在全球范围内,越来越多地观察到来自不同来源的各种生物,例如受污染的超声凝胶,静脉(IV)液体和IV药物。其中,超声凝胶是最常见的洋葱伯克霍尔德菌(Bcc)爆发的来源之一。在这项研究中,我们描述了我们在调查和管理由三级护理中心污染的超声凝胶引起的Bcc菌血症爆发的经验,南印度。
在2016年10月的10天内,我们儿科重症监护病房(ICU)的7名儿童被发现患有从血液培养物中分离出的Bcc菌血症。在较短的潜伏期内,从同一地点重复分离具有相似抗菌药物敏感性模式的同一生物,证实了疫情。积极的疫情调查,包括环境监测,进行了寻找源头和控制疫情。对分离株进行多位点序列分型(MLST)和全局eBURST(goeBURST)分析。
环境监测显示受污染的超声凝胶是感染源。MLST和goeBURST分析证实,爆发是由具有相同克隆复合物CC517的新序列类型1362引起的。疫情得到严格的感染控制措施控制,从常规使用中撤回受污染的超声凝胶,并实施使用超声检查(USG)探头盖进行USG筛查和指导程序的实践。
这份报告强调了早期识别疫情的重要性,ICU和感染控制小组的快速反应,健全的环境和流行病学监测方法,以确定源头和严格的感染控制措施,以控制疫情。受污染的超声凝胶可能是医疗保健相关感染的潜在来源,这是不可忽视的。
Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India.
Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis.
Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures.
This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.