Nosocomial Malaria From Contamination of a Multidose Heparin Container With Blood

Abstract

A girl developed Plasmodium falciparum malaria in Riyadh, Saudi Arabia, a non-malarious area. Twelve to 18 days before onset, she had been hospitalized for asthma on the same ward as three malaria patients. The only link between the malaria patients and the asthma patient was a multidose heparin container used to fill syringes for use on heparin locks and intravenous devices. Contamination of the heparin with blood occurred on at least one occasion when a needle had been left in place through the septum of this container and was used to refill a used syringe.

Untitled

“…Transmission of malaria via heparin locks has been reported previously by other authors, the source of contamination was a multidose heparin container [3]. Although the practice of multiple dose preparations of heparin into large volume syringes to be distributed among the several patients of the ward is forbidden at this tertiary institution, it has been difficult to eradicate due to the high volume of patients and the limited economical resources of the hospital.…”

Malaria

“…However, there is also a risk of transmission with platelet concentrates [64], leucocyte concentrates [65], and even fresh frozen plasma; the latter has only been observed with the administration of fresh frozen plasma within one day following collection [66]. Three infections with malaria were described due to nonobservance of the basic principles of hygiene [67] or needle perforation injury [10,68], and three other transfusion associated cases of malaria recently were described in Canada [46]. These give rise to the assumption that even low numbers of infected red blood cells can cause malaria infection.…”

Malaria

“…(Modifiziert nach den Empfehlungen der Deutschen Gesellschaft für Tropenmedizin und internationale Gesundheit, DTG)67] bzw. durch Nadelstichverletzung[10,68] sowie 3 kürzlich beschriebene transfusionsassoziierte Malariafälle in Kanada[46] durch Thrombozytenkonzentrate lassen vermuten, dass auch geringe Zahlen infizierter Erythrozyten ausreichend für eine Malaria beim Empfänger sind.Wegen zum Teil sehr langer Überle-benszeiten im menschlichen Organismus (z.…”