A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Anaesthesiology Johannesburg, 2013 / Background: Microbial contamination of multi-dose vials is one of the mechanisms by which transmission of pathogens to patients can occur in anaesthesia. Common practice at Chris Hani Baragwanath Academic Hospital (CHBAH) is to use boluses of a self-prepared, multi-dose phenylephrine solution (referred to as the solutions) to treat hypotension, due to the vasodilatory effects of a spinal anaesthetic, in stable patients undergoing a caesarean section. Aims: The aims of this study were to determine if there was microbial contamination of the solutions used at CHBAH and to evaluate if appropriate labelling and aspiration practices were adhered to with regard to the solutions A sample was collected and the labelling data was documented from the solutions found in the obsteric theatres at CHBAH over a period of three months. The samples were sent to a laboratory for microbial investigation. Microbial contamination was identified in seven of 110 (6.36%) samples collected from the solutions. The name of the solution was indicated on all 110 (100%) containers and the concentration of the solution was indicated on 106 (96.36%) containers. The date the solution was prepared was indicated on 82 (74.55%) containers and the time the solution was prepared was indicated on 63 (57.27%) containers. Only nine (8.18%) of the healthcare workers that prepared the solutions confirmed it by placing a signature on the container. Labelling data was written directly on all 110 (100%) containers and a spike device was used in 71 (64.54%) containers. This study demonstrated microbial contamination of the solutions and that safe injection practices were not adhered to when intravenous medications were prepared and administered. This is important at CHBAH since a large proportion of South African patients are immunocompromised and susceptible to opportunistic infections. Inappropriate labelling of medications is a cause of medication administration errors and this may have serious legal implications for the anaesthetist.

Globalization has transformed the pharmaceutical industry into a vast, interconnected network. However, this complexity has led to inefficiencies in the supply chain, with existing ERP systems struggling to keep up due to their centralized nature, resulting in a lack of transparency and increased errors. This research proposes efficient distributed ledger-based architectures to address these challenges. In Chapter 3, a new transparent supply chain architecture is introduced to eliminate blind spots and enable stakeholders to verify the authenticity of pharmaceutical products. This system creates a secure, single source of truth for the entire lifecycle of medicines, thereby eliminating counterfeits. Chapter 4 focuses on securing the cold pharmaceutical supply chain using IoT and distributed ledgers. The proposed architecture monitors and controls environmental parameters, ensuring safe drug transport. Scalability is addressed with a novel proof of authentication (PoAh) blockchain called EasyChain. In Chapter 5, the serialization of pharmaceutical products is enhanced through digital twinning, providing an efficient and cost-effective solution while complying with regulations. This research aims to create scalable and efficient pharmaceutical supply chains, reducing counterfeits and improving overall security.