This report summarises the findings arising from a comprehensive study of antibiotic ‘line flushing’ and disposal practices in NHS organisations across Great Britain. It argues that is a need for concerted, UK-wide action on antibiotic line flushing policies.
‘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.
This report highlights the following findings in relation to this:
- 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.
- 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.
- Scotland leads the way in designing and implementing antibiotic line flushing policies, followed by Wales, with English NHS organisations trailing behind.
- A large number of NHS organisations do not engage in line flushing dispose of antibiotics inappropriately, such as in unsealed containers (e.g. medical waste bags).
- A substantial proportion of NHS organisations in Great Britain dispose of administration sets in unsealed containers such as medical waste bags. In addition, a small minority of NHS organisations in Great Britain (up to 17.3%) do so without separating the spike from the administration set, against organisational policies to dispose of spikes in sharps bins and thus potentially causing occupational hazards.
The report makes five policy recommendations:
- That all NHS organisations implement line flushing policies by late 2024, with support from the Department for Health and Social Care.
- That national regulators integrate adherence to line flushing policies into their assessment framework when assessing hospitals.
- That Government funds be made available to enable research into underdosing’s impact on DRIs and environmental AMR.
- That comprehensive training be provided to all appropriate staff surrounding how to dispose of antibiotics appropriately.
- That hospitals monitor environmental antibiotics contamination, both in effluent and on wards.