Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: Considerations for nosocomial mortality

Background: Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamina tion was not uncommon in a hospital in Mexico with lapses in aseptic techni ques. To determine whether this problem exists in other similar institution s, we undertook a multi-institutional study. Methods: We surveyed 6 hospitals (A to F) lacking an infection control comm ittee to determine the level of extrinsic contamination. We visited each ho spital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bact erial cultures were performed. Chlorine levels of the tap water were measur ed. Visits were repeated until the survey was completed. Results: A total of 751 infusions were cultured, of which 16 (2.13%) were c ontaminated. Hospital contamination rates varied from zero to 5.56%. Klebsi ella pneumoniae was the most common isolate (10 cases). During the first sa mpling day in hospital C, the 7 infusions from the pediatric ward were foun d to be contaminated with a similar K pneumoniae strain. In-service educati on was started in this hospital. Infusion contamination was eliminated foll owed by a reduction in mortality rate. Overall, a higher risk for infusion contamination was noted for pediatric patients (P =.01, odds ratio = 3.28, 95% CI, 1.10-9.91) and in wards with inadequate water chlorine levels (P =. 02, odds ratio = 3.64, 95% CI, 1.08-13.51). Conclusions: If the hospitals surveyed are representative of others in deve loping countries, an endemic level of parenteral infusion contamination cou ld exist in many hospitals throughout the world.