Contamination Of Intravenous Fluids Research Articles

A Case of Nosocomial Outbreak of Pantoea agglomerans Related to Parenteral Nutrition Procedures.

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamination from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found as an opportunistic pathogen in immunocompromised patients. It is not rare to find reports of bacteremia and sepsis from contamination of intravenous fluid, parenteral nutrition, blood products and anesthetic agents—that is, through contamination of medical devices and products. We reported a bacterial infection epidemic occurred in 2011 in a hospital in middle Italy which involved different hospital wards; Pantoea agglomerans was isolated from blood cultures of all infected patients and the source of infection was identified in contaminated parenteral nutrition prepared from the local pharmacy.

Rapid Detection of Microbial Contamination in Intravenous Fluids by ATP-Based Monitoring System.

In this study, we investigated four clinical cases of microbial contamination of in-use intravenous infusion fluid, detected by measuring "Adenosine triphosphate (ATP) + adenosine monophosphate (AMP)" ("ATP+AMP") levels. High "ATP+AMP" values correlate with microbial contamination, and by utilizing these values as indicator for microbial contamination possibility, we were able to rapidly detect the contamination and recommend replacement of catheters and administration sets. In three out of four cases, changing the infusion fluid led to improvement in the condition of the patients. "ATP+AMP" levels can be used to confirm microbial contamination of in-use intravenous infusion fluids, as it is fast (several minites) and convenient to measure them.

The contamination of intravenous fluids by writing on the infusion bag: Fact or fiction?

Introduction -Laboratory experiments were conducted to ascertain whether Sharpie® brand black permanent marker ink will permeate through intravenous infusion bags. The practice of writing directly on infusion bags is a frequent yet controversial practice. There are no known written standards that exist which pertain to this practice. Methods – Five types of intravenous bags containing different solutions marked with black ink from a fine point felt tipped Sharpie® marker. Sample extraction occurred after infusion bags had been warmed to 40 C or remained ambient. Spectrophotometric scans and measurements were conducted at 300 to 600 NM on each solution contained in the experimental bags. Writing with Sharpie® pens on filter paper and surgical tape was also conducted. Results – A total of 17 experiments were conducted with intravenous bags of five different types of manufacture. There appeared to be no visible or ultraviolet spectrophotometric evidence of leaching of the ink from Sharpie® pens. Four different lot numbers of Sharpie® pens were used. Surgical tape that was written on using Sharpie® markers readily exhibited visible evidence of permeability. Discussion - The experiments conducted would appear to indicate that the infusion containers tested maintained an intact barrier to the application of Sharpie® brand permanent marker ink. Writing on surgical tape does not stop the permeability of Sharpie® pens. This study could serve as a suitable pilot study for others to conduct a much more comprehensive study using a greater number of intravenous containers, solutions and ink markers. Keywords: Fluid therapy, infusion, ink, intravenous, writing.

Progress towards a standard to limit particulate contamination in intravenous fluids.

Journal Article Progress towards a standard to limit particulate contamination in intravenous fluids Get access M J GROVES M J GROVES Pharmacy Department, Chelsea College of Science and Technology (University of London), Manresa Road, London, S.W.3, UK Search for other works by this author on: Oxford Academic Google Scholar Journal of Pharmacy and Pharmacology, Volume 23, Issue Supplement_1, December 1971, Pages 238S–239S, https://doi.org/10.1111/j.2042-7158.1971.tb08825.x Published: 12 April 2011

Contamination of intravenous fluids: A continuing cause of hospital bacteremia

Nosocomial bacteremia caused by the contamination of intravenous (IV) infusates is considered rare. Unfortunately, this problem has been underestimated because its identification requires culturing infusates, a procedure not performed routinely. This study was conducted in a referral hospital where IV infusates are admixed in nursing areas. The aim was to determine the prevalence of infusate contamination in adult patients with gram-negative rod (GNR) bacteremia. Over a period of 32 months, a specimen of infusate was drawn for culture from each patient recruited after the laboratory reported a GNR in the blood. A total of 384 infusates were cultured from 384 patients who had been diagnosed with GNR bacteremia. Seven infusates grew a GNR in culture, for a contamination rate of 2% (7/384; 95% confidence interval [CI] = 1% to 3%). In all cases, the infectious organism was the same as the organism isolated from the blood. Infusate contamination was responsible for 7% (7/108; 95% CI = 2% to 11%) of all primary bloodstream infections and 11% (7/62; 95% CI = 2% to 22%) of all primary bloodstream infections not associated with central venous catheter infection. For patients in hospitals where IV drugs are admixed in nursing units, we recommend instituting infusate culture as routine practice following the diagnosis of a GNR in the blood.

Pediatric primary gram-negative nosocomial bacteremia: a possible relationship with infusate contamination.

