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A Pseudo-Outbreak of Aureobasidium Species Lower Respiratory Tract Infections Caused by Reuse of Single-Use Stopcocks During Bronchoscopy

Published online by Cambridge University Press:  02 January 2015

Stephen J. Wilson*
Affiliation:
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
Richard J. Everts
Affiliation:
Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina
Kathryn B. Kirkland
Affiliation:
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
*
Duke University Medical Center, Box 3824, Durham, NC 27710

Abstract

Objective:

To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species.

Design:

Outbreak investigation.

Setting:

University-affiliated medical center.

Patients:

Nine patients who underwent bronchoscopy between June and August 1998.

Results:

Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grew Aureobasidium species during the outbreak period; whereas, respiratory specimens from only two patients grew Aureobasidium species during the preceding 6 years. No patient was judged to have true infection due to Aureobasidium species either before or after bronchoscopy. Nine of the 10 bronchoscopies that yielded Aureobasidium species were performed in the outpatient bronchoscopy suite. The Aureobasidium isolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been “disinfected” yielded a heavy growth of Aureobasidium species, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period, Aureobasidium species were not isolated from any BAL specimen.

Conclusions:

Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000 

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References

1. Campbell, BA, Wells, GA, Palmer, WN, Martin, DL. Reuse of disposable medical devices in Canadian hospitals. Am J Infed Control 1987;15:196200.Google Scholar
2. Collignon, PJ, Graham, E, Dreimanis, DE. Reuse in sterile sites of single-use medical devices: how common is this in Australia? Med J Aust 1996;164:533536.Google Scholar
3. Gibson, NK. Debate on reuse of “disposable” medical equipment fueled by FDA. J Clin Monit Comput 1998;14:75.Google Scholar
4. Emergency Care Research Institute. Special Report: Reuse of Single-Use Medical Devices: Making Informed Decisions. Plymouth Meeting, PA ECRI; 1997:1.Google Scholar
5. Wendt, C, Herwaldt, LA. Epidemics: identification and management. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1997:175213.Google Scholar
6. Zaza, S, Jarvis, WR. Investigation of outbreaks. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:105113.Google Scholar
7. Matsumoto, T. Ajello, L. Agents of phaeohyphomycosis. In: Collier, LH, Balows, A, Sussman, M, eds. Topley & Wilson's Microbiology and Microbial Infections. New York City, NY: Oxford University Press; 1998:503524.Google Scholar
8. Tan, HP, Wahlstrom, HE, Zamora, JU, Hassanein, T. Aureobasidium pneumonia in a post liver transplant recipient: a case report. Hepatogastroenterology 1997;44:12151218.Google Scholar
9. Girardi, LS, Malowitz, R, Tortora, GT, Spitzer, ED. Aureobasidium pullulans septicemia. Clin Infect Dis 1993;16:338339.Google Scholar
10. Kaczmarski, EB, Liu Yin, JA, Tooth, JA, Love, EM, Delamore, IW. Systemic infection with Aureobasidium pullulans in a leukaemic patient. J Infect 1986;13:289291.Google Scholar
11. Pritchard, RC, Muir, DB. Black fungi: a survey of dematiaceous hyphomycetes from clinical specimens identified over a five year period in a reference laboratory. Pathology 1987;19:281284.Google Scholar
12. Clark, EC, Silver, SM, Hollick, GE, Rinaldi, MG. Continuous ambulatory peritoneal dialysis complicated by Aureobasidium pullulans peritonitis. Am J Nephrol 1995;15:353355.Google Scholar
13. Ibanez, PR, Chacon, J, Fidalgo, A, Martin, J, Paraiso, V, Munoz-Bellido, JL. Peritonitis by Aureobasidium pullulans in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1997;12:15441545.Google Scholar
14. Redondo-Bellon, P, Idoate, M, Rubio, M, Ignacio, HJ. Chromoblastomycosis produced by Aureobasidium pullulans in an immunosuppressed patient. Arch Dermatol 1997;133:663664.Google Scholar
15. Mitchell, TG. Subcutaneous mycoses. In: Joklik, WK, Willett, HP, Amos, DB, Wilfert, CM, eds. Zinsser Microbiology. Norwalk, CT: Appleton & Lang; 1992:11131124.Google Scholar
16. Aziz, S. Recurrent use of disposable syringe-needle units in diabetic children. Diabetes Care 1984;7:118120.Google Scholar
17. Stepanas, TV, Turley, H, Tuohy, EA. Reuse of disposable insulin syringes. Med J Aust 1982;1:311313.Google Scholar
18. Hodge, RH Jr, Krongaard, L, Sande, MA, Kaiser, DL. Multiple use of disposable insulin syringe-needle units. JAMA 1980;244:266267.Google Scholar
19. Crouch, M, Jones, A, Kleinbeck, E, Reece, E, Bessman, AN. Reuse of disposable syringe-needle units in the diabetic patient. Diabetes Care 1979;2:418420.Google Scholar
20. Browne, KF, Maldonado, R, Telatnik, M, Vlietstra, RE, Brenner, AS. Initial experience with reuse of coronary angioplasty catheters in the United States. J Am Coll Cardiol 1997;30:17351740.Google Scholar
21. Mak, KH, Eisenberg, MJ, Plante, S, Strauss, BH, Arheart, KL, Topol, EJ. Absence of increased in-hospital complications with reused balloon catheters. Am J Cardiol 1996;78:717719.Google Scholar
22. Avitall, B, Khan, M, Krum, D, Jazayeri, M, Hare, J. Repeated use of ablation catheters: a prospective study. J Am Coll Cardiol 1993;22:13671372.Google Scholar
23. Dunnigan, A, Roberts, C, McNamara, M, Benson, DW Jr, Benditt, DG. Success of re-use of cardiac electrode catheters. Am J Cardiol 1987;60:807810.Google Scholar
24. Centers for Disease Control and Prevention. Endotoxic reactions associated with the reuse of cardiac catheters—Massachusetts. MMWR 1979;28:2527.Google Scholar
25. Reyes, MP, Ganguly, S, Fowler, M, Brown, WJ, Gatmaitan, BG, Friedman, C, et al. Pyrogenic reactions after inadvertent infusion of endotoxin during cardiac catheterizations. Ann Intern Med 1980;93:3235.Google Scholar
26. Grimandi, G, Sellal, O, Grimandi, F, Crochet, D. Risks of reusing coronary angioplasty catheters: results of an experimental study. Cathet Cardiovasc Diagn 1996;38:123130.Google Scholar
27. Maidment, HJ, Petersen, J. The dialysis prescription: reuse. Am J Nephrol 1996;16:5259.Google Scholar
28. Schoenfeld, FY. The technology of dialyzer reuse. Semin Nephrol 1997;17:321330.Google Scholar
29. Feldman, HI, Kinosian, M, Bilker, WB, Simmons, C, Holmes, JH, Pauly, MV, et al. Effect of dialyzer reuse on survival of patients treated with hemodialysis. JAMA 1996;276:620625.Google Scholar
30. Feldman, HI, Bilker, WB, Hackett, MH, Simmons, CW, Holmes, JH, Pauly, MV, et al. Association of dialyzer reuse with hospitalization and survival rates among US hemodialysis patients: do comorbidities matter? J Clin Epidemiol 1999;52:209217.Google Scholar
31. Powe, NR, Jaar, B, Furth, SL, Hermann, J, Briggs, W. Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 1999;55:10811090.Google Scholar