The relationship between intravenous infusate colonisation and fluid container hang time

Abstract

Routine replacement of intravenous fluids continues in many settings, often 24 hourly, in the belief that this prevents infection. We found no relationship between duration of use and colonisation and routine replacement may be unnecessary. Further research is needed to investigate the effectiveness of routinely replacing intravenous fluids at set time points to prevent colonisation and infection.

Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting

“…Our fluid contamination rate was 4.4% overall by day 7, and 6.7% in the ER. It should be noted that this rate is higher than most human studies, where fluid contamination rates have been <3% . However, our fluid contamination rate is almost identical to a pediatric self‐disclosed substandard of care setting where the authors collected samples from various parenteral solutions clinically used in 4 general pediatric hospitals in Mexico City (6.8%) .…”

“…Differences in fluid contamination rates between human studies and our experimental design can be explained by several factors. First, human studies where fluid type is available use 0.9% NaCl in 83–100% of the time, , whereas, veterinarians mostly use lactated balanced‐electrolytes solution such as solution L for daily use . Normal saline (ie, 0.9% NaCl) is less likely to support bacterial growth compared to solution L and dextrose‐containing solutions .…”

“…It is likely that the lower contamination rates in human studies are related to the rapid turnover (ie, every 24 h) of fluid containers. In one study investigating compliance with the “24 hour rule,” it was found that 77% of bags were discarded after 48 hours . It should be noted that the “24‐hour rule” has been challenged as obsolete and the current CDC Guidelines for Prevention of Intravascular Catheter‐Related Infections consider maximal hang time an unresolved question and does not recommend a specific time frame …”

“…There is no consensus on what constitutes a clinically relevant bacterial load and most veterinary studies do not report bacterial load in studied contaminated devices . Although some authors in both veterinary and human studies consider 5–10 cfu/sample to be a significant bacterial load, the relationship between bacterial load and clinical signs is mainly unknown . Macias et al s ampled intravenous fluid from patients with gram‐negative serious infection complications and found that the bacterial load in the fluid that was presumed to be the cause for the infection was between 30 and >1,000 cfu/mL .…”

Prolonged Infusions of Ketamine and Impact on Infections and Waste

“…To conserve ketamine supplies our policy was changed to a concentrated “standardised” concentration of ketamine (250 mg in 50 ml 0.9% sodium chloride) that could be run for a maximum of 72 hrs. There is evidence demonstrating no relationship between duration of infusion and microbiological contamination for 72 hrs 1 2. EPIC 3 guidelines recommend using infusion equipment for 72 hrs3.…”