Efficacy of intravascular catheter lock solutions containing preservatives in the prevention of microbial colonization

Abstract

There is little published evidence regarding whether heparin lock solutions containing preservatives prevent catheter-related infections. However, adverse effects from preservative-containing flushes have been documented in neonates, leading many hospitals to avoid their use altogether. Infection control records from 1982 to 2008 at St. Jude Children's Research Hospital (SJCRH) were reviewed regarding the incidence of catheter-related infections and the use of preservative-containing intravenous locks. In addition, the antimicrobial activities of heparin lock solution containing the preservatives parabens (0.165%) or benzyl alcohol (0.9%), and 70% ethanol were examined against Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Bacillus cereus, Pseudomonas aeruginosa and Candida albicans, and compared with preservative-free saline with and without heparin. Growth was assessed after exposure to test solutions for 0, 2, 4 and 24h at 35 °C. The activities of preservatives were assessed against both planktonic (free-floating) and sessile (biofilm-embedded) micro-organisms using the MBEC Assay. Infection control records revealed two periods of increased catheter-related infections, corresponding with two intervals when preservative-free heparin was used at SJCRH. Heparin solution containing preservatives demonstrated significant antimicrobial activity against both planktonic and sessile forms of all six microbial species. Ethanol demonstrated the greatest antimicrobial activity, especially following short incubation periods. Heparin lock solutions containing the preservatives parabens or benzyl alcohol, and 70% ethanol demonstrated significant antimicrobial activity against both planktonic and sessile micro-organisms commonly responsible for catheter-related infections. These findings, together with the authors' historical infection control experience, support the use of preservatives in intravenous lock solutions to reduce catheter related infections in patients beyond the neonatal period.

Conflict of interest statement

Conflict of interest statement

None declared.

Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1

Planktonic organisms challenged against test solutions. (a) Bacillus cereus, (b) Candida albicans, (c) Escherichia coli, (d) Pseudomonas aeruginosa; (e) Staphylococcus aureus, (f) Staphylococcus epidermidis. Parabens, heparin/parabens combination; benzyl, heparin/benzyl combination; cfu, colonu-forming unit. Points on the graph indicate the number of organisms that survived after the indicated exposure time to each test solution.

Figure 2

Sessile organisms (embedded in biofilm) challenged against test solutions. (a) Bacillus cereus, (b) Escherichia coli, (c) Pseudomonas aeruginosa; (d) Staphylococcus aureus, (e) Staphylococcus epidermidis. Parabens, heparin/parabens combination; benzyl, heparin/benzyl combination; cfu, colonu-forming unit. Points on the graph indicate the number of organisms that survived after the indicated exposure time to each test solution.