Cole Devon C, Baslanti Tezcan Ozrazgat, Gravenstein Nikolaus L, Gravenstein Nikolaus
From the *Department of Anesthesiology, University of Florida College of Medicine; and †University of Florida College of Medicine, Gainesville, Florida.
Anesth Analg. 2015 Apr;120(4):861-7. doi: 10.1213/ANE.0b013e318292ed45.
Acute care handling of IV stopcocks during anesthesia and surgery may result in contaminated IV tubing sets. In the context of widespread propofol use, a nutrient-rich hypnotic drug, we hypothesized that propofol anesthesia increases bacterial contamination of IV stopcocks and may compromise safety of IV tubing sets when continued to be used after propofol anesthesia.
We conducted an in vitro trial by collecting IV tubing sets at the time of patient discharge from same-day ambulatory procedures performed with and without propofol anesthesia. These extension sets were then held at room temperature for 6, 24, or 48 hours. We cultured 50 samples at each interval for both cohorts. Quantitative cultures were done by aspirating the IV stopcock dead space and plating the aspirate on blood agar for colony count and speciation.
Positive bacterial counts were recovered from 17.3% of propofol anesthesia stopcocks (26/150) and 18.6% of nonpropofol stopcocks (28/150). At 6 hours, the average bacterial counts from stopcocks with visible residual propofol was 44 colony forming units (CFU)/mL, compared with 41 CFU/mL with no visible residual propofol and 37 CFU/mL in nonpropofol anesthesia stopcocks. There was a 100-fold increase in bacterial number in contaminated stopcock dead spaces at 48 hours after propofol anesthesia. This difference remained significant when comparing positive counts from stopcocks with no visible residual propofol and nonpropofol anesthesia (P = 0.034).
There is a covert incidence and degree of IV stopcock bacterial contamination during anesthesia which is aggravated by propofol anesthetic. Propofol anesthesia may increase risk for postoperative infection because of bacterial growth in IV stopcock dead spaces.
麻醉和手术期间对静脉输液旋塞进行急性护理操作可能会导致静脉输液管路被污染。在广泛使用富含营养成分的催眠药物丙泊酚的背景下，我们推测丙泊酚麻醉会增加静脉输液旋塞的细菌污染，并且在丙泊酚麻醉后继续使用时可能会危及静脉输液管路的安全性。
我们进行了一项体外试验，在患者接受有或无丙泊酚麻醉的当日门诊手术后出院时收集静脉输液管路。然后将这些延长管在室温下放置6、24或48小时。我们对两个队列的每个时间间隔的50个样本进行培养。通过抽吸静脉输液旋塞的死腔并将抽吸物接种在血琼脂上进行菌落计数和菌种鉴定来进行定量培养。
从17.3%的丙泊酚麻醉旋塞（26/150）和18.6%的非丙泊酚旋塞（28/150）中培养出阳性细菌计数。在6小时时，有可见丙泊酚残留的旋塞的平均细菌计数为44菌落形成单位（CFU）/毫升，无可见丙泊酚残留的为41 CFU/毫升，非丙泊酚麻醉旋塞为37 CFU/毫升。丙泊酚麻醉后48小时，受污染旋塞死腔内的细菌数量增加了100倍。在比较无可见丙泊酚残留的旋塞和非丙泊酚麻醉的阳性计数时，这种差异仍然显著（P = 0.034）。
麻醉期间静脉输液旋塞存在隐蔽的细菌污染发生率和程度，丙泊酚麻醉会使其加重。丙泊酚麻醉可能因静脉输液旋塞死腔内的细菌生长而增加术后感染风险。
