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Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous
A Chodoff1, A M Pettis, D Schoonmaker
1Hospital Epidemiology Team, Highland Hospital, Rochester, NY 14620, USA.
American Journal of Infection Control
|December 1, 1995
Summary
Needleless dispensing systems may pose patient safety risks. A nosocomial outbreak of gram-negative rod bacteremia was linked to contaminated saline solution bags and dispensing pins, highlighting risks of new medical technologies.
Area of Science:
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
- Microbiology
Background:
- Seven cases of polymicrobial gram-negative rod bacteremia occurred on a medical and cardiac step-down unit over two weeks.
- Isolates included Enterobacter cloacae, Klebsiella pneumoniae, and Citrobacter freundii.
Purpose of the Study:
- To investigate the source and common exposures related to a cluster of nosocomial bacteremia cases.
- To evaluate the safety of needleless intravascular systems in patient care.
Main Methods:
- Concurrent and retrospective chart reviews to identify additional cases and exposures.
- Epidemiologic methods to determine common exposure sources.
- Restriction enzyme DNA analysis of bacterial isolates to confirm common origin.
Main Results:
- Four additional probable cases were identified.
- All patients were exposed to saline solution flushed via peripheral or central venous catheters using a common saline bag and needleless dispensing pin.
- Extrinsic contamination of the saline bag and pin was implicated as the probable source (Fisher's Exact Test, p < 0.002).
- DNA analysis supported a common source for the outbreak.
Conclusions:
- The study identified a patient safety risk associated with needleless intravascular systems.
- Rapid introduction of new technologies requires careful evaluation of potential patient harm.
- Balancing patient health, employee safety, and cost containment is crucial when implementing new medical devices.