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.

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About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on August 5, 2012, in Microbes in the News, Wash your hands! and tagged . Bookmark the permalink. 2 Comments.

  1. It astounds me that there are still outbreaks that are occurring because health care workers are not following the protocol or standards of practice that are given concerning use of these drugs. I understand medication is very expensive however by not following protocol and giving these patients these infections this worker has just cost the hospital much more money. When a patient acquires a nosocomial infection the insurance companies will not cover a penny of it and the burden of payment falls upon the place the infection occurred. And not only the cost but the fact that these poor patients now have another medical problem the deal with and one that if they are immunocompromised could be potentially fatal. I set high standards for myself as a nurse, because I entered this field knowing it is life and death and its not like if you make the wrong change at the register no one gets hurt. I pride my self on being meticulous, diligent, prudent, and safe, and I expect the same from those around me which can make me a difficult person to work with at times because I hold them to the same standards as myself. Also I liked the article mentioned about the pharmacy repackaging the meds into single use vials, because we do that all the time for residents at my facility. These articles outrage me and embarrass me as a nurse and the occurrence of these events are really uncalled for!!

    • Thanks Lynn. As I indicated in the write up, it’s actually not a simple issue, although basic universal precautions in patient care should be at first glance be a no-brainer. The initiating factor in this case was the fact that a national pharmaceutical shortage resulted in only the larger vials being available in the local pharmacy. The high cost of health care (and the administrators who see the bottom line in budgets) puts a huge pressure on reining in those costs, and I think that is initially what prompted this situation more so than any true negligence. So what should be basic common sense then shifts to cold calculus: the savings of expensive medical supplies (and the time cost of health care workers) in comparison to the risks to the patients, and subsequent added costs in nosocomially acquired infections. My personal feeling is that the “first do no harm” philosophy of medicine should trump all other factors, but unfortunately I think that is not the case in the real world.

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