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 1/3 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 with their associated morbidity, mortality, and costs to the NHS.

In this report, we find that fewer than 1 in 3 responding NHS organisations across Great Britain have an antibiotic line flushing policy. Of these, only a minority 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 responding NHS organisations have done so.