Paul-Enguerrand Fady: Antibiotic underdosing and disposal in NHS organisations across Great Britain

'Line flushing’ is the act of pushing an appropriate diluent, such as saline, through the tubing connecting patients with infusion bags which contain medicines. Up to 1/3rd of the total dose prescribed by clinicians can remain sequestered in un-flushed tubing, resulting in patients receiving too little of the antibiotic they need to fight infection. This acts as a driver for antimicrobial resistance (AMR), potentially making patients more susceptible to future drug - resistant infections(DRIs) with their associated morbidity, mortality, and costs to the NHS.

In this report, we find that fewer than 1 in 3 (29.1%) responding NHS organisations across Great Britain have an antibiotic line flushing policy. Of these, only a minority (43.8%) are fully compliant with their own policies. This means that, overall, only 12% of NHS organisations in Great Britain — fewer than 1 in 8 — are fully compliant with their own established antibiotic line flushing policies. Fewer organisations still have audited compliance in a measurable way: only 1 in 20 (5.1%) responding NHS organisations have done so. We find that Scotland leads the way in designing and implementing antibiotic line flushing policies, followed by Wales, with English NHS organisations trailing behind.

In addition, we find that a large number of NHS organisations who do not engage in line flushing dispose of antibiotics inappropriately, such as in unsealed containers (e.g. medical waste bags).From pre - existing contact with frontline health workers, we have found that the practice of pouring remaining antibiotic down the sink is commonplace.

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