Saline Nasal Irrigations and Bacterial Contamination

Product contamination is a major risk factor for outbreaks of infectious diseases. Contamination of products, such as the contamination that caused a recent Burkholderia cepacia outbreak, has shined a light upon the vulnerabilities of the pharmaceutical and biomedical world. In health care, a surge of cases of relatively unusual pathogens, like B cepacia, especially if they meet definitions for health care-onset, raise concern for product contamination.

A new study has taken this issue of contamination and “run with it,” by studying the bacterial contamination of saline nasal irrigations in pediatric patients. Nasal saline irrigations (NSIs) are very common and frequently used for patients with upper respiratory infections and allergic rhinitis. Unfortunately, contamination is a vulnerability and although it does not always lead to an infection, the ability for bacteria to contaminate these products is concerning. Investigators sought to address the realities of frequent NSI use in pediatric patients and understand the potential for bacterial colonization.

To assess this, the team sampled the saline solution from the bottles that were used for NSIs in patients admitted for either a respiratory infection or for daily use. Patients with severe diseases, such as cystic fibrosis, were excluded from the survey. According to the authors, “before the first use, the syringe needle was used to pierce the rubber bottle cap by the pediatric nurse; then the needle was removed and the syringe bulb was placed and left inside the pierced rubber bottle cap.”

Health care workers were instructed to continue hand hygiene and glove practices (ie, handwashing and donning of gloves prior to pulling solution into the syringe) and continue the practice of filling the syringe with the saline solution and then using it for irrigation. Either a health care worker or the child’s parent would perform the nasal saline irrigation on the child.

The investigators encouraged the health care workers to continue picking up 5-mL samples of the saline solution from the bottle via the syringe for NSI use. They instructed the nurses to continue to pick up saline solution samples just after the bottle was opened to test for contamination. Measurements were taken the day of bottle opening, 1 day after, 2 days after, then 3, 4, 5, and 6 days after opening the bottle. The 5mL samples were taken to a microbiology lab for analysis.

Overall, the team collected 253 samples from bottles for administering NSIs. Samples were taken from a total of 118 children, with a mean of 2.1 samples per patient. Health care workers performed the majority of the NSIs on the patients (56.5%). Following analysis, 25% of the samples were positive and bacterial contamination was found in at least 1 sample for 22% of patients. Bacterial contamination tended to occur earlier in the timeframe when NSIs were administered by the health care worker versus the parent, and the number of positive samples increased over time.

Of the organisms that were isolated, the majority were Staphylococcus aureus (28.6%), followed by Neisseria spp. (17.55%), and Klebsiella pneumoniae (14.3%), among others.

The investigators underscored that bacterial contamination of the saline solution bottles for NSI use is common and that the increase in contamination overtime should discourage use of the bottles for long periods of time. The role of care givers, especially health care workers, should reinforce the importance of proper precautions and hand hygiene. Because hospitals are hubs for disease transmission, and environmental contamination is common, health care facilities should encourage single-patient use of the bottles and reinforce infection prevention practices.