A Comparison of the Surface Contaminants of Handwritten Recycled and Printed Electronic Parenteral Nutrition Prescriptions and Their Transfer to Bag Surfaces During Delivery to Hospital Wards

Abstract

Background: Handwritten recycled paper prescription for parenteral nutrition (PN) may become a concentrated source of viable contaminants, including pathogens. This study examined the effect of using fresh printouts of electronic prescriptions on these contaminants. Materials and Methods: Cellulose sponge stick swabs with neutralizing buffer were used to sample the surfaces of PN prescriptions (n = 32 handwritten recycled; n = 32 printed electronic) on arrival to the pharmacy or following printing and PN prescriptions and bags packaged together during delivery (n = 38 handwritten recycled; n = 34 printed electronic) on arrival to hospital wards. Different media plates and standard microbiological procedures identified the type and number of contaminants. Results: Staphylococcus aureus, fungi, and mold were infrequent contaminants. Nonspecific aerobes more frequently contaminated handwritten recycled than printed electronic prescriptions (into pharmacy, 94% vs 44%, Fisher exact test P < .001; onto wards, 76% vs 50%, P = .028), with greater numbers of colony-forming units (CFU) (into pharmacy, median 130 [interquartile range (IQR), 65–260] vs 0 [0–75], Mann-Whitney U test, P < .001; onto wards, median 120 [15–320] vs 10 [0–40], P = .001). Packaging with handwritten recycled prescriptions led to more frequent nonspecific aerobic bag surface contamination (63% vs 41%, Fisher exact test P = .097), with greater numbers of CFU (median 40 [IQR, 0–80] vs 0 [0–40], Mann-Whitney U test, P = .036). Conclusion: The use of printed electronic PN prescriptions can reduce microbial loads for contamination of surfaces that compromises aseptic techniques.