Report of Intravenous Fluid Contamination Originated from Rubber Caps: A Study of Contamination Routes of Intravenous Fluid

Kim, Sung Mio; Shin, Hyoung Shik; Oh, Myoung Don; Suk, Jong Sung; Kim, Eui Chong; Lee, Song Eun; Choe, Kang Woo

Abstract

BACKGROUND
Nosocomial septicemia associated with contamination of infusate occurs infrequently. Three patients in a university hospital developed fever that was suspected to be infusion-related. These patients were receiving Hartman's solutions that were found to be contaminated by Klebsiella oxytoca, Pseudomonas species, and Citrobacter species. We evaluated the contamination routes of infusates.
METHODS
Samples for culture were collected from used intravenous fluids and unused fluids, and the top of rubber caps were swapped. These were cultured in trypticase soy broth and blood agar plate.
RESULTS
Cultures of used intravenous fluids showed that five of 33 fluids were contaminated by bacteria, and cultures of unused fluids yielded no microorganism. We suspected that contamination of the fluids developed during insertion of administration set, especially from top of the caps. Cultures of the caps disclosed that 26 of 40 caps were contaminated, and contamination rate was higher when caps had been moistured with water. After disinfection with 70% alcohol, culture positive rate of the rubber caps was reduced to 15.0% (6/40). Of the fluids which had standed for seven hours with administration set inserted, four were culture-positive, and two of them showed same organism obtained from their caps.
CONCLUSIONS
The results of this study suggest that the rubber cap can be the source of contamination of IV fluids.