B. cepacia complex is a group of Gram-negative bacilli that are usually associated with soil and water. While infections are rare, this organism can be epidemiologically significant. We report a pseudo-outbreak of B. cepacia infections among 29 otorhinolaryngology (ENT) patients in a 900-physician, multispecialty medical group.
32 sinus cultures from 29 patients over 8 months grew B. cepacia. An outbreak investigation was initiated, with cultures obtained from medication, compounded medication, atomizers, manual spray bottles, medication preparation areas, sinks and hand hygiene products. Potential point-sources were compared to positive clinical isolates using pulsed-field gel electrophoresis (PFGE).
All of the positive cultures were obtained from 3 ENT clinics by 2 physicians. These physicians regularly used a pump-action spray bottle with a disposable nozzle to anesthetize patients prior to nasal endoscopy using a common 4% lidocaine and 0.05% oxymetazoline mixture compounded by the inpatient pharmacy. The 22 spray bottles were sequestered and cultured; 14 plastic atomizers as well as the sinks and drains were cultured at the point of care. 16 of the 22 (72.7%) spray bottles were positive for B. cepacia, as were 2 of the 14 plastic atomizers (14.3%).
Observations were conducted in the inpatient pharmacy, and air sampling was done along with cultures of hand hygiene sinks, moisturizer, manufacturer solutions of lidocaine and oxymetazoline, leeches stored in the pharmacy, and sterile transport bottles. All pharmacy cultures resulted negative for the target B. cepacia.
While it was difficult to identify a point-source for the introduction of Burkholderia cepacia, it was clear that the non-sterilizable spray bottles and atomizers could not be adequately disinfected to prevent long-term contamination. As a result, the ENT clinics discontinued with use of the pump-style spray bottles, and only use sterilizable atomizers. Also, the inpatient pharmacy moved the compounding of lidocaine and oxymetazoline mixtures from an open bench to aclean room in a laminar flow cabinet to prevent contamination. One year of subsequent surveillance cultures have continued to be negative for B. cepacia.
M. O. Wright, None
D. Schora, None
S. Das, None
M. Harazin, None
R. Thomson Jr., None
L. Peterson, None