Training reinforcement impact evaluation in parenteral nutrition preparation practices within CAA

C. Imbert, J. Zerbit, C. Cros, F. Nadji, J. Bordenave, G. Benoit Hôpital Armand Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France 

Hygiene rules and sterility management is necessary to avoid possible contamination of preparation within Controlled Atmosphere Areas (CAA). This study aims to determine whether the training reinforcement in parenteral nutrition preparation practices improves the quality of work within CAA.

We have designed an audit grid to evaluate operators (O) and operators assistants (OA) practices. This grid includes respectively 77 and 48 items (whose 47 critical items in total) split in 5 themes: pre and post production cleaning, robot assembly, production and transversal tasks. Items are weighted in accordance with sterility breach and contamination risks. The grid is completed for each pharmacy assistant (PA) (n=10) before and after training reinforcement. Reinforcement includes a personal performance interview following 1st audit, group meetings with team return and educational movies watching.

PA scores (stated in percentage of highest possible score ± 95% CI) set up to 67,0% ± 7,5 in 1st audit versus 80,9% ± 11,1 in 2nd for O position ; 62,1% ± 11,2 in 1st audit versus 75,9% ± 4,9 in 2nd for OA practices ; 62,3% ± 10,6 in 1st audit versus 78,8% ± 8,0 in 2nd for critical items. All of those results are statistically significant.

Theoretical and practical training reinforcement lead to improve significantly the operator quality of work. However, this study shows the inherent difficulties within the staff training to those high risk activities. Indeed, substantial individual variability remain and global performance shall still be improved mostly on some critical items. Regular audit are necessary for best practices application upholding.

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