POLYMICROBIAL GRAM-NEGATIVE BACTEREMIA ASSOCIATED WITH SALINE SOLUTION FLUSH USED WITH A NEEDLELESS INTRAVENOUS SYSTEM

Background: During a 2-week period, seven cases of nosocomial polymicr obial gram-negative rod bacteremia occurred on a 39-bed medical and ca rdiac step-down unit. Combinations of Enterobacter cloacae (seven isol ates), klebsiella pneumoniae (five isolates), and Citrobacter freundii (two isolates) were isolated from blood cultures. Methods: Concurrent and retrospective chart reviews were used to look for further cases a nd common exposures. Epidemiologic methods were used to refine determi nation of common exposure. Restriction enzyme DNA analysis was perform ed on the isolates. Results: Concurrent and retrospective chart review s revealed four additional possible cases during the same period. All case patients were exposed, through peripheral saline solution locks o r central venous catheters, to saline solution ''flush'' from a centra l 0.9% saline solution bag and a needleless dispensing pin. Epidemiolo gic methods implicated probable extrinsic contamination of a single ba g and pin used during a 24- 48-hour period (Fisher's Exact Test, p < 0 .002). There were no other common exposures. Restriction enzyme DNA an alysis of the isolates further supported a common source for the outbr eak. Conclusions: The introduction of needleless intravascular systems has been embraced for employee protection. Our report is the first to raise the question of patient safety with such systems. This outbreak highlights the inherent risks in rapid introduction of new technologi es and points out the delicate balance among patient health, employee safety, and cost containment.