Skip to main content
Article thumbnail
Location of Repository

Control de bacteriemia nosocomial pediátrica mediante un programa de cultivo de soluciones parenterales en uso Pediatric nosocomial bacteremia control program based on culturing in use parenteral infusions

By Juan M. Muñoz, Alejandro E. Macías, Francisco J. Guerrero, Isabel Hernández, Humberto Medina and Enrique Vargas

Abstract

OBJETIVO. Dado que Klebsiella, Enterobacter y Serratia se multiplican en soluciones parenterales y son responsables de una elevada proporción de bacteriemias en los hospitales de México, se propone una estrategia de control mediante la vigilancia microbiológica de las soluciones en uso. MATERIAL Y MÉTODOS. Hospital de enseñanza de segundo nivel con 193 camas. Atiende principalmente pacientes de escasos recursos. En 1992 se inició la vigilancia de la esterilidad de las soluciones parenterales en los servicios pediátricos mediante cuatro estrategias: durante la primera etapa se cultivó el total de soluciones en uso. Durante la segunda se cultivaron muestras aleatoriamente elegidas. Tercera y cuarta etapas con muestreo controlado y dirigido, respectivamente. RESULTADOS. Se han cultivado 1940 infusiones. Se ha observado una reducción de la tasa de contaminación (de 29.6% en 1992 a 12.9% en 1997, p< 0.001). Asimismo se redujo la proporción de bacilos gramnegativos aislados en sangre (72.7% vs 40.85%, p< 0.001) y las bacteriemias nosocomiales primarias (BNP) (3.12 vs 1.54 por 100 egresos, p< 0.0001). CONCLUSIONES. La detección de contaminantes señala posibles fallas en el manejo parenteral, áreas de riesgo y pacientes potencialmente afectados. El programa permite estudiar el nivel endémico de contaminación de infusiones y limitar los brotes de bacteriemias nosocomiales primarias a un costo bajo.<br>OBJECTIVES. As Klebsiella, Enterobacter and Serratia are capable of growth in IV fluids and these bacteria are commonly implicated in nosocomial bacteremia, a control strategy through microbiological surveilance of in-use parenteral solutions is proposed. MATERIAL AND METHODS. A second level general teaching hospital, serving low-income patients. Through four consecutive strategies, a continous surveillance program of IV 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

Topics: infección hospitalaria, infusiones parenterales, México, cross infection, Mexico, LCC:Medicine (General), LCC:R5-920, LCC:Medicine, LCC:R, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Instituto Nacional de Salud Pública
Year: 1999
OAI identifier: oai:doaj.org/article:291874463d5141c086978f80e98acfa1
Journal:
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://doaj.org/search?source=... (external link)
  • Suggested articles


    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.