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Enterobacter cloacae—contaminated cardioplegic solution

Discovery and eradication of a pharmacy reservoir
  • George H. Talbot
    Correspondence
    Reprint requests: George H. Talbot, M.D., Infectious Diseases Section, 536 Johnson Pavillion/G2, 36th St. and Hamilton Walk, Philadelphia, PA 19104.
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Douglas E. Miller
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Margaret Doorley
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Mary Provencher
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Maureen Skros
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Raymond J. Coghlan
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • William E. Judd
    Affiliations
    From the Infectious Diseases Section, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section and Pharmacy and Drug Information Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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      Abstract

      Our conclusions and recommendations are as follows:
      • 1.
        1. Pressurized cannisters used in the production or large-volume parenteral fluids may serve as a reservoir of bacterial contamination unless they are routinely disassembled, cleaned, and sterilized.
      • 2.
        2. Filtration cannot be assumed to ensure sterility, since filters may be defective. Microbiologic quality control measures are essential.
      • 3.
        3. Quality control procedures must be part of an established surveillance system for reporting of problems with large-volume solutions. Ideally, representatives of the pharmacy, the microbiology laboratory, and infection control should be involved.
      • 4.
        4. Quarantine of products awaiting microbiological clearance should be strictly enforced.
      • 5.
        5. Microbiologic quality control tests that reveal gram-negative rods must be viewed with concern and investigated appropriately.
      • 6.
        6. Record keeping should allow precise, rapid identification of the specific patients receiving a pharmacy-prepared product.
      • 7.
        7. The use of both positive and negative pressure to increase filtration rate conceiveably may produce a total pressure exceeding that recommended for the filter used. Therefore users of such filtration systems should periodically recalibrate pressure-monitoring gauges to ensure that excess pressure is not generated.
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