid detection of influenza A and B viruses.

BACKGROUND: Timely detection of influenza viruses is required to facilitate infection control measures and appropriate patient management. The Alere™ i Influenza A&B assay for detection of viral RNA and multianalyte mariPOC(®) test for detection of viral antigens enable rapid detection of influenza viruses with little hands-on time. OBJECTIVES: To evaluate the performance of the Alere i Influenza A&B assay and the mariPOC test in comparison to the Xpert(®) Flu A/B assay and laboratory-developed real-time reverse transcription-polymerase chain reaction. STUDY DESIGN: A total of 140 and 108 nasopharyngeal specimens were analysed for evaluation of the Alere i and mariPOC, respectively. RESULTS: The sensitivity and specificity of the Alere i Influenza A&B assay for detection of influenza A virus was 80.0% and 98.1%, and for influenza B virus 45.2% and 98.2%, respectively. For the mariPOC test, a sensitivity and specificity of 53.1% and 98.7%, respectively, for detection of influenza A virus was achieved. CONCLUSIONS: The mariPOC test proved insensitive for detection of influenza A virus and therefore unsuitable for individual patient diagnosis without confirmatory testing. In contrast, the Alere i Influenza A&B assay was reasonably sensitive and specific for detection of influenza A and B virus, although decreased detection of specimens with low viral load was observed particularly for detection of influenza B virus. Taken together with its rapidity and ease of use, the Alere i influenza A&B assay is a welcome alternative to immunochromatographic rapid influenza detection tests and may provide timely results that enable appropriate patient care and management of patient flow during high-prevalence seasons.

Negative bacterial polymerase chain reaction (PCR) findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer.

BACKGROUND: The etiology of chronic pelvic pain syndrome (CPPS) remains obscure. Although, bacterial etiology has frequently been suggested, evidence of both bacterial involvement in CPPS and the presence of normal bacterial flora in the prostate remain uncertain. MATERIALS AND METHODS: We investigated the presence of bacterial DNA using polymerase chain reaction (PCR) techniques on prostatic tissue samples obtained in radical prostatectomy from 10 patients with moderate to severe symptoms of CPPS and 10 nonsymptomatic patients with localized prostate cancer. For symptom evaluation we used the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). RESULTS: All but one sample were negative for bacterial DNA. The PCR from a symptomatic patient was reproducibly positive in 16S rDNA PCR but negative in 23S rDNA PCR. Bacterial DNA was found in only one out of two sample aliquots and cloning yielded different sequences in two PCR products. CONCLUSIONS: A bacterial etiology for CPPS symptoms could not be demonstrated in patients with prostate cancer. The results also suggest that the prostate is unlikely to harbor bacterial normal flora.

Resistance to second- and third-generation cephalosporins among Escherichia coli and Klebsiella species is rare in Finland.

OBJECTIVE: To investigate the antimicrobial resistance of Escherichia coli and Klebsiella spp. from pus, urine and respiratory specimens, with particular emphasis on the detection of third-generation cephalosporin resistance. METHODS: E. coli (698) and Klebsiella sp. (476) strains from pus, respiratory and urinary specimens from hospital patients were collected from 19 laboratories. Data about consumption of third-generation cephalosporins and cefuroxime were collected from 24 hospitals. Antimicrobial susceptibility was tested with disk diffusion in primary laboratories and by an agar dilution method. Extended-spectrum beta-lactamase (ESBL) production was studied with a double disk synergy test and an ESBL Etest. The beta-lactamase classes were characterized with polymerase chain reaction probes of the TEM and SHV beta-lactamase families and isoelectric focusing. RESULTS: Only 0.6% of E. coli and 2.3% of Klebsiella spp. strains were resistant or intermediately resistant to cefotaxime, ceftriaxone and/or ceftazidime. The ESBL producers detected comprised one E. coli harboring TEM-like genes and five Klebsiella pneumoniae strains, two of which harbored SHV-like genes, two TEM-like genes and one both. Although consumption of cefuroxime has increased in the years 1990-1994, from 3.48 to 5.84 defined daily doses/100 bed-days, and the consumption of third-generation cephalosporins from 1.25 to 1.94 defined daily doses/100 bed-days, cefuroxime resistance of E. coli was only 3%. CONCLUSION: Although the use of broad-spectrum cephalosporins has increased, resistance to second- and third-generation cephalosporins is still rare in Finland.