An Outbreak of cepacia Respiratory Tract Colonization and Infection Associated with Nebulized Albuterol Therapy

Abstract

Multiple-dose medications and reliance on benzalkonium chloride as a medication preservative provide a mechanism for nosocomial spread of microorganisms, particularly if infection control procedures are not carefully followed. Repetitive-element PCR is a useful fingerprinting technique for molecular epidemiologic studies of B. cepacia.

Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak

“…Six 20 ml vial of albuterol solution 0.5 % and held at room temperature. One ml samples were cultured before inoculation and on days 2 and 7 after inoculation as described above.…”

“…Our investigation indicated that B. cepacia respiratory acquisition was associated with receipt of nebulized medications. This outbreak and the recent report of B. cepacia respiratory acquisition linked to extrinsic contamination of albuterol solution emphasize the potential for microbial contamination of nebulized medications despite the presence of the preservative benzalkonium chloride [20]. The administration of nebulized medications should be done carefully, using standard administration techniques and disinfection practices.…”

“…In contrast, the B. cepacia respiratory isolates from 17 (26) 1 (3) 5 (14) 4 (11) 2 (6) 2 (6) 11 (31) (n = 35) 13 (37) 7 (20) 6 (17) 5 (14) 3 (9) 9 (26) 5 (14) 6 (17) 7 (20) 22 (63) 6 (17) 5 (14) 31 (88) 5 (14) 25 (71) 21 (60) 14 (40) 1-7 (0 6-5 6) 65+ 164 71 9 (26) 8 (23) 8 (23) 2 (6) 1 (3) 5 (14) 2 (6) (29) 12 (34) 19 (54) 3 (9) 3 (9) 23 (66) 15 (05-5l)t 0-6 (0-2-1-8) and RFLP patterns by pulsed-field gel electrophoresis. The occurrence of scattered cases after the peak in February and March 1994 suggested that following its introduction into the hospital environment, B. cepacia acquisition may have been facilitated by multiple modes of transmission, including person-to-person transmission via the hands of health-care workers [7].…”

“…However, nebulizer reservoirs were not always rinsed with sterile water and dried after each use nor discarded after 24 h use in compliance with the MGH policy, thus increasing the risk for extrinsic contamination. Previous studies have demonstrated that nebulized medication devices can become contaminated by using non-sterile water to rinse nebulizers between use [17], by extrinsic contamination of nebulized medications [18,20] and presumably by the hands of health-care workers manipulating the equipment. Although we did not examine exposure to health-care workers nor perform handwiping cultures of personnel, exposure to an individual health-care worker appears to be an unlikely source of the outbreak, because each individual worked in only one or two patient care units while cases were widely distributed throughout the hospital.…”

“…The tract [8]. Outbreaks of B. cepacia respiratory tract acquisition have been associated with inadequate or contamination of nebulized medications or solutions have also been associated with outbreaks of nosocomial Gram-negative respiratory infections [12][13][14][15][16][17][18][19][20]. The Massachusetts General Hospital (MGH) is a 900-bed university teaching hospital and tertiary-care referral centre with 9 intensive-care units (ICUs) containing 113 beds.…”