To evaluate the potential contribution of "extrinsic" contamination of intravenous fluids in hospital bacteremia and infection. Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993. A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients. SAMPLES AND PATIENTS: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience. A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P = .59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges. Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.

Comparison of the standard pour plate procedure and the ATP and Limulus amebocyte lysate procedures for the detection of microbial contamination in intravenous fluids

The intrinsic and extrinsic microbial contamination of large-volume parenterals has been associated with bacteremias in hospitalized patients. When epidemiologic data suggest the association of contaminated intravenous (i.v.) fluids with disease, appropriate laboratory methods must be devised to analyze quickly the suspect fluid. A study was undertaken to compare three laboratory test methods (standard pour plate [SPP] technique, ATP procedure, and Limulus amebocyte lysate [LAL] assay) for detecting the presence of microorganisms in artificially contaminated i.v. fluid. SPP proved the most sensitive of the assay techniques used, but a 24-h period was required for microbial growth. The LAL assay appeared more sensitive in detecting i.v. contamination than the ATP method. These studies suggest that the LAL and ATP methods can be used for the rapid detection of microbial contamination in i.v. fluid. SPP and LAL procedures would have practical laboratory application when the contamination of i.v. fluids is suspected, and they are more sensitive in detecting microbial contamination in these solutions than the ATP method.

Evaluation of a device for monitoring sterility of injectable fluids

An evaluation of a sterility-testing device (Addi-Chek) that uses total-sample membrane filtration is presented. Parenteral nutrition solutions were deliberately contaminated at low levels with 16 bacterial and four fungal strains. Some contaminated solutions were stored at 20 degrees C or 4 degrees C for up to 24 hours before testing; the rest were tested immediately. Additionally, one liter of pharmacy-prepared infusion fluid was tested each day for 100 days. Broth (added to the Addi-Chek unit after filtration to permit microbial growth) was cultured when it became turbid or after a 10-day incubation. Fifty-nine deliberate-inoculation tests were done. The organism was recovered from 56 of these; the other three tests may have been negative because no organisms were present in the aliquot used for inoculation or because of experimental error. The number of organisms used for inoculation varied from 1 to 80; 86% of the tests used 25 organisms or less. Storage for up to 24 hours at 20 degrees C and 4 degrees C had no effect on the results of sterility testing. In testing 100 units of pharmacy-prepared fluid (not deliberately contaminated), one unit (1%) was found to be contaminated. Pharmacy personnel correctly identified positive and negative Addi-Chek units based on visual turbidity of the broth. It is concluded that Addi-Chek is easy to use and effective in detecting low-level contamination in intravenous fluids.

Comparison of two methods for detecting microbial contamination in intravenous fluids

An aliquot sampling method and a qualitative membrane filltration method of microbial detection in intravenous infusion solutions were compared. One-liter plastic bags of total parenteral nutrition solutions were contaminated at approximately 1000, 100, 10, and 1 organisms per liter using clinically isolated strains of Escheichia coli, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Candida albicans. Ten-milliliter aliquots of the solutions were injected into blood culture bottles to test the aliquot method. All remaining fluid was filtered through the Addi-Chek system to test the filtration method. Samples were incubated at 30 degrees C for 10 days and inspected daily for turbidity. The aliquot sampling method consistently detected each of the four organisms at levels of 100 organisms/liter and above. The membrane filtration method consistently detected all levels of contamination (as few as four organisms/liter). The aliquot sampling method is inexpensive and easy to use but may fail to detect some contaminated solutions. The qualitative membrane filtration system will detect all levels of contamination but is more costly in both time and money, and its reliability has not been assessed objectively.

Adventitious contamination of intravenous admixtures during sterility testing

The extent to which contamination of intravenous fluids measured by inhospital sterility-testing may be due to adventitious contamination (i.e., contamination introduced during the sterility-testing procedure) was studied. All one-liter admixtures prepared during a three-day period in a busy centralized i.v. admixture service were studied. Samples of i.v. admixtures were cultured before and after administration by direct ioculation or by culturing the membrane through which the admixture was filtered. Samples of similarly cultured large-volume parenterals served as controls. Contamination rates for control and admixture samples were not significantly different (p = 0.23). Of 10 control and test (admixture) solutions showing contamination before administration, only one test solution again showed contamination after administration but this was with a different microbe. The results suggest that adventitious contamination during sampling/culturing procedures is a component of, and possibly a dominant factor in, the contamination rates detected by inhospital sterility tests. Combined with infection surveillance, sterility tests may be of value when infections are possibly related to admixture contamination.

Contamination of Intravenous Fluids by Bacteria and Fungi During Preparation and Administration

Contamination of Intravenous Fluids by Bacteria and Fungi During Preparation and Administration

Bacterial Contamination of Intravenous Fluids Opened In Unsterile Air

Bacterial Contamination of Intravenous Fluids Opened In Unsterile Air