Leaving More Than Your Fingerprint on the Intravenous Line: A Prospective Study on Propofol Anesthesia and Implications of Stopcock Contamination

• Published in: Anesthesia and analgesia Vol. 120; no. 4; pp. 861 - 867
• Main Authors: Cole, Devon C, Baslanti, Tezcan Ozrazgat, Gravenstein, Nikolaus L, Gravenstein, Nikolaus
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.04.2015
• Subjects: Administration, Intravenous - adverse effects; Anesthesia - adverse effects; Anesthesia, Intravenous - adverse effects; Anesthesia, Intravenous - instrumentation; Anesthesiology - instrumentation; Central Venous Catheters; Colony Count, Microbial; Cross Infection - microbiology; Cross Infection - prevention & control; Equipment Contamination; Humans; Propofol - administration & dosage; Propofol - adverse effects; Prospective Studies; Time Factors
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0b013e318292ed45

BACKGROUND: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. METHODS: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. RESULTS: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). CONCLUSIONS: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.