Original Contribution
A survey of anesthesiologist and anesthetist attitudes toward single-use vials in an academic medical center

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Abstract

Study Objective

To evaluate whether proper implementation of safety measures was uniform at 5 hospitals, and to elucidate motivating factors that lead to nonadherence.

Design

Electronic anonymous survey instrument.

Setting

Academic medical center.

Measurements

Of the 319 surveys sent to anesthesia providers across 5 hospitals, 89 responses were obtained. Questions addressed compliance with Centers of Disease Control (CDC) safety standards and the rationale for anesthesia providers’ decisions to comply or not comply with these standards.

Main Results

59.6% of respondents reported that they had reused vials between cases, while 40.4% had never done so. Of the 89 respondents, 63 (44%) felt that cost was the primary factor that prevented them from using entirely new medications on each case. Thirty-two (23%) reported convenience/efficiency as the reason; 11 (8%) responded that time prevented them from using entirely new medications on each case; 14 (10%) reported that the environment was a driving factor; and 3 individuals (2%) responded apathy. Eighteen (13%) responded “other” and, when asked to amplify a response, most of these individuals reported that they do use entirely new medications on each case.

Conclusions

Safe anesthetic practices were not uniform among respondents, and one of the main reasons given for noncompliance with safe standards was cost.

Introduction

In 1990, the Centers for Disease Control (CDC) was notified of a surge of simultaneous and sudden infections that were investigated and linked to the appearance of a new anesthetic hypnotic known as propofol. Previously, outbreaks of postoperative infections were attributed largely to surgeons’ habits or to the surgical procedure itself. However, this contamination was later identified as extrinsic and a direct result of improper technique by the anesthesia provider [1]. Since that time, the controversy surrounding proper aseptic techniques including multiple use of single-use vials has been widely debated and a topic of intense scrutiny by the medical field. The CDC initially stated that “intravenous medication vials labeled for single use, including erythropoietin, should not be punctured more than once” [2]. Subsequently, multiple statements have been released by the CDC reinforcing infection control and proper use of single-use vials. We aimed to answer whether this recommendation has been followed and to evaluate reasons for compliance versus noncompliance in our anesthetic community.

Section snippets

Materials and methods

After a waiver from the Emory University Institutional Review Board was obtained, an electronic survey was sent to all anesthesia providers at 5 Atlanta area hospitals (n=319). Each email address was issued a unique login, which prevented multiple responses by any individual. We obtained 89 survey responses from a variety of anesthesia providers including attending anesthesiologists (n=39), residents (n=18), fellows (n=7), anesthetists [certified registered nurse-anesthetists (CRNAs) and

Results

Of the 319 anesthesia providers polled, 89 responded to the survey. Data were collected and analyzed using simple statistical methods. Of the 89 respondents, most (43.8%) were anesthesia attendings. Eighteen (20.2%) respondents were residents, 15 (16.9%) were CRNAs, 7 (7.9%) were fellows, and 6 (6.7%) were AAs. Four PAs made up the smallest group of respondents (4.5%) (Table 1). There were no significant differences in the response rate across groups (P > 0.05 for all groups surveyed).

Discussion

The possible occult transmission of infections, including hepatitis C, by anesthesiology providers engaging in improper aseptic techniques and improper use of single-use vials, has given further credence to a report of an identified cluster of hepatitis C cases that was made public in the state of Nevada in 2007. Three individuals, identified by a local health district as having a singular link as common patients of a local endoscopic clinic, brought to light the specter of massive

Acknowledgments

The authors wish to thank Patrick Wiseman for his assistance in creating an anonymous internet survey system.

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