title: Microbial contamination of syringes during preparation: the direct influence of environmental cleanliness and risk manipulations on end-product quality.
abstract: OBJECTIVE
  The direct influence of environmental cleanliness and risk manipulations on prepared syringes was evaluated.
  
  
  METHODS
  Media-fill testing was used to estimate potential microbial contamination. Syringes were prepared in three different environments using four different uncontrolled high-risk manipulations. The three environments included an International Organization for Standardization (ISO) class 5 horizontal laminar-airflow hood in an ISO class 6 cleanroom (in accordance with United States Pharmacopeia [USP] chapter 797), an ISO class 7 drug preparation area of an operating room, and an uncontrolled decentralized pharmacy in a ward. For each combination of environment and manipulation, 100 syringes were filled by a single operator. The four high-risk manipulations used included simple filling of syringes with trypticase soy broth, three-second contact by the ungloved fingers of the operator with the hub of the syringe, three-second contact between an object and the hub of the syringe, and exposure of the filled syringes to ambient air for 10 minutes.
  
  
  RESULTS
  Of the 1500 syringes prepared in three different environments, none produced within the cleanroom contained microorganisms, 6% were contaminated in the operating room, and 16% were contaminated in the ward (p < 0.0001). Certain high-risk manipulations were associated with a significant increase in the contamination of the surrogate syringes, including exposure to nonsterile ambient air and nonsterile objects or fingers (p < 0.0001).
  
  
  CONCLUSIONS
  High contamination rates were measured when the hub of syringes touched nonsterile environmental surfaces and fingers, whereas the drawn-air manipulation was associated with a lower risk of contamination. Working within a properly operating unidirectional airflow primary engineering control in an ISO class 5 cleanroom in accordance with USP chapter 797 requirements was demonstrated to be the best way to avoid bacterial or fungal contamination of injectable drugs directly resulting in patient infections.
authors.affiliation: University Hospitals of Geneva, Geneva, Switzerland. cyril.stucki@hcuge.ch
authors.forename: Cyril
authors.initials: C
authors.lastname: Stucki
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Sautter
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Favet
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
mesh_terms: D004339:Drug Compounding / Q000379:methods / Q000592:standards*; D004340:Drug Contamination / Q000517:prevention & control*; D004356:Drug Storage; D004780:Environment, Controlled; D004866:Equipment Contamination; D006801:Humans; D007267:Injections / Q000592:standards; D010602:Pharmacopoeias as Topic; D010607:Pharmacy Service, Hospital / Q000592:standards; D011786:Quality Control; D013594:Syringes / Q000382:microbiology*; D014481:United States