Viral and Bacterial Contamination of Multiple-dose Drug Vials Kept in Anesthesia Machines

Petty, W. Clayton; Heccers, John P.; Shelton, Dohthy F.; Mendeniiall, Max K.; Colone, L

doi:10.1097/00000542-196904000-00019

Cited by 9 publications

(4 citation statements)

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“…Samples of both were LAL positive but culture negative 18 h after the vials were opened. DISCUSSION Only a few studies and reports have addressed the possibility of contamination of multiple-dose vials during use; most have found a relatively low frequency of contamination (1,2,4,(8)(9)(10)17). To formulate rational recommendations for the safe handling of these medication vials in health-care settings, we believe it is important to assess systematically the bactericidal activity of various medications after deliberate contamination and to determine any critical time at which such microbial growth might reach high levels.…”

Section: Resultsmentioning

confidence: 99%

“…Many of these medications contain a preservative to retard microbial growth, but microbial contamination introduced during use could theoretically cause infection in patients receiving the medications. Although few reports suggest that this has actually occurred, several studies have shown that some medications or pharmaceuticals available in multiple-dose vials allow persistence or proliferation of microorganisms after being contaminated (1,4,8,10,12,15). To test whether methods of handling these medications in a hospital could result in a level of contamination sufficient to cause infections in patients, we contaminated eight medications available in multiple-dose vials with 13 microbial pathogens common in hospital environments.…”

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confidence: 99%

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Growth of Nosocomial Pathogens in Multiple-Dose Parenteral Medication Vials

1982

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The extent to which microbial contamination of medications dispensed in multiple-dose vials might serve as a source of infection to patients has not been fully investigated. To characterize the effects of microbial contamination, we studied the growth-supporting properties of eight medications dispensed in multiple-dose vials. Two medications, procainamide and methohexital, demonstrated no survival of any microbes 24 h after inoculation. Succinylcholine chloride, regular insulin, potassium chloride, heparin, and thiopental slowly killed or allowed limited survival of several of the microorganisms used as contaminants. Lidocaine allowed survival or proliferation of several microbial strains suspended in 0.25% peptone water in saline, but slowly killed all strains except Pseudomonas cepacia suspended in 0.9% saline. Endotoxin, measured by the Limulus amebocyte lysate assay, was found in the two medications tested, lidocaine contaminated with Pseudomonas cepacia and insulin contaminated with enterococci. Inadvertent microbial contamination of at least some parenteral medications in multiple-dose vials may result in the exposure of patients to viable organisms. The potential, however, for medications such as lidocaine to support growth of organisms under selected circumstances should be noted by those responsible for preparing and administering these drugs. The potential hazard to patients from endotoxin in contaminated medications under these circumstances has not been assessed. Additional studies of this type should be pursued to provide more complete information about the risk of microbial contamination of products for parenteral use.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Growth of Nosocomial Pathogens in Multiple-Dose Parenteral Medication Vials

1982

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“…In all, 24 contaminated vials have been reported in 11 published studies which examined 4,036 MDV. Removing the 14 contaminated antibiotic or diluent vials from the numerator and 484 similarly designated vials from the denominator yields an estimated overall con- 10 Kohan 9 Ravnik 8 Rosenzweig 11 Ridgeway 12 Corley 13 Petty 14 Bothe 10 Olson 15 Bawden 16 Sheth 17 Present Study Total tamination rate of 10/3,552 or 0.28% for other medication types.…”

Section: Table 4 Duration In-use When Last Specimen Obtained From Datmentioning

confidence: 88%

Multidose Medication Vial Sterility: An In-Use Study and a Review of the Literature

Longfield

Smith

et al. 1984

Infect. Control

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Contaminated multiple-dose medication vials (MDV) have been implicated in transmission of bacterial infections. It has been suggested that MDV be discarded after 24 hours or even after a single use. At our hospital, we cultured 1,223 weekly samples from 864 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. The duration of use was 9.5d (median), 18d (mean), and 1-402d (range) with 13% of vials in-use for more than 30 days. The mean duration of use was significantly shorter for medicine wards, emergency room, and outpatient clinics than for surgery and obgyn wards (p<0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p<0.05), and insulin MDV were more regularly dated (p=0.001). The percentage of undated MDV declined significantly by month during die study (p=0.003). These results lend support to our current guideline that MDV should be dated upon opening and that, unless visible or suspected contamination occurs, vials are discarded either when empty or at the manufacturer's expiration date.

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“…Previous studies have suggested that these preservatives or the medications themselves may be only partially effective in preventing infections. Therefore, since the risk of contamination by bacteria is unpredictable, several authors recommend that unit-dose vials of medication be used whenever possible (1,4,5,(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

Survival of Serratia marcescens in benzalkonium chloride and in multiple-dose medication vials: relationship to epidemic septic arthritis

Nakashima¹,

Highsmith²,

Martone³

1987

J Clin Microbiol

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In an epidemic of septic arthritis due to Serratia marcescens, the intra-articular injection of contaminated methylprednisolone may have played a key role. The epidemic strain was found in used multiple-dose vials of methylprednisolone and in a canister of cotton balls soaked in benzalkonium chloride. The cotton balls had been used for antisepsis and disinfection. Growth characteristics of the epidemic strain of S. marcescens were compared with those of control strains of S. marcescens which had been obtained from unrelated nosomial outbreaks. The epidemic strain was able to survive in 1:100 dilutions of benzalkonium chloride and was able to grow to > 105 CFU/ml in multiple-dose vials of methylprednisoline; control strains could not be recovered after 24 h in the same solutions. The preservative in methylprednisolone is-y-myristyl picolinium chloride, a compound chemically related to benzalkonium chloride. We speculate that the epidemic strain of S. marcescens, which was resistant to benzalkonium chloride, had cross-resistance to y-myristyl picolinium chloride. If the cotton balls were used to disinfect the tops of the multiple-dose vials of methylprednisolone, small numbers of organisms subsequently introduced into the solution could have grown to high concentrations.

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Viral and Bacterial Contamination of Multiple-dose Drug Vials Kept in Anesthesia Machines

Cited by 9 publications

References 0 publications

Growth of Nosocomial Pathogens in Multiple-Dose Parenteral Medication Vials

Growth of Nosocomial Pathogens in Multiple-Dose Parenteral Medication Vials

Multidose Medication Vial Sterility: An In-Use Study and a Review of the Literature

Survival of Serratia marcescens in benzalkonium chloride and in multiple-dose medication vials: relationship to epidemic septic arthritis

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