491. Methicillin-Susceptible Staphylococcus aureus Infections After Intra-Articular Injections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Georgia Division of Public Health was notified of five patients who experienced joint infections after intra-articular (IA) corticosteroid injections at Clinic A during 1 week. IA corticosteroid injections are therapeutic techniques for inflammatory joint conditions. Reported infections from IA injections are rare (<1/15,000 injections). However, lapses in infection control (IC) practices and extrinsic contamination of multidose vials (MDVs) have been associated with similar outbreaks. We investigated the outbreak to determine its extent, identify its source, and prevent additional cases.
Methods: Clinic activity, injection logs, and medical records were reviewed for case finding and IC practices were assessed. A case was defined as redness, warmth, and pain at the injection site in a patient who received a methylprednisolone injection at Clinic A during December 1, 2008-February 12, 2009. MDVs and prepared syringes were tested for pathogen contamination and genetic typing was performed on clinical isolates by pulsed-field gel electrophoresis (PFGE).
Results: Five consecutive cases occurred among 15 patients who had received injections. Four case-patients (80%) were female (median age, 71 years). All patients required hospitalization and prolonged intravenous antibiotic treatment. Four had culture-confirmed methicillin-susceptible Staphylococcus aureus (MSSA) with indistinguishable PFGE patterns. MSSA was not identified in tested MDVs. The environmental investigation revealed IC errors at Clinic A, including (1) mishandling of MDVs, (2) inadequate hand hygiene, and (3) incorrect cleaning and disinfection of medical equipment.
Conclusion: Clinical isolates were genetically indistinguishable, indicating a common source of joint infections. Despite lack of MSSA growth, injected medication from MDVs represents a possible source. IC errors increase likelihood of extrinsic contamination of MDVs. Recommendations include using single-dose medication vials, consistent hand hygiene, and appropriate cleaning and disinfection.
W. Roodly Archer, PhD1, Matthew Arduino, MS, DrPH1, Kathryn Arnold, MD2, Heidi Davidson, MPH3, Cherie Drenzek, MS, DVM4, Gregory Fosheim, MPH2, Bette Jensen, MMSc1, Sigrid McAllister, BS, MT(ASCP)1, Judith Noble-Wang, PhD1, Joseph Perz, DrPH1, Ariane Reeves, RN, BSN, MPH, CIC4, Melissa Schaefer, MD1, Arjun Srinivasan, MD5 and  W. Archer, None..
K. E. Arnold, None..
M. Schaefer, None..
H. Davidson, None..
A. Reeves, None..
J. Noble-Wang, None..
A. Srinivasan, None..
J. F. Perz, None..
M. J. Arduino, None..
G. Fosheim, None..
B. J. Jensen, None..
S. K. McAllister, None..
C. Drenzek, None., (1)Centers for Diseases Control and Prevention, Atlanta, GA, (2)CDC, Atlanta, GA, (3)DeKalb County Board of Health, Decatur, GA, (4)Georgia Division of Public Health, Atlanta, GA, (5)Centers for Disease Control and Prevention, Atlanta, GA