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Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial
A E Macías1, J M Muñoz, D A Bruckner
1School of Medicine of León, University of Guanajuato, México.
Background:
Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamination was not uncommon in a hospital in Mexico with lapses in aseptic techniques. To determine whether this problem exists in other similar institutions, we undertook a multi-institutional study.
Methods:
We surveyed 6 hospitals (A to F) lacking an infection control committee to determine the level of extrinsic contamination. We visited each hospital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bacterial cultures were performed. Chlorine levels of the tap water were measured. Visits were repeated until the survey was completed.
Results:
A total of 751 infusions were cultured, of which 16 (2.13%) were contaminated. Hospital contamination rates varied from zero to 5.56%. Klebsiella pneumoniae was the most common isolate (10 cases). During the first sampling day in hospital C, the 7 infusions from the pediatric ward were found to be contaminated with a similar K pneumoniae strain. In-service education was started in this hospital. Infusion contamination was eliminated followed by a reduction in mortality rate. Overall, a higher risk for infusion contamination was noted for pediatric patients (P =.01, odds ratio = 3.28, 95% CI, 1.10-9.91) and in wards with inadequate water chlorine levels (P =. 02, odds ratio = 3.64, 95% CI, 1.08-13.51).
Conclusions:
If the hospitals surveyed are representative of others in developing countries, an endemic level of parenteral infusion contamination could exist in many hospitals throughout the world.
Insights
Extrinsic contamination of parenteral infusions is a significant issue in hospitals, with 2.13% of infusions contaminated in a multi-institutional study. This highlights a potential global problem in healthcare settings, especially in developing countries.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- Parenteral infusions can become contaminated during administration (extrinsic contamination).
- Previous surveys indicated lapses in aseptic techniques contributing to contamination in a Mexican hospital.
- This study aimed to assess extrinsic contamination in similar institutions.
Purpose of the Study:
- To determine the prevalence of extrinsic contamination in parenteral infusions across multiple hospitals.
- To identify risk factors associated with infusion contamination.
- To assess the impact of interventions on contamination rates.
Main Methods:
- A multi-institutional survey of 6 hospitals lacking infection control committees.
- Sampling of parenteral infusions (n=751) for bacterial cultures.
- Measurement of tap water chlorine levels and correlation with contamination rates.
Main Results:
- Overall, 2.13% of parenteral infusions were contaminated, with rates varying by hospital (0-5.56%).
- Klebsiella pneumoniae was the most frequent isolate.
- Pediatric patients and wards with inadequate water chlorine levels showed higher contamination risk.
Conclusions:
- A significant level of parenteral infusion contamination may be endemic in hospitals, particularly in developing countries.
- Intervention, such as in-service education, can effectively reduce infusion contamination and associated mortality.
- Maintaining adequate water chlorine levels is crucial for preventing contamination.