Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic

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• 作者：Rachel Radcliffe ; DVM ; MPH^a ; ^b ; ^{Rachel.Radcliffe@wv.gov} ; ^gon8@cdc.gov ; Elissa Meites ; MD ; MPH^a ; ^c ; Janet Briscoe ; RN ; BSN ; MBA^d ; Rahul Gupta ; MD ; MPH ; FACP^d ; ^e ; ^f ; Gregory Fosheim ; MPH^c ; Sigrid K. McAllister ; BS ; MT (ASCP)^c ; Bette Jensen ; MMSc^c ; Judith Noble-Wang ; PhD^c ; Maria del Rosario ; MD ; MPH^b ; Jeff Hageman ; MHS^c ; Priti R. Patel ; MD ; MPH^c
• 关键词：Staphylococcus aureus ; Pain clinic ; Outbreak ; Epidural injection
• 刊名：American Journal of Infection Control
• 出版年：2012
• 出版时间：March, 2012
• 年：2012
• 卷：40
• 期：2
• 页码：144-149
• 全文大小：215 K

文摘

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Background

Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic.

Methods

We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ?14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis.

Results

Eight (7 % ) of 110 cohort patients met the case definition; 6 (75 % ) cases were laboratory confirmed. Eight (12 % ) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P?= .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis.

Conclusion

Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission.