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Burkholderia cepacia Lower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist

Published online by Cambridge University Press:  02 January 2015

Alan H. Ramsey ,
Patrice Skonieczny ,
Diane T. Coolidge ,
Terry A. Kurzynski ,
Mary E. Proctor  and
Jeffrey P. Davis
Alan H. Ramsey*
Affiliation:
Epidemic Intelligence Service assigned to the Wisconsin Division of Public Health, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
Patrice Skonieczny
Affiliation:
Department of Infection Control, St Francis Hospital, Milwaukee, Wisconsin
Diane T. Coolidge
Affiliation:
Department of Infection Control, St Francis Hospital, Milwaukee, Wisconsin
Terry A. Kurzynski
Affiliation:
Wisconsin State Laboratory of Hygiene, Wisconsin Division of Public Health, Madison, Wisconsin
Mary E. Proctor
Affiliation:
Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin
Jeffrey P. Davis
Affiliation:
Bureau of Communicable Diseases, Wisconsin Division of Public Health, Madison, Wisconsin
*
University of Wisconsin, Department of Family Medicine, 777 S Mills St, Madison, WI53715-1896
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Abstract

Objective:

To investigate and control a nosocomial outbreak of Burkholderia cepacia lower respiratory tract infection.

Design:

Outbreak investigation and case-control study.

Setting:

A 260-bed community hospital.

Patients:

Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive for B cepacia between January 1 and November 6, 1998.

Methods:

Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit.

Results:

Nine case-patients were identified; B cepacia likely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission of B cepacia: multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses. B cepacia was grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns of B cepacia from seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days; P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-∞ P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No new B cepacia infections were identified after control measures were implemented.

Conclusions:

B cepacia probably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 423 - 426
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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