Leaving More Than Your Fingerprint on the Intravenous Line

Abstract

Introduction Acute care handling of IV stopcocks during anesthesia and surgery may result in contaminated IV tubing sets. In the context of widespread propofol use, a nutrient-rich hypnotic drug, we hypothesized that propofol anesthesia increases bacterial contamination of IV stopcocks and may compromise safety of IV tubing sets when continued to be used after propofol anesthesia. Methods We conducted an in vitro trial by collecting IV tubing sets at the time of patient discharge from same-day ambulatory procedures performed with and without propofol anesthesia. These extension sets were then held at room temperature for 6, 24, or 48 hours. We cultured 50 samples at each interval for both cohorts. Quantitative cultures were done by aspirating the IV stopcock dead space and plating the aspirate on blood agar for colony count and speciation. Results Positive bacterial counts were recovered from 17.3% of propofol anesthesia stopcocks (26/150) and 18.6% of non-propofol stopcocks (28/150). At 6 hours, the average bacterial counts from stopcocks with visible residual propofol was 44 colony forming units (CFU)/mL, compared to 41 CFU/mL with no visible residual propofol and 37 CFU/mL in non-propofol anesthesia stopcocks. There was a 100-fold increase in bacterial number in contaminated stopcock dead spaces at 48 hours after propofol anesthesia. This difference remained significant when comparing positive counts from stopcocks with no visible residual propofol and non-propofol anesthesia (p-value=0.034). Conclusion There is a covert incidence and degree of IV stopcock bacterial contamination during anesthesia which is aggravated by propofol anesthetic. Propofol anesthesia may increase risk for postoperative infection because of bacterial growth in IV stopcock dead spaces.

Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–20141

“…The most common reservoirs associated with extrinsic contamination of propofol are syringes or micro-droppers, vials, and IV stopcock dead space. Syringes or micro-droppers have been implicated in most outbreaks ( 23 – 27 ). Propofol vials have been demonstrated to be a reservoir for microbes when contents are exposed to the environment ( 28 ).…”

“…It is believed that administering a dose >200 mg to an adult in an OR will increase the probability of using an additional vial as a multi-dose vial for > 1 patients. IV stopcock dead space has been shown to provide a potential route of entry for pathogenic, multidrug-resistant bacteria in infusion lines ( 20 , 27 ).…”

“…A number of microorganisms are associated with propofol in clinical- and laboratory-based studies at varying frequencies ( Table 2 ). We report the specific pathogens that have been associated in several outbreaks ( 2 – 4 , 6 , 8 – 10 , 12 – 15 , 30 , 31 ), as well as all of the transmissible microorganisms that have been observed in contaminated propofol in syringes, vials, and infusion lines ( 23 , 25 , 27 , 30 , 32 ). We also describe 3 reported cases of septic shock related to propofol ( 33 , 34 ).…”

“…In 1995, McHugh and Roper reported an incidence of 6.3% (16/254) of infection when propofol was administered from vials but did not find that delays in the administration of propofol were associated in any increased likelihood of bacterial contamination ( 25 ). Cole et al recorded the incidence of contamination as high as 17.3% (26/150) in propofol found in stopcock dead space ( 27 ).…”

The effect of implementing an aseptic practice bundle for anaesthetists to reduce postoperative infections, the Anaesthetists Be Cleaner (ABC) study: protocol for a stepped wedge, cluster randomised, multi-site trial

“…Cole et al found that 12–16% of multi-use injection ports through which medications are administered contain bacteria within 6 h [23]. Crucially, Loftus et al have demonstrated an association between contamination of these ports and postoperative mortality [20] and transmission of pathogenic bacteria from one patient on an operating list to another, including transmission via the hands of providers and environmental surfaces [24].…”