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Bacterial contamination and greenhouse gas emissions A randomised study of reuse versus single-use of infusion-set components for intravenous anaesthesia

Karlsson, Snorri Laxdal ; Edman-Wallér, Jon ; Gudmundsson, Magni Vidar ; Bentzer, Peter LU and Moller, Per Werner (2024) In European Journal of Anaesthesiology 41(12). p.910-920
Abstract

BACKGROUND Reusing anaesthesia infusion-set components may reduce the climate impact from plastic waste and discarded medications. Infusion-set contents can be shielded from patient contact by single use of an infusion line fitted with dual antireflux valves, preventing retrograde entry of microorganisms, and eliminating the risk for patient-to-patient cross-contamination. However, infusion-set contamination from compromised aseptic handling could affect quality of care. INTERVENTIONS To determine the prevalence of infusion-set bacterial contamination and compare the climate effects, we randomised operating rooms scheduled for total intravenous anaesthesia to handle procedures by infusion-set reuse or single-use. Both methods used dual... (More)

BACKGROUND Reusing anaesthesia infusion-set components may reduce the climate impact from plastic waste and discarded medications. Infusion-set contents can be shielded from patient contact by single use of an infusion line fitted with dual antireflux valves, preventing retrograde entry of microorganisms, and eliminating the risk for patient-to-patient cross-contamination. However, infusion-set contamination from compromised aseptic handling could affect quality of care. INTERVENTIONS To determine the prevalence of infusion-set bacterial contamination and compare the climate effects, we randomised operating rooms scheduled for total intravenous anaesthesia to handle procedures by infusion-set reuse or single-use. Both methods used dual single-use antireflux valves. OUTCOMES The primary outcome was infusion-set bacterial contamination assessed by aerobic culture of infusion-set fluid collected after each procedure. The secondary outcome was CO2 emissions (CO2-eq) estimated by life cycle assessment of component and medication use. To assess feasibility of detecting an inter-method difference in bacterial contamination, an interim analysis was planned after including at least 150 procedures per group. RESULTS After allocating 54 operating rooms per method, 189 and 159 procedures of reuse and single use were included. Reuse permitted a median of three procedures per infusion set (range 1 to 8). Positive cultures occurred in two procedures per method [mean (95% CI)]; prevalence 1.15% (0.03 to 2.27); relative risk of reuse versus single use 0.84 (0.12 to 5.93), P = 0.861. As prespecified, inclusion was stopped due to futility. The median (95% CI) per-procedure climate emissions were 0.43 (0.41 to 0.47) and 1.39 (1.37 to 1.40) kg CO2-eq for reuse and single-use respectively; difference -0.96 (-0.99 to -0.93), P < 0.0005. The main sources for climate emissions were production of infusion-set components and waste handling. CONCLUSIONS We conclude that the prevalence of bacterial contamination was low for both methods. A much larger study would be needed to detect an inter-method difference. Reuse of infusion-set components allowed significantly reduced intravenous anaesthesia climate emissions.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Anaesthesiology
volume
41
issue
12
pages
11 pages
publisher
European Society of Anaesthesiology
external identifiers
  • scopus:85204496396
  • pmid:39285791
ISSN
0265-0215
DOI
10.1097/EJA.0000000000002067
language
English
LU publication?
yes
additional info
Publisher Copyright: Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.
id
f419ac46-6fe3-479a-aefa-e2e9854f360d
date added to LUP
2024-12-03 10:03:23
date last changed
2025-06-04 00:31:25
@article{f419ac46-6fe3-479a-aefa-e2e9854f360d,
  abstract     = {{<p>BACKGROUND Reusing anaesthesia infusion-set components may reduce the climate impact from plastic waste and discarded medications. Infusion-set contents can be shielded from patient contact by single use of an infusion line fitted with dual antireflux valves, preventing retrograde entry of microorganisms, and eliminating the risk for patient-to-patient cross-contamination. However, infusion-set contamination from compromised aseptic handling could affect quality of care. INTERVENTIONS To determine the prevalence of infusion-set bacterial contamination and compare the climate effects, we randomised operating rooms scheduled for total intravenous anaesthesia to handle procedures by infusion-set reuse or single-use. Both methods used dual single-use antireflux valves. OUTCOMES The primary outcome was infusion-set bacterial contamination assessed by aerobic culture of infusion-set fluid collected after each procedure. The secondary outcome was CO<sub>2</sub> emissions (CO<sub>2</sub>-eq) estimated by life cycle assessment of component and medication use. To assess feasibility of detecting an inter-method difference in bacterial contamination, an interim analysis was planned after including at least 150 procedures per group. RESULTS After allocating 54 operating rooms per method, 189 and 159 procedures of reuse and single use were included. Reuse permitted a median of three procedures per infusion set (range 1 to 8). Positive cultures occurred in two procedures per method [mean (95% CI)]; prevalence 1.15% (0.03 to 2.27); relative risk of reuse versus single use 0.84 (0.12 to 5.93), P = 0.861. As prespecified, inclusion was stopped due to futility. The median (95% CI) per-procedure climate emissions were 0.43 (0.41 to 0.47) and 1.39 (1.37 to 1.40) kg CO<sub>2</sub>-eq for reuse and single-use respectively; difference -0.96 (-0.99 to -0.93), P &lt; 0.0005. The main sources for climate emissions were production of infusion-set components and waste handling. CONCLUSIONS We conclude that the prevalence of bacterial contamination was low for both methods. A much larger study would be needed to detect an inter-method difference. Reuse of infusion-set components allowed significantly reduced intravenous anaesthesia climate emissions.</p>}},
  author       = {{Karlsson, Snorri Laxdal and Edman-Wallér, Jon and Gudmundsson, Magni Vidar and Bentzer, Peter and Moller, Per Werner}},
  issn         = {{0265-0215}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{12}},
  pages        = {{910--920}},
  publisher    = {{European Society of Anaesthesiology}},
  series       = {{European Journal of Anaesthesiology}},
  title        = {{Bacterial contamination and greenhouse gas emissions A randomised study of reuse versus single-use of infusion-set components for intravenous anaesthesia}},
  url          = {{http://dx.doi.org/10.1097/EJA.0000000000002067}},
  doi          = {{10.1097/EJA.0000000000002067}},
  volume       = {{41}},
  year         = {{2024}},
}