Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering. A case for selective drug screening of health care personnel.

Three patients in a university hospital developed nosocomial infusion-related Pseudomonas pickettii bacteremia. Investigation identified six additional patients who had received intravenous fluid contaminated by P pickettii but did not become ill. All nine patients had had surgery, and each of these patients but only nine of 19 operated-on control patients had received intravenous fentanyl citrate in the operating room; the mean dose given to the nine case patients was far greater than that given to control patients. Fentanyl in 20 (40%) of 50 predrawn 30-mL syringes was shown to be contaminated by P pickettii. Contamination was caused by theft of fentanyl from predrawn synringes and replacement by distilled water contaminated by P pickettii. Narcotic theft by health care personnel may cause patients to suffer pain needlessly and can also result in dire unanticipated consequences, such as nosocomial bacteremia. Whereas drug testing in the workplace is highly controversial, we believe that testing of health care personnel is indicated when drug abuse or theft is suspected.

Endemic rate of fluid contamination and related septicemia in arterial pressure monitoring.

Contamination of the fluid within intra-arterial infusions used for hemodynamic monitoring has produced epidemic bacteremias, but little data exist on endemic rates of contamination and related septicemia. We prospectively studied 102 intra-arterial infusions used in 56 high-risk patients who required prolonged monitoring. During the study, administration sets were changed every 48 hours, but transducer chamber-domes and continuous flow devices were used until the intra-arterial infusion was discontinued. Cultures were obtained from the transducer-transducer chamber-dome interface and of fluid in the transducer chamber-dome of the 102 intra-arterial infusions; 12 (11.8 percent) showed contamination of transducer chamber-dome fluid, in 8 cases (7.8 percent) associated with concordant bacteremia. In each bacteremia, transducer chamber-dome fluid contained 1 to greater than 10(5) (median, 10(4)) cfu/ml. Four bacteremias are considered definitely related and four, possibly related, to the intra-arterial infusion. In all 12 contaminated intra-arterial infusions and with all eight bacteremias, the transducer chamber-dome had been used for more than two days (P = 0.006). No concordant contamination of transducer-transducer chamber-dome interfaces was identified. (1) Intra-arterial infusions for pressure monitoring cause sporadic septicemias endemically. (2) With prolonged monitoring, transducer chamber-domes and continuous flow devices should be replaced at periodic intervals, ideally with the administration set, every 48 hours; since implementing this policy, only three contaminated intra-arterial infusions and no related septicemias have been detected in 53 intra-arterial infusions monitored over our months (P = 0.02).