title: Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality.
abstract: BACKGROUND
  Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamination was not uncommon in a hospital in Mexico with lapses in aseptic techniques. To determine whether this problem exists in other similar institutions, we undertook a multi-institutional study.
  
  
  METHODS
  We surveyed 6 hospitals (A to F) lacking an infection control committee to determine the level of extrinsic contamination. We visited each hospital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bacterial cultures were performed. Chlorine levels of the tap water were measured. Visits were repeated until the survey was completed.
  
  
  RESULTS
  A total of 751 infusions were cultured, of which 16 (2.13%) were contaminated. Hospital contamination rates varied from zero to 5.56%. Klebsiella pneumoniae was the most common isolate (10 cases). During the first sampling day in hospital C, the 7 infusions from the pediatric ward were found to be contaminated with a similar K pneumoniae strain. In-service education was started in this hospital. Infusion contamination was eliminated followed 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 developing countries, an endemic level of parenteral infusion contamination could exist in many hospitals throughout the world.
authors.affiliation: School of Medicine of León, University of Guanajuato, México.
authors.forename: A E
authors.initials: AE
authors.lastname: Macías
authors.forename: J M
authors.initials: JM
authors.lastname: Muñoz
authors.forename: D A
authors.initials: DA
authors.lastname: Bruckner
authors.forename: A
authors.initials: A
authors.lastname: Galván
authors.forename: A B
authors.initials: AB
authors.lastname: Rodríguez
authors.forename: F J
authors.initials: FJ
authors.lastname: Guerrero
authors.forename: H
authors.initials: H
authors.lastname: Medina
authors.forename: J C
authors.initials: JC
authors.lastname: Gallaga
authors.forename: G
authors.initials: G
authors.lastname: Cortés
mesh_terms: D000328:Adult; D001419:Bacteria / Q000302:isolation & purification*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003430:Cross-Sectional Studies; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D006801:Humans; D017053:Infection Control / Q000379:methods; D007263:Infusions, Parenteral / Q000009:adverse effects*; D008800:Mexico / Q000453:epidemiology; D009096:Multi-Institutional Systems / Q000706:statistics & numerical data