Contamination of intravenous fluids: a continuing cause of hospital bacteremia

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Microbiology

Background:

• Nosocomial bacteremia from contaminated intravenous (IV) infusates is an underrecognized issue.
• Current diagnostic methods often overlook infusate contamination as it requires specific culturing procedures not routinely performed.

Purpose of the Study:

• To determine the prevalence of IV infusate contamination in adult patients diagnosed with gram-negative rod (GNR) bacteremia.
• To assess the contribution of infusate contamination to primary bloodstream infections in a hospital setting where IV admixtures are prepared in nursing areas.

Main Methods:

• A prospective study was conducted over 32 months in a referral hospital.
• IV infusate cultures were obtained from adult patients immediately after a GNR was detected in their blood cultures.
• Data on GNR bacteremia and primary bloodstream infections were analyzed to calculate contamination rates.

Main Results:

• A total of 384 infusates were cultured from patients with GNR bacteremia, revealing a 2% contamination rate (7/384).
• The GNR isolated from the infusates matched the GNR found in the patients' blood in all positive cases.
• Infusate contamination accounted for 7% of all primary bloodstream infections and 11% of those not linked to central venous catheters.

Conclusions:

• Hospitals preparing IV admixtures in nursing units should implement routine infusate culturing.
• This practice is recommended following the detection of GNR bacteremia to identify and mitigate contamination risks.