Evaluation of a safe infusion device on reducing occupational exposure of nurses to antineoplastic drugs: a comparative prospective study. Contamoins-1.

PURPOSE: Despite the decreasing of environmental contamination throughout the anticancer drug circuit, the administration of chemotherapies remains at risk of occupational exposure for nurses. Many medical devices aim at securing administration, but none have been scientifically evaluated to verify the actual improvement. METHODS: A monocentric comparative before/after study was carried out in an oncology day hospital to evaluate the efficacy of Safe Infusion Devices in reducing drug exposure compared to usual infusion practices. The rate of nurses' gloves contamination was estimated. To avoid false negatives and to ensure sampling reproducibility, each sample of gloves was contaminated with a drop of topotecan. Association between contamination and other variables was investigated using a multivariate logistic regression analysis. RESULTS: The usual practice led to a rate of 58.3% of contaminated samples while Safe Infusion Devices to a rate of 15%: Safe Infusion Devices reduced the risk of gloves contamination by 85% in multivariate analysis (Odds ratio = 0.15; 95% confidence interval = 0.05-0.46; p < 0.001). Topotecan was identified in 100% of the samples. Only one case of cross-contamination has occurred. CONCLUSION: Despite the current practice of using neutral solvent-purged infusers, the occupational exposure remains high for nurses and Safe Infusion Devices significantly reduced this risk of exposure. However, glove contamination is only a surrogate endpoint. The results confirmed that the disconnection of empty bags resulted in occupational exposure. Except a contamination due to the leakage of a bag, no cross-contamination was detected. Safe Infusion Devices were highly effective but did not completely eliminate exposure.

[Assessing nurses' knowledge of insulin administration and the impact of the introduction of concentrated insulins.] / Évaluation des connaissances des personnels soignants sur les pratiques d'administration de l'insuline et impact de l'introduction des insulines à forte concentration.

Insulin is a high-risk medication, and even slight changes in blood levels can lead to serious side effects or can even result in death. Error in administering drugs is one of the main causes of over- or under-dosing, and the recent introduction of concentrated insulins (CI) has increased this risk. We assessed nurses' knowledge of these CI, their beliefs about the "insulin unit" (IU), and the impact that this knowledge had on the risk of making medication errors. A direct interview survey was conducted in eight departments of medicine and surgery in a university hospital. Sixty-eight nurses and midwives were interviewed. Twenty-six percent of them had already encountered a CI prescription and only 51.5 percent correctly defined the notion of IU. Only 18 percent responded correctly to a practical case of a CI prescription, whilst 35 percent multiplied the dose by two and 24 percent divided it by two. Sixty percent indicated that they regularly use a U-100 graduated insulin syringe to withdraw insulin from the pen. Insulin administration errors related to this misuse, which are very well documented in the literature, are linked to nurses' lack of knowledge about the true definition of IU. These administration errors have increased with the introduction of concentrated insulins.

Correlation of parasites with growth of yellow perch.

The possible influence of parasites on the short-term and long-term growth and condition of yellow perch Perca flavescens was examined by investigating correlations between parasite abundance and specific growth variables. The following parasites were enumerated in age-1 yellow perch collected from Lake St. Pierre in June 2008: Apophallus brevis, Diplostomum spp., Ichthyocotylurus spp., Tylodelphys scheuringi, Phyllodistomum superbum, and Raphidascaris acus. Short-term growth was estimated using RNA/DNA ratios and long-term growth via the total length and condition as measured by the Fulton index. No correlation was found between parasite abundance and short-term growth, but a negative influence of combined infections of T. scheuringi and P. superbum on long-term growth was detected. In addition, the abundance of Ichthyocotylurus spp. was positively correlated with the condition of the yellow perch. Together these results suggest that limited or subtle pathogenic effects in juvenile fish are not discernable in recent growth but only in long-term growth indices. Furthermore, in future studies examination of parasite effects on fish growth should account for multiple infections.