Correspondence  |   October 2016
Underestimated and Modifiable? From Intraoperative Drug Application to Postoperative Infections
Author Notes
  • Hospital Waldfriede, Berlin, Germany (I.N.). i.nachtigall@waldfriede.de
  • (Accepted for publication June 21, 2016.)
    (Accepted for publication June 21, 2016.)×
Article Information
Correspondence
Correspondence   |   October 2016
Underestimated and Modifiable? From Intraoperative Drug Application to Postoperative Infections
Anesthesiology 10 2016, Vol.125, 820. doi:10.1097/ALN.0000000000001251
Anesthesiology 10 2016, Vol.125, 820. doi:10.1097/ALN.0000000000001251
With great interest, we followed the recent publication of Gargiulo et al.1  reporting on perioperative microbiological contamination during drug application. Bacterial contaminants were detected in 6.3% of patients and in 2.4% of sampled syringes. These numbers are alarming, suggesting a potential role of intraoperative management in postoperative infections. The study inherits an interesting design including close-to-real-life conditions. However, there remains some source of bias that is not completely addressable in this setting, and the number of contaminations may even be higher. Especially high contamination rates of propofol are a known problem related to its formulation; consequently, propofol syringes should be prepared directly before application and used propofol syringes should be disposed immediately. Although even the laboratory environment of drug preparation may inherit a, very low, bacterial contamination risk, syringe handling is a key element in this context.2  Compared to the study by Gargiulo et al.,1  other authors observed higher contamination rates of syringes,2–4  and as the study was performed unblinded, there is a high probability of a relevant Hawthorne effect. Additionally, some aspects are not completely reported in study description:
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