Archive April 2018 XIX, No. 4

Ideas That Work: Drawer-to-Arm Phenomenon

Does That Injection Come With an Infection?

Outpatient Surgery Editors


BE AWARE Are your anesthesia providers spreading infection with their injection practices? The risk may be higher than you think.

I call it drawer-to-arm phenomenon An anesthesia provider is about to inject a patient with a local anesthetic as she awaits a routine surgery. He reaches first to the anesthesia workstation for a swab, then back to the patient. Then he goes back to his incredibly-difficult-to-clean station for a syringe, reaches for the vial in one of the drawers, fills the syringe and then goes back to the patient to inject her with the anesthetic.

Every time one of your anesthesia providers make one of those pre-injection steps, every time he touches a drawer on his station for a vial or a syringe or a swab, he's increasing the risk of contamination. Besides practicing consistently good hand hygiene practices, here are a couple ideas for safer injection practices.

  • Pre-filled syringes. Many anesthesia providers are split on the topic of prefilled syringes, but I see them as a useful way to cut back on the risk of infection by taking drawer-to-arm phenomenon out of at least part of the equation. Of course, there are drawbacks to prefilled syringes; namely, pricing. A prefilled syringe of ephedrine, say, could run you $10 and those costs add up. But it's often worth the cost to remove the extra step of drawing up a drug and thus, running the risk of contamination. Moreover, prefilled syringes hold anesthetists accountable so there is no risk of "double dipping" into a vial.
  • Micron syringe filters. I rarely see anesthesia providers using these filters, but they can catch a whole host of potentially harmful microorganisms. One downside to filters: you can't inject propofol through them because it's too viscous of a drug. But that's only one of many drugs you use in your practice so it's worth considering filters for all other injections. A 25 mm, 0.2 micron syringe filter costs around $5 online, half the price of some prefilled syringes. A pack of 50, 32 mm, 0.2 micron filters can cost around $100 — even cheaper.

Chuck Biddle, CRNA, PhD
Virginia Commonwealth University Medical Center
Richmond, Va.


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