Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989-2014(1)

Abstract

Administration of propofol, the most frequently used intravenous anesthetic worldwide, has been associated with several iatrogenic infections despite its relative safety. Little is known regarding the global epidemiology of propofol-related outbreaks and the effectiveness of existing preventive strategies. In this overview of the evidence of propofol as a source of infection and appraisal of preventive strategies, we identified 58 studies through a literature search in PubMed, Embase, and Lilacs for propofol-related infections during 1989-2014. Twenty propofol-related outbreaks have been reported, affecting 144 patients and resulting in 10 deaths. Related factors included reuse of syringes for multiple patients and prolonged exposure to the environment when vials were left open. The addition of antimicrobial drugs to the emulsion has been instituted in some countries, but outbreaks have still occurred. There remains a lack of comprehensive information on the effectiveness of measures to prevent future outbreaks.

Keywords: 2,6-diisopropylphenol; EDTA; Propofol; anesthesia; contamination; edetate disodium; fospropofol; glycerol; hospital infection; iatrogenic; intravenous; lipidemulsion; lipophilic; nosocomial; outbreak; phenol; phosphatide; safety; soybean.

Figure 1

Flowchart of the selection of studies of infectious disease risk associated with contaminated propofol anesthesia, 1989–2014

Figure 2

Geographic distribution of propofol-related infectious disease outbreaks worldwide, 1989–2014. Values indicate number of outbreaks for each country.

Figure 3

Timing of propofol-related infectious disease outbreaks worldwide during 1989–2014. An outbreak was defined as >2 cases. Dashed line indicates cumulative no. case-patients (secondary y-axis).

Figure 4

Algorithm for helping reduce the likelihood of infectious disease events when using propofol. To avoid intrinsic contamination, sufficient quality control during the manufacturers’ process is required (1). Personnel must be aware of the importance of performing healthcare procedures in a clean environment and the use of gloves and sterile syringes for anesthetic procedures. Syringes and needles must never be reused (2). Also, the aseptic technique for administration of propofol includes cleaning of the rubber bung, if present, with isopropyl alcohol, leaving it to dry. Propofol should be drawn up immediately before its use and not left standing. Intravenous (IV) infusion lines and stopcock dead spaces should be completely flushed to ensure no residual propofol remains. Vials must be discarded after opening for single use, no matter the amount of the remainder (3).