MRSA outbreak from a health care worker
The importance of preventing nosocomially acquired diseases cannot be overstated. A posting earlier this summer summarized an outbreak of Hepatitis C among patients of a gastroenterology practice in New York City, and how the outbreak had been traced back to a lapse in universal precautions by an anesthesiologist. A new report from the Centers for Disease Control describes a very recent outbreak of Staphylococcus aureus in Arizona and Delaware, also attributable to lapses in protocol by health care professionals.
In the Delaware case, 7 patients of an orthopedic clinic displayed signs associated with septic arthritis or arthritis requiring subsequent hospitalization in mid-March. The patients were admitted for an average of 6 days, and all the wounds required surgical removal of damaged tissue along with intravenous antibiotics. All of the patients had previously been treated between March 6-8 at the orthopedic clinic, and had received joint injections on an outpatient basis. Three additional patients treated at the same time also reported symptoms consistent with infection, but were resolved with oral antibiotics.
Isolates collected by the CDC were analyzed by a technique called Pulsed-Field Gel Electrophoresis, and were found to be indistinguishable from one another. Clinic staff associated with the care of the patients were swabbed to see if they were carrying the S. aureus strain isolated, and one staff person responsible for preparing injections were positive for the isolate.
The lapses in control in the outbreaks in Arizona and Delaware in this report were again attributable to a failure to adhere to recommendations on the use of Single Dose Vials (SDV) of medication. Bupivacaine is a pain relief drug administered by injection, and is distributed in 10 mL vials intended only to be used on one patient. A national disruption in the supply of the drug resulted in only 30 mL vials of bupivacaine being available, and consequently the clinic workers reused the vials between patients until the vials were emptied.
The CDC offers several recommendations to prevent these situations from occurring:
- contents from SDVs should be drawn into sterile syringes in an aseptic manner
- syringes should be used promptly in single patients in single procedures
- drug vials and remaining contents should be disposed of
When single use vials are not available, as apparently was the case in these outbreaks, health care workers can repackage previously unused larger doses into single use vials in the clinic setting. This procedure should only be done in a laminar flow hood with strict adherence to best practices aseptic technique.