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Outbreak of Pseudomonas aeruginosa Ventriculitis Among Patients in a Neurosurgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

William E. Trick ,
Clare M. Kioski ,
Kathleen M. Howard ,
Gary D. Cage ,
Jerome I. Tokars ,
Bertina M. Yen  and
William R. Jarvis
William E. Trick*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office; Phoenix, Arizona
Clare M. Kioski
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona
Kathleen M. Howard
Affiliation:
St Joseph’s Hospital, and Medical Center, Phoenix, Arizona
Gary D. Cage
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona
Jerome I. Tokars
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Bertina M. Yen
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-69, Atlanta, GA 30333
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Abstract

Objective:

To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure.

Methods:

Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates.

Results:

P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P = 002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P = .004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P = .02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns.

Conclusions:

These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 3 , March 2000 , pp. 204 - 208
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1.Pearson, ML. Guideline for prevention of intravascular device-related infections. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:438–473.Google Scholar
2.Paramore, CG, Turner, DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 1994;127:79–84.CrossRefGoogle ScholarPubMed
3.Mayhall, CG, Archer, NH, Lamb, VA, Spadora, AC, Baggett, JW, Ward, JD, et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984;310:553–559.Google Scholar
4.Constantini, S, Cotev, S, Rappaport, ZH, Pomeranz, S, Shalit, MN. Intracranial pressure monitoring after elective intracranial surgery. A retrospective study of 514 consecutive patients. J Neurosurg 1988;69:540–544.Google Scholar
5.Ohrstrom, JK, Skou, JK, Ejlertsen, T, Kosteljanetz, M. Infected ventriculostomy: bacteriology and treatment. Acta Neurochir (Wien) 1989;100:67–69.CrossRefGoogle ScholarPubMed
6.Mangi, RJ, Quintiliani, R, Andriole, VT. Gram-negative bacillary meningitis. Am J Med 1975;59:829–836.CrossRefGoogle ScholarPubMed
7.Jang, TN, Wang, FD, Wang, LS, Yu, KW, Liu, CY. Gram-negative bacillary meningitis in adults: a recent six-year experience. J Formos Med Assoc 1993;92:540–546.Google ScholarPubMed
8.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
9.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1997;18:426–439.Google Scholar
10.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996;24:380–388.CrossRefGoogle Scholar
11.Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.CrossRefGoogle ScholarPubMed
12.Pegues, DA, Schidlow, DV, Tablan, OC, Carson, LA, Clark, NC, Jarvis, WR. Possible nosocomial transmission of Pseudomonas cepacia in patients with cystic fibrosis. Arch Pediatr Adolesc Med 1994;148:805–812.Google Scholar
13.Doring, G, Jansen, S, Noll, H, Grupp, H, Frank, F, Botzenhart, K, et al. Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward. Pediatr Pulmonol 1996;21:90–100.3.0.CO;2-T>CrossRefGoogle Scholar
14.Becks, VE, Lorenzoni, NM. Pseudomonas aeruginosa outbreak in a neonatal intensive care unit a possible link to contaminated hand lotion. Am J Infect Control 1995;23:396–398.CrossRefGoogle Scholar
15.Crane, LR, Tagle, LC, Palutke, WA. Outbreak of Pseudomonas paucimobilis in an intensive care facility. JAMA 1981;246:985–987.CrossRefGoogle Scholar
16.Bert, F, Maubec, E, Bruneau, B, Berry, P, Lambert-Zechovsky, N. Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998;39:53–62.CrossRefGoogle Scholar
17.MaM, DG, Stolz, SS, Wheeler, S, Mermel, LA. A prospective randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 1992;22:1729–1737.Google Scholar