[Control of pediatric nosocomial bacteremia by a program based on culturing of parenteral solutions in use].
OBJECTIVE
As Klebsiella, Enterobacter and Serratia are capable of growth in i.v. fluids and these bacteria are commonly implicated in nosocomial bacteremia, a control strategy through microbiological surveillance of in-use parenteral solutions is proposed.


METHODS
A second level general teaching hospital, serving low-income patients. Through four consecutive strategies, a continuous surveillance program of i.v. fluids sterility in pediatric 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 stage included samples drawn in convenience. Positive cultures point out eventual infusion mishandling, as well as high-risk areas and patients.


RESULTS
After culturing 1940 parenteral solutions, infusion contamination rates decreased 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 rate dropped from 3.12 to 1.54 per 100 discharges.


CONCLUSIONS
The program has enabled us to: 1) Detect and control eventual bacteremia outbreaks; 2) Assess the endemic infusion contamination rate; 3) Arouse healthcare workers awareness about infusion line precautions; 4) Have a suitable surveillance strategy according to our laboratory's workload.
Muñoz
J M
JM
Hospital General Regional de León, Guanajuato, México.
Macías
A E
AE
Guerrero
F J
FJ
Hernández
I
I
Medina
H
H
Vargas
E
E
D016470:Bacteremia / Q000517:prevention & control*; D001419:Bacteria / Q000302:isolation & purification*; D001431:Bacteriological Techniques; D016022:Case-Control Studies; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D006784:Hospitals, Teaching; D006801:Humans; D008800:Mexico; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012996:Solutions / Q000009:adverse effects*
D012996:Solutions