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Safety of refrigerated storage of admixed parenteral fluids
1Infection Control Program, University of Chicago Hospitals and Clinics, Illinois 60637.
Abstract:
Many hospital pharmacies are reluctant to store admixed parenteral fluids longer than 24 to 48 h because of concern about possible microbial contamination. We evaluated the safety of prolonged refrigerated storage of admixtures by culturing mixtures in 471 bags prepared routinely in a hospital pharmacy and stored at 4 degrees C for up to 15 days. Low-level contamination (1 CFU per bag) was found in 3 of 253 solutions of saline and/or glucose into which nonantibiotic additives had been injected. None of 171 saline and/or glucose solutions with antibiotic additives or 47 parenteral nutrition fluids was culture positive. The risk of contamination did not increase with duration of storage, and none of 107 bags stored greater than or equal to 5 days was culture positive. Laboratory studies to measure growth of bacteria and fungi in glucose infusate and parenteral nutrition solutions confirmed that storage at 4 degrees C suppresses growth. Eight of twelve bacterial isolates grew in glucose solutions at 25 degrees C, while none grew at 4 degrees C. Of 13 species of bacteria and fungi inoculated in parenteral nutrition fluids, 8 proliferated at 25 degrees C and none proliferated at 4 degrees C. We conclude that refrigerated storage of parenteral fluids for up to 1 week following admixture, as permitted by Centers for Disease Control guidelines, does not appear to increase the risk of microbial contamination when standard aseptic procedures for admixing and storage are followed.
Insights
Hospital pharmacies can safely refrigerate parenteral fluid admixtures for up to 15 days. Refrigerated storage at 4°C suppresses microbial growth, reducing contamination risks for intravenous solutions.
Area of Science:
- Pharmaceutical Sciences
- Microbiology
- Hospital Pharmacy Practice
Background:
- Hospital pharmacies often limit refrigerated storage of parenteral fluid admixtures to 24-48 hours due to microbial contamination concerns.
- Limited data exists on the safety of prolonged refrigerated storage for these intravenous solutions.
Purpose of the Study:
- To evaluate the safety of prolonged refrigerated storage (up to 15 days) of admixed parenteral fluids.
- To determine if storage duration impacts microbial contamination risk in hospital pharmacy preparations.
Main Methods:
- Cultured 471 routinely prepared parenteral fluid admixtures stored at 4°C for up to 15 days.
- Assessed microbial growth in glucose and parenteral nutrition solutions at 4°C versus 25°C in laboratory studies.
Main Results:
- Low-level contamination (1 CFU/bag) found in 3 of 253 non-antibiotic additive solutions; no contamination in antibiotic or parenteral nutrition fluids.
- No increase in contamination risk with storage duration; 107 bags stored ≥5 days were culture-negative.
- Refrigeration at 4°C significantly suppressed bacterial and fungal growth in glucose and parenteral nutrition solutions compared to 25°C.
Conclusions:
- Prolonged refrigerated storage of parenteral fluids up to 1 week does not appear to increase microbial contamination risk.
- Standard aseptic techniques for admixture and storage are crucial for maintaining the safety of parenteral fluids.
- Findings support current Centers for Disease Control guidelines regarding parenteral fluid storage.