Bacteria Outbreak Closes Baby And Children Units In LA Hospital
Featured ArticleMain Category: Pediatrics / Children's Health
Also Included In: Medical Devices / Diagnostics; Infectious Diseases / Bacteria / Viruses; MRSA / Drug Resistance
Article Date: 17 Dec 2006 - 2:00 PDT
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Neonatal and intensive care pediatric units at White Memorial Center Hospital near downtown Los Angeles, California, are closed following an outbreak of a bacterium that is suspected of killing one baby and infecting 6 other children. Four of the other six children infected are also babies.
The bacterium is called Pseudomonas aeruginosa and is not usually harmful to healthy people. It causes what is known as opportunistic infections, that is people with weak immune systems, such as premature infants or children and elderly people who are already sick, or people with AIDS, are vulnerable to it. In those cases it infects the respiratory or urinary system, and it can get into burns and wounds and the blood as well. It is resistant to a number of antibiotics, although there are some that do work.
Laurene Mascola, MD, Chief of Los Angeles County's Acute Communicable Disease Control Unit says the bacterium was first detected on 30th November and it is likely that the baby who died did so as a result of the infection. She emphasised that the infants were vulnerable to this infection because they were already "very, very sick babies".
Uninfected children have been moved to separate units and mothers due to give birth at the hospital are advised to discuss with their practitioner whether to go ahead or choose another hospital.
Hospital staff who are working closely with the county's officials believe that the source of the infection is a laryngoscope blade which may not have been cleaned properly.
A laryngoscope is a medical device that doctors use to examine the throat (larynx). It lis essentially a medical handheld torch with a curved blade at one end enclosing a light. The blade is inserted into the mouth and pushes away a flap of cartilage at the back of the tongue (epiglottis) to allow proper examination of the interior of the larynx and the trachea (tube through which air is drawn into the lungs).
If you are a fan of the TV hospital soap "ER" you will probably have seen Dr Mark Greene on numerous occasions inserting a laryngoscope into the throat of an unconscious road accident or gunshot victim before calling for an intubation to be performed.
Routine cleaning of the laryngoscope is important to stop spread of bacteria from patient to patient. You should clean the blade immediately after use with a brush and hot soapy water to remove secretions. Then you should disinfect it by soaking in antiseptic solution.
Click here to find out more about bacteria and opportunistic infections (MSN Encarta).
Written by: Catharine Paddock
Writer: Medical News Today
Copyright: Medical News Today
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Infections Linked To Pseudomonas Aeruginosa
posted by Lawrence F Muscarella PhD on 18 Dec 2006 at 6:15 amWhile at this time the source and cause of this Pseudomonas aeruginosa outbreak linked to laryngoscopes appear to be unknown, a factor that might have contributed to, and might have been the cause of, this specific outbreak is the water (tap water?, "sterile" filtered water?) that might have been used to rinse and reprocess (i.e., disinfect or sterilize between uses) the laryngoscope's blades prior to their use on these infants.
Establishment of the specific method of reprocessing these laryngoscope blades (and handles) is crucial to the completeness and thoroughness of the investigation into this outbreak's source and cause.
Contrary to my published recommendations and for unclear reasons, several national healthcare organizations have published guidelines that do not recommend drying instruments, such as endoