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Endemic infusate contamination and related bacteremia.

Macias AE, de Leon SP, Huertas M, Maravilla E, Romero C, Montoya TG, Muñoz JM, Lopez-Vidal Y

National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico. aaeemmhh@yahoo.com

BACKGROUND: Recent reports suggest that in-use contamination of intravenous infusates is uncommon in hospitals with good standards of care. METHODS: We conducted a survey in a referral hospital in Mexico with good standards of care but no pharmacists to prepare intravenous infusates; we tested the a priori hypothesis that the contamination rate is zero. Using a sterile syringe, we took an initial infusate specimen at the time of recruitment, specimen 1, for culture. We took a second specimen, specimen 2, from administration sets that were maintained for 72 hours. Blood cultures were obtained at the discretion of the physicians caring for the patients. RESULTS: We cultured 1093 infusate specimens from 621 administration sets comprising 421 patients. We obtained a specimen 1 from each of the enrolled sets and a specimen 2 from 472 sets (76%). We analyzed 10 significant cultures and obtained a global infusate contamination rate of 0.9% (10/1093; 95% CI: 0.5%-1.7%). Two cases of infusate-related bacteremia occurred, establishing a global rate of 0.003/72 infusion hours. CONCLUSIONS: Even in institutions with good nursing standards, endemic in-use infusate contamination may be a present danger. We must avoid the use of intravenous therapy whenever possible.

Published 4 February 2008 in Am J Infect Control, 36(1): 48-53.
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