Control of nosocomial infection -microbial contamination of in-use drugs and its preventive measures-

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1.We evaluated particulate and microbial contamination in a total of 192 samples of in-use admixed and unadmixed parenteral nutrition solutions remaining in infusion bags in 10 hospitals. The mean numbers (range) of drug glass ampoules, plastic ampoules, and vials used in a total of 192 admixed solutions were 3.38 (1-13), 0.79 (0-7), and 1.2 (0-8), respectively. The mean number of particles (range) contained in the 192 samples according to the particle size (diameter) was 960.9 (30-9539)/ml for particles ≧1.3μm, 42.8 (0-587)/ml for those ≧5μm, 6.4 (0-146)/ml for those ≧10μm, and 0.09 (0-1)/ml for those ≧50μm. On the other hand, none of the 199 samples showed bacteria or fungi/5ml residual solution. Measures against particulate contamination of admixed parenteral nutrition solutions are neccessary.2.We evaluated the microbial contamination of nebulization solutions in medication cups from a total of 76 ultrasonic nebulizers in use in 10 hospitals. In addition, an interview survey was given to nurses to evaluate the disinfection methods of these ultrasonic nebulizers. Of a total of 76 nebulization solution samples, 11 (14.5%) were contaminated with 10-10^2 colony-forming units (CFU)/ml and 9 (11.8%) with 10^3 - 10^5 CFU/ml. The major contaminants were glucose fermentative bacilli such as Burkholderia cepacia, CDC gr.IV C-2, and Sphingomonas paucimobilis. These results show that disinfection of ultrasonic nebulizers at 24-h intervals is desirable. In particular, when nebulization solutions not containing preservatives are used, disinfection at 24-h intervals is indispensable.