A survey of propofol injection practices reveals poor knowledge of and unsatisfactory adherence to the SASA Guidelines for Infection Control

Abstract

Background: Propofol lipid emulsion supports bacterial growth and various outbreaks of postoperative infection are attributed to extrinsic contamination. This study’s objectives were to ascertain propofol administration practices among South African anaesthesiologists and to determine the influence of the 2014 South African Society of Anaesthesiologists (SASA) Guidelines for Infection Control in Anaesthesia.

Methods: A total of 1 598 SASA members were invited to participate anonymously and 634 replies were received. Using a riskscoring system developed from 13 questionnaire items, 542 respondents who administer propofol infusions were stratified into Low-, Moderate-, High- and Very High-Risk groups.

Results: The majority (65%) of the 542 participants who administer propofol infusions were classified as Moderate Risk, 29% as Low Risk and 6% as High and Very High Risk. Some 61% were aware of the SASA Guidelines, of whom 47.3% had studied them. The median risk-score of the Studied Guidelines group was significantly smaller (p < 0.001). They included a greater proportion who were categorised as low risk (58% vs. 45%) and a lower proportion who were moderate risk (38% vs. 51%). Proportions of high-risk individuals did not differ. Of the total 634 respondents, 247 used rubber-stoppered vials of whom 28% had studied the SASA Guidelines; 20% of the Studied Guidelines group often/always shared vial contents between patients versus 12% of those who had not studied them (p = 0.13). Conversely, 40% (studied group) versus 13.6% (not-studied group) often/always wiped the diaphragm and seldom/never shared vial contents between patients (p < 0.0001). In all, 25% of the total 634 respondents often/ always pre-prepared multiple propofol syringes; 5.0% diluted propofol and often/always pre-prepared syringes.

Conclusion: Penetration of the SASA Guidelines was low. Differences in unsafe practices among anaesthesiologists who had read the guidelines were statistically significant but clinically inconsequential. This highlights a need for greater publicity, emphasising their practical importance.

Keywords: drug compounding, Infection control, propofol, postoperative complications, practice guidelines as topic