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Nosocomial Pediatric Bacteremia: The Role of Intravenous Set Contamination in Developing Countries

Published online by Cambridge University Press:  02 January 2015

Alejandro E. Macías ,
Juan M. Muñoz ,
Laura E. Herrera ,
Humberto Medina ,
Isabel Hernández ,
Dolores Alcántar  and
Samuel Ponce de León
Alejandro E. Macías*
Affiliation:
University of Guanajuato School of Medicine at Leon, Leon, Mexico
Juan M. Muñoz
Affiliation:
University of Guanajuato School of Medicine at Leon, Leon, Mexico
Laura E. Herrera
Affiliation:
University of Guanajuato School of Medicine at Leon, Leon, Mexico
Humberto Medina
Affiliation:
University of Guanajuato School of Medicine at Leon, Leon, Mexico
Isabel Hernández
Affiliation:
University of Guanajuato School of Medicine at Leon, Leon, Mexico
Dolores Alcántar
Affiliation:
National Autonomous University of Mexico, Experimental Medicine Department, Mexico City, Mexico
Samuel Ponce de León
Affiliation:
National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
*
Facultad de Medicina de León, 20 de Enero 929, León Guanajuato 37320, México
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Abstract

Objective:

To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates.

Design:

Cultures of injection ports and infusate during 26 visits to 4 hospitals.

Setting:

Four public general pediatric hospitals in Mexico City with substandard care practices.

Patients:

Hospitalized pediatric patients receiving intravenous solutions.

Results:

Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%).

Conclusion:

These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 3 , March 2004 , pp. 226 - 230
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Arnow, PM, Quimosing, EM, Beach, M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993;16:778–784.CrossRefGoogle ScholarPubMed
2.Maki, DG. Infections due to infusion therapy. In: Bennett, JV, Brachman, PS, Sanford, JP, eds. Hospital Infections. Boston: Little, Brown;1992:849–892.Google Scholar
3.Mermel, LA, Farr, BM, Sherertz, RJ, et al. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001;32:1249–1272.CrossRefGoogle ScholarPubMed
4.Maki, DG, Martin, WT. Nationwide epidemic of septicemia caused by contaminated infusion products: IV. Growth of microbial pathogens in fluids for intravenous infusion. J Infect Dis 1975;131:267–272.CrossRefGoogle Scholar
5.Pegues, DA, Arathoon, EG, Samayoa, B, et al. Epidemic gram-negative bacteremia in a neonatal unit in Guatemala. Am J Infect Control 1994;22:163–171.CrossRefGoogle Scholar
6.Macias, AE, Bruckner, DA, Hindler, JA, et al. Parenteral infusions as culture media from a viewpoint of nosocomial bacteremia. Rev Invest Clin 2000;52:39–43.Google ScholarPubMed
7.Macias-Hernandez, AE, Hernandez Ramos, I, Muñoz Barrett, JM, et al. Pediatric primary gram-negative nosocomial bacteremia: a possible relationship with infusate contamination. Infect Control Hosp Epidemiol 1996;17:276–280.CrossRefGoogle ScholarPubMed
8.Jarvis, WR, Cookson, ST, Robles, B. Prevention of nosocomial bloodstream infections: a national and international priority. Infect Control Hosp Epidemiol 1996;17:272–275.CrossRefGoogle ScholarPubMed
9.Macias-Hernandez, AE, Ortega-Gonzalez, P, Muñoz-Barrett, JM, et al. Pediatric nosocomial bacteremia: culturing infusion liquids may help in its control. Rev Invest Clin 1994;46:295–300.Google Scholar
10.Macias, AE, Muñoz, JM, Bruckner, DA, et al. Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality. Am J Infect Control 1999;27:285–290.CrossRefGoogle Scholar
11.Bennett, SN, McNeill, MM, Bland, LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995;333;147–154.CrossRefGoogle ScholarPubMed
12.Gorbea, HF. Intravenous tubing with burettes can be safely changed at 48-hour intervals. JAMA 1984;251:2112–2115.CrossRefGoogle ScholarPubMed
13.Maki, DG, Botticelli, JC, LeRoy, ML, et al. Prospective study of replacing administration sets for intravenous therapy at 48- vs. 72-hour intervals. JAMA 1987;258:1777–1781.CrossRefGoogle ScholarPubMed
14.Raad, I, Hanna, HA, Awad, A, et al. Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours? Infect Control Hosp Epidemiol 2001;22:136–139.CrossRefGoogle Scholar
15.Huskins, WC, O'Rourke, EJ, Rhinehart, E, Goldman, D. Infection control in countries with limited resources. In: Mayhall, C, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott, Williams and Wilkins; 1999:1489–1513.Google Scholar
16.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strains typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Hosp Epidemiol 1997;18:426–439.CrossRefGoogle ScholarPubMed
17.Lwanga, SK, Lemeshow, S. Sample Size Determination in Health Studies: A Practical Manual, ed. 1. Geneva: World Health Organization; 1991.Google Scholar
18.Weiss, NA. Introductory Statistics, ed. 6. Boston: Addison Wesley; 2001:605.Google Scholar
19.Maki, DG, Klein, BS, McCormick, RD, et al. Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering: a case for selective drug screening of health care personnel. JAMA 1991;265:981–986.CrossRefGoogle ScholarPubMed
20.Hernández-Ramos, I, Gaitán-Meza, J, Gaitán-Gaitán, E, León-Ramírez, AR, Justiniani-Cedeno, N, Avila-Figueroa, C. Extrinsic contamination of intravenous infusates administered to hospitalized children in Mexico. Pediatr Infect Dis J 2000;19:888–890.CrossRefGoogle ScholarPubMed
21.Rudnick, JR, Beck-Sague, CM, Anderson, RL, et al. Gram-negative bacteremia in open-heart-surgery patients traced to probable tap-water contamination of pressure-monitoring equipment. Infect Control Hosp Epidemiol 1996;17:281–285.Google ScholarPubMed
22.Buxton, AE, Highsmith, AK, Garner, JS, et al. Contamination of intravenous fluid: effects of changing administration sets. Ann Intern Med 1979;90:764–768.CrossRefGoogle ScholarPubMed
23.Muñoz, JM, Macías, AE, Guerrero, FJ, Hernández, I, Medina, H, Vargas, E. Pediatric nosocomial bacteremia control program based on culturing in parenteral infusions. Salud Publico Mex 1999;41(suppl 1):S32–S37.Google Scholar
24.Secretaría de Salud, Mexico. Estadistica de egresos hospitalarios de la Secretaría de Salud, 2000. >Salud Publico Mex 2001;43:494–510.Salud+Publico+Mex2001;43:494–510.>Google Scholar
25. Institute Nacional de Estadística, Geografía e Informática. México. XII Censo General de Población y Vivienda, 2000. Available at www.inegi.gob.mex/difusion/espanol/poblacion/definitivos/nal/sintesis/salud.pdf. Accessed November 5, 2001.Google Scholar
26.Pearson, ML. Guideline for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:438–473.Google ScholarPubMed