Quality assurance of home and inpatient parenteral nutrition Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/mw22v932b

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  • The microbial contamination rate was compared for parenteral nutrition solutions prepared by patients for home use and by pharmacy personnel for inpatient use. The methodology was divided into three phases. Phase I validated the Ivex[superscript R]-2 0.22 micron inline filter as a tool for microbiological testing in 5% dextrose injections. Phase II tested a new method of determining microbial contamination of total parenteral nutrition (TPN) solutions. Phase III compared inpatient and home TPN microbial contamination rates using the methodology validated in Phase II. In Phase I, test organisms were Candida albicans, Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes. All contaminated 5% dextrose injections showed visual turbidity within 48 hours. Identification of contaminating organisms by subculturing the inoculum of each filter was successful. Nine TPN solutions were inoculated with test organisms using the methods in Phase I. All contaminated TPN solutions showed visual turbidity after 96 hours. Subcultures verified the identity of each test organism. One hundred samples from the TPN solutions were collected randomly and aseptically mixed with Tryptic Soy Broth during the six month Phase III study period. Six patients and two hospitals participated in the study. None of the 44 home parenteral nutrition samples and none of the 56 inpatient TPN samples had any visible turbidity on macroscopic examination. Subcultures of each sample on blood agar were negative for microbial growth. This methodology offers a means to establish contamination rates of home parenteral nutrition solutions and a method to monitor patient aseptic technique at home.
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