Outbreaks of hepatitis C virus (HCV) infections can occur among hemodialysis patients when recommended infection control practices are not followed (1). On January 30, 2014, a dialysis clinic in Tennessee identified acute HCV in a patient (patient A) during routine screening and reported it to the Tennessee Department of Health. Patient A had enrolled in the dialysis clinic in March 2010 and had annually tested negative for HCV (including a last HCV test on December 19, 2012), until testing positive for HCV antibodies (anti-HCV) on December 18, 2013 (confirmed by a positive HCV nucleic acid amplification test). Patient A reported no behavioral risk factors, but did have multiple health care exposures.
BACKGROUND: From June to July 2014, four patients in our intensive care units (ICUs) grew Elizabethkingia meningoseptica from respiratory cultures. Investigation of the cluster included a review of products that could serve as potential sources, including sterile water. Our policy calls for sterile water for oral care in ICU patients and for discarding opened bottles within 24 hours. METHODS: We conducted an anonymous on line survey of all nurses in 4 ICUs (pediatric medical/surgical, medical, cardiac, and neonatal) regarding use of sterile water for oral care and flushing enteral tubes. We cultured 20 environmental sources and products, including 1 unopened and 2 in use sterile water bottles. Patient isolates underwent pulse field gel electrophoresis (PFGE) to determine relatedness. RESULTS: Of 509 eligible nurses, 166 (33%) completed the survey; 69% reported at least 6 years in critical care nursing. Nearly all used sterile water for oral care and flushing medications through enteral tubes; 52% also used it for cleaning suction catheters. 21 (13%) respondents using sterile water for oral care reported dipping a toothbrush into the bottle; of these, 4 (19%) reported having done so after use in the patient's mouth. 55 (30%) respondents using sterile water in enteral tubes reported putting the syringe into the bottle; of these, 11 (20%) reported having done so after flushing a tube.69% reported always labeling an opened bottle with date/time, and 35% reported always performing hand hygiene before opening a bottle. PFGE of the isolates revealed unique chromosomal patterns. No non-clinical cultures grew E. meningoseptica. Two in-use water bottles grew four other organisms. CONCLUSIONS: Improvements are needed to standardize sterile water use in pediatric ICUs and should focus on hand hygiene, labeling bottles, and not putting items into bottles after patient use. Contamination of in-use water bottles could serve as a source of outbreaks.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.