Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-20T05:27:47.463Z Has data issue: false hasContentIssue false
  • English
  • Français

Sputum Induction Problems Identified Through Genetic Fingerprinting

Published online by Cambridge University Press:  02 January 2015

Beth Nivin ,
Tholief O'Flaherty ,
Eric Leibert ,
Ben Yang Zhao  and
Jeffrey Driscoll
Beth Nivin*
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Tholief O'Flaherty
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Eric Leibert
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Ben Yang Zhao
Affiliation:
New York City Department of Health, Public Health Laboratories, Wadsworth Center, New York, New York
Jeffrey Driscoll
Affiliation:
New York State Department of Health, Wadsworth Center, New York, New York
*
New York City Department of Health, 125 Worth Street, Room 225, New York, NY 10013
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify the contamination source of a cluster of eight positive Mycobacterium tuberculosis isolates from one laboratory session.

Methods:

Spoligotyping was performed on M. tuberculosis isolates processed during one laboratory session. Laboratory and sputum induction protocols and records were reviewed. Sputum induction staff were interviewed. An environmental assessment of the sputum induction booth was performed.

Results:

Spoligotyping identified a unique strain of susceptible M. tuberculosis from five induced sputa collected at Clinic A on the same day. Three specimens processed concurrently from other clinics had spoligotypes different from each other and from the cluster strain. A laboratory investigation revealed no procedural lapses. Sputum induction records from Clinic A indicated that patient 1 in the sputum induction booth had prior culture-confirmed tuberculosis. Patient 2 had a history of a drug-resistant strain. Patient 3 had completed tuberculosis treatment, with positive cultures 7 months earlier. Patients 4 and 5 were new to the clinic and had no subsequent positive M. tuberculosis specimens. The sputum induction booth was working within normal parameters. Sputum induction that day was overseen by a new employee with limited training and no supervision. A review of the sputum induction protocol identified ambiguity regarding care of the ultrasonic nebulizer between patients, which may have led to reuse of the discarded nebulizer solution from patient 1.

Conclusions:

A break in the sputum induction protocol may have contributed to contamination of patient specimens. Sputum induction is complicated, mandating adequate staff training and supervision and patient preparation. Spoligotyping identified a potential source of M. tuberculosis contamination.(Infect Control Hosp Epidemiol 2002;23:580-583).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 580 - 583
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Nivin, B, Driscoll, J, Glaser, T, Bifani, P, Munsiff, S. Use of spoligotype analysis to detect laboratory cross-contamination. Infect Control Hosp Epidemiol 2000;21:525–527.CrossRefGoogle ScholarPubMed
2.Nivin, B, Kaye, K, Munsiff, S. Detection of laboratory cross-contamination of Mycobacterium tuberculosis cultures. Clin Infect Dis 1997;25:943.CrossRefGoogle Scholar
3.van Embden, JD, Cave, MD, Crawford, JT, et alStrain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–409.CrossRefGoogle ScholarPubMed
4.Goyal, M, Saunders, NA, van Embden, JD, Young, DB, Shaw, RJ. Differentiation of Mycobacterium tuberculosis isolates by spoligotyping and IS6110 restriction length polymorphisms. J Clin Microbiol 1997;35:647–651.CrossRefGoogle Scholar
5.Kamerbeek, J, Schouls, L, Kolk, A, et alSimultaneous detection and strain differentiation of Mycobacterium tuberculosis for diagnosis and epidemiology. J Clin Microbiol 1997;35:907–914.CrossRefGoogle ScholarPubMed
6.New York City Department of Health. Information Summary 2000. New York: Tuberculosis Control Program, New York City Department of Health; 2000.Google Scholar
7.New York City Department of Health. Clinical Policies and Protocols, 3rd ed. New York: Tuberculosis Control Program, New York City Department of Health; 1999:101–103.Google Scholar
8.New York City Department of Health. Exposure Control Plan, 2nd ed. New York: New York City Department of Health; 2000:1F2–1F4.Google Scholar
9.Wright, GD. Fundamentals of Air Sampling. Chelsea, MI: Lewis Publishers; 1994.Google Scholar
10.Hering, S. Air Sampling Instruments fi>r Evaluation of Atmospheric Contaminants. Cincinnati, OH: American Conference of Government Industrial Hygienists; 1989.Google Scholar
11.Lodge, J. Methods of Air Sampling and Analysis, 3rd ed. Chelsea, MI: Lewis Publishers; 1989.Google Scholar
12.American Conference of Government Industrial Hygienists. Threshold Limit Values and Biological Exposure Indices. Cincinnati, OH: American Conference of Government Industrial Hygienists; 1998:155–160.Google Scholar