Normal Saline and Dextrose 5% in Water Do Not Support Bacterial Growth 24 Hours After Being Spiked in the Perioperative Environment.

BACKGROUND: The Joint Commission requirement is that the US Pharmacopeia Chapter <797> is followed, which recommends that administration of compounded sterile preparations should begin no later than 1 hour after their preparation. We hypothesized that simply spiking the IV fluid in a nonsterile environment does not pose an increased risk of infection to the patient. METHODS: Two 1000-mL bags of IV fluid (normal saline and dextrose 5% in water) were spiked and hung in 5 busy perioperative locations, once a week for a 13-week period. A 10-mL sample was drawn from each bag of IV fluid at time zero and 24 hours resulting in 260 samples in total. All samples were inoculated in 2 separate growth media (sheep's blood agar and thioglycollate broth). The primary outcome was growth versus no growth in any of the specimens. If any growth was noted, the sample was marked as positive and further testing to identify the organism was undertaken. RESULTS: A total of 257 samples (normal saline = 127, dextrose 5% in water = 129) were collected over a period of 13 weeks, yielding 514 specimens. Three samples were excluded from the study secondary to the IV bags being discarded accidentally. No growth was identified in any of the specimens. The 97.5% CIs were as follows: normal saline = 127 (0-0.034) and dextrose 5% in water = 129 (0-0.033), correcting for multiple tests. CONCLUSIONS: No bacterial growth was noted in any of the 257 samples collected. Normal saline and dextrose 5% in water do not support bacterial growth 24 hours after their preparation using standard sterile techniques in the perioperative space.

How Long Is Too Long? The Prespiked Intravenous Debate.

BACKGROUND: As the number of operative cases increases, there is a greater emphasis on reducing inefficiency while maintaining patient safety. Recently, the issue of prespiking intravenous (IV) bags was raised. No study has assessed whether the risk of infection is related to the length of time a sterile (IV) fluid bag has been spiked. After completion of a pilot study revealed no microbial growth within 24 hours of an IV spike, a larger formal study was undertaken to determine whether there was an increased infection risk within 4 hours of spiking an intravenous fluid bag. METHODS: Five IV administration sets were spiked and hung in busy perioperative areas once a week for a 5-week period. Five samples were drawn from each IV set. Approximately 10 mL was collected per sample. All samples were inoculated in 2 separate growth media. If any growth was noted, the sample was marked as positive. RESULTS: A total of 125 samples were collected over a period of 5 weeks, yielding 250 specimens. No samples were excluded from the study. No growth was identified in any of the specimens. The 95% confidence interval was estimated to be 0, 0.063. DISCUSSION: There was no bacterial growth in prespiked normal saline IV bags in a perioperative environment. Thus, prespiking of normal saline IV bags in advance should pose no risk of infection to a patient if prepared within 4 hours.