Polymicrobial gram-negative bacteremia associated with saline solution flush used with a needleless intravenous...

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.