MICROBIAL-CONTAMINATION OF BLOOD CONSERVATION DEVICES DURING ROUTINE USE IN THE CRITICAL CARE SETTING - RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL

Objectives: To compare microbial contamination of two different blood conservation devices; to determine if there was an association between contamination of the blood conservation devices and clinical infectio ns; to determine if there was a significant user preference for either of the two devices. Design: Prospective, randomized trial. Setting: M edical, neurosurgical, and spinal cord intensive care units of an urba n, university hospital. Patients: Forty patients who required clinical ly indicated intraarterial catheters placed at new sites. Intervention s: The two most widely available blood conservation devices at the tim e of the study (Venous Arterial blood Man agement Protection system(TM ) [VAMP], Baxter Edwards Critical-Care, Irvine, CA; and Safe Draw(TM), Ohmeda, Madison, WI) were chosen for comparison. After the normal 48 to 72 hrs of device use, the blood conservation systems were removed a nd semiquantitative and quantitative cultures were taken from comparab le sites of the two devices. Positive cultures from the patients were recorded and correlated with cultures obtained from the devices. In or der to assess preference for either device, a survey tool was administ ered to the nursing staff who participated in the study. Measurements and Main Results: Quantitative cultures from all sites cultured in bot h groups demonstrated mean colony counts of <10(3) colony-forming unit s (cfu)/mL. There were no statistically significant differences in the colony counts at any of the sites compared between the two groups. Th ere were no statistically significant relationships between positive c ultures and patient age, gender, duration of device utilization, frequ ency of device entry, or the intensive care unit in which the study wa s conducted. In no circumstance did positive cultures from any of the blood conservation devices correlate with positive culture results fro m any sites of clinical infection. The clinical survey demonstrated a statistically significant preference for the VAMP system, which persis ted despite increased experience with the Safe Draw system. Conclusion s: The levels of microbial contamination noted in these devices were n ot consistent with clinical infection (defined as 10(3) cfu/mL on quan titative cultures). There was no significant difference in degree or p attern of contamination between the two devices. When utilized and cha nged according to the Centers for Disease Control guidelines, blood co nservation devices are not harbors of infection in the critical care s etting. Blood conservation devices can be used as part of a comprehens ive blood conservation program in the critical care setting without un due concern for exacerbating infectious processes.