Pediatric nosocomial bacteremia control program based on culturing in use parenteral infusions.

Objective. As Klebsiella, Enterobacter and Serratia are capable of growth i n IV fluids and these bacteria are commonly implicated in nosocomial bacter emia, a control strategy through microbiological surveilance of in-use pare nteral solutions is proposed. Material and methods. A second level general teaching hospital, serving low-income patients, Through four consecutive st rategies, a continous surveillance program of IV fluids sterility in pediat ric wards was stablished in 1992. During the first stage all of the in-use solutions were cultured. During the second stage randomly selected samples were studied. Third stage was designed as a case-control study. The last st age included samples drawn in convenience. Positive cultures point out even tual infusion mishandling, as well as high-risk areas and patients. Results , After culturing 1940 parenteral solutions, infusion contamination rates d ecreased from 29.6% in 1992 to 12.9% in 1997 (p< 0.001). The proportion of Gram-negative rods isolated from blood cultures went from 72.7% to 40.85% ( p< 0.0001), and the nosocomial bacteremia rare dropped from 3.12 to 1.54 pe r 100 discharges. Conclusions, The program has enabled us to: I) Detect and control eventual bacteremia outbreaks; 2) Assess the endemic infusion cont amination rate; 3) Arouse healthcare workers awareness about infusion line precautions; 4) Have a suitable surveillance strategy according to our labo ratory's workload.