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Investigation and Control of an Outbreak of Achromobacter xylosoxidans Bacteremia

Published online by Cambridge University Press:  02 January 2015

Brie Behrens-Muller ,
Judith Conway ,
Jonathan Yoder  and
Craig S. Conover
Brie Behrens-Muller
Affiliation:
Illinois Department of Public Health, Springfield, Illinois
Judith Conway
Affiliation:
Illinois Department of Public Health, Springfield, Illinois
Jonathan Yoder
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Craig S. Conover*
Affiliation:
Illinois Department of Public Health, Springfield, Illinois
*
122 South Michigan Avenue, 7th floor, Chicago, IL 60603 ([email protected])
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Abstract

Objective.

To define the extent of an outbreak of Achromobacter xylosoxidans bacteremia, determine the source of the outbreak, and implement control measures.

Design.

An outbreak investigation, including environmental and infection control assessment, and evaluation of hypotheses using the binomial distribution and case control studies.

Setting.

A 50-bed medical surgical unit in a hospital in Illinois during the period January 1–July 15, 2006.

Interventions.

Discontinuation of use of opioid delivery via patient-controlled analgesia (PCA) until the source of the outbreak was identified and implementation of new protocols to ensure more rigorous observation of PCA pump cartridge manipulations.

Results.

Calculations based on the binomial distribution indicated the probability that all 9 patients with A. xylosoxidans bacteremia were PCA pump users by chance alone was <.001. A subsequent case control study identified PCA pump use for administration of morphine as a risk factor for A. xylosoxidans bacteremia (odds ratio, undefined; P< .001). Having a PCA pump cartridge with morphine started by nurse C was significantly associated with becoming a case-patient (odds ratio, 46; 95% confidence interval, 4.0–525.0; P< .001).

Conclusions.

We hypothesize that actions related to diversion of morphine by nurse C were the likely cause of the outbreak. An aggressive pain control program involving the use of opioid medication warrants an equally aggressive policy to prevent diversion of medication by staff.

Infect Control Hosp Epidemiol 2012;33(2):180-184

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 180 - 184
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Spear, JB, Fuhrer, J, Kirby, BD. Achromobacter xylosoxidans (Alcalagines xylosoxidans subsp. xylosoxidans) bacteremia associated with a well-water source: case report and review of the literature. J Clin Microbiol 1988;26:598–599.Google Scholar
2.Wang, J, Chen, M, Lin, YE, et al. Association between contaminated faucets and colonization or infection by nonfermenting gram-negative bacteria in intensive care units in Taiwan. J Clin Microbiol 2009;47(10):3226–3230.Google Scholar
3.Steinberg, JP, Burd, EM. Other gram-negative and gram-variable bacilli. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone, 2010.Google Scholar
4.De Baets, F, Schelstraete, P, Van Daele, S, Haerynck, F, Vaneechoutte, M. Achromobacter xylosoxidans in cystic fibrosis: prevalence and clinical relevance. J Cyst Fibros 2007;6(1):75–78.Google Scholar
5.Kanellopoulou, M, Pournaras, S, Iglezos, H, Skarmoutsou, N, Papafrangas, E, Maniatis, AN. Persistent colonization of nine cystic fibrosis patients with an Achromobacter (Alcaligenes) xylosoxidans clone. Eur J Clin Microbiol Infect Dis 2004;23(4):336–339.CrossRefGoogle ScholarPubMed
6.Tena, D, Carranza, R, Barberá, JR, Valdezate, S, Garrancho, JM, Arranz, M, Sáez-Nieto, JA. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit. Eur J Clin Microbiol Infect Dis 2005;24(11):727–732.Google Scholar
7.Kim, MJ, Bancroft, E, Lehnkering, E, Donlan, R, Mascola, L. Alcaligenes xylosoxidans bloodstream infections in outpatient oncology office. Emerg Infect Dis 2008;14(7):1046–1052.Google Scholar
8.Vu-Thien, H, Darbord, JC, Moissenet, D, Dulot, C, Dufourcq, JB, Marsol, P, Garbarg-Chenon, A. Investigation of an outbreak of wound infections due to Alcaligenes xylosoxidans transmitted by chlorhexidine in a burn unit. Eur J Clin Microbiol Infect Dis 1998;17:724–726.Google Scholar
9.Ribot, EM, Fair, MA, Gautom, R, Cameron, DN, Hunter, SB, Swaminathan, B, Barrett, TJ. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli 0157: H7, Salmonella, and Shigella for Pulse Net. Foodborne Pathog Dis 2006;3(1):59–67.Google Scholar
10.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
11.Binomial calculator. http://www.stat.tamu.edu/w̃est/applets/binomialdemo.html. Accessed April 29, 2011.Google Scholar
12.Larson, EL, Cimiotti, JP, Haas, J, et al. Gram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units. Pediatr Crit Care Med 2005;6:457–461.CrossRefGoogle ScholarPubMed
13.Substance Abuse and Mental Health Services Administration, Office of Applied Studies (OAS). Preliminary Results from the 1996 National Household Survey on Drug Abuse. Rockville, MD: OAS series #H-13, DHHS Publication No. (SMA) 97–3149; 1997.Google Scholar
14.Public Health Citizens Research Group. Questionable doctors. http://www.citizen.org/hrg/qdsite/map.htm. Accessed April 30, 2011.Google Scholar
15.Sullivan, E, Decker, P. Effective Leadership and Management in Nursing. Upper Saddle River, NJ: Prentice Hall, 2001.Google Scholar
16.Ostrowsky, BE, Whitener, C, Bredenberg, HK, et al. Serratia marcescens bacteremia traced to an infused narcotic. N Engl J Med 2002;346:1529–1537.CrossRefGoogle Scholar
17.Maki, DG, Klein, BS, McCormick, RD, et al. Nosocomial Pseudomonas picketti bacteremias traced to narcotic tampering. JAMA 1991;265:981–986.CrossRefGoogle Scholar
18.McGrath, T. Addicted docs put patients in peril: random drug screening urged for health care workers. MSNBC. http://www.msnbc.msn.com/id/37396390/ns/health-addictions//. Updated June 24, 2010. Accessed April 30, 2011.Google Scholar
19.American Hospital Association. Substance Abuse Policies for Health Care Institutions. Chicago: Management Advisory Human Resources, American Hospital Association, 1992.Google Scholar
20.American Medical Association (AMA) Council on Scientific Affairs. Issues in Employee Drug Testing. Chicago: AMA Policy 95.984, CSA Report A, 1-90; 1990.Google Scholar