247. Investigating A Mycobacterium Avium Complex Pseudo-outbreak Associated with Outpatient Bronchoscopy Clinic: Lessons for Reprocessing
Session: Poster Abstract Session: HAI: Environment and Device Cleaning
Thursday, October 27, 2016
Room: Poster Hall
Background: Mycobacterium avium complex (MAC) are environmental organisms that have been associated with endoscopy outbreaks and pseudo-outbreaks. In Fall 2015, we identified an increase in volume of MAC isolates from bronchoalveolar lavage (BAL) samples from an outpatient bronchoscopy suite. We performed the following investigation and terminated the pseudo-outbreak.
Methods: We reviewed MAC cultures identified from BAL specimens obtained from an outpatient bronchoscopy clinic from 1/2014 - 3/2016. In 10/2014, the monthly average volume of procedures performed at the clinic increased from 103 to 156 . We reviewed processes within the microbiology lab, clinic procedure rooms, and scope reprocessing areas. A subset of 8 MAC isolates was submitted for 16s RNA sequencing and molecular relatedness testing by variable number tandem repeats (VNTR).
Results: We defined 3 periods: Baseline (4/1/2014-3/31/2015), outbreak (8/1/2015-10/19/2015) and post-remediation (2/15/2016-3/31/2016) (Fig 1). Prevalence of MAC was 5% ± 0.04% during the baseline period and increased to 20% ± 0.12% during the outbreak phase (p< 0.0001). The pseudo-outbreak terminated after the frequency of changing water-filters for the automated endoscope reprocessors (AER)s was increased to monthly from the manufacturerÕs recommended every 3 months (post-remediation prevalence 4%). 16s RNA sequencing and VNTR confirmed all 8 selected isolates from this pseudo-outbreak were clonally-related.
Conclusion: We report a pseudo-outbreak of clonally-related MAC isolates from BAL specimens that was terminated by increased the frequency of AER filter changes. We hypothesize that increased procedure volume at the clinic led to increased AER use and was associated with earlier failure of water filters. Thus, we propose filter change schedules should be adjusted based on AER utilization instead of fixed-time maintenance schedules. Furthermore, surveillance for environmental organisms such as MAC should be performed by infection control to detect outbreaks in the endoscopy setting.
Jessica Seidelman, M.D.1, Sarah S. Lewis, MD MPH2, Art Keating, BA, MS, RN, BSN3 and Luke F. Chen, MBBS, MPH, MBA, CIC, FRACP2, (1)Internal Medicine, Duke University, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)GI Endoscopy and Bronchoscopy, Duke University Hospital, Durham, NC


J. Seidelman, None

S. S. Lewis, None

A. Keating, None

L. F. Chen, None

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