Reduction of Microbial Contaminants in Extemporaneous Compounded Oral Medicines Following a Hand Hygiene Intervention at a Tertiary Hospital in Tanzania

Abstract

Background: Extemporaneously compounded medicines are essential for individualized patient care, particularly when age-specific commercial formulations are unavailable. However, the process of compounding is susceptible to microbial contamination, which may result to product spoilage and risk to patient safety.
Objectives: This study aimed to assess the microbial quality of extemporaneously compounded oral medicines at Bugando Medical Center
Methodology: A cross-sectional study was conducted at Bugando Medical Centre (BMC) compounding unit, involving 388 freshly prepared oral compounded medicines. Samples were cultured on Blood agar, MacConkey agar, and Sabouraud’s Dextrose Agar for bacterial and fungal isolation. Microorganisms were identified using colony morphology, Gram staining, and standard biochemical tests. Following initial findings, selected environmental samples and a few additional samples were collected to explore potential sources of contamination. Results were then shared with staff in the unit, who agreed to reinforce hand hygiene practices. Contamination rates were then compared before and after the hand hygiene intervention. Data was analyzed using STATA version 15 (Texas, USA).
Results: Majority of compounded medicines were diuretics 228 (58.8%), primarily prepared for children aged 1–5 years with cardiovascular conditions. Overall, 170 (43.8%) extemporaneously compounded medicine samples were contaminated. Among these, Gram-negative bacteria predominated 136 (80.0%), followed by fungi 17 (10.0%) and Gram-positive bacteria 17 (10.0%). Following reinforcement of hand hygiene practices, the overall contamination rate significantly decreased by 18.8% (P<.001).
Conclusion: A high prevalence of microbial contamination was observed for oral extemporaneously compounded medicines at BMC. Reinforcing hand hygiene and routine quality monitoring, is critical to improving the safety of compounded medicines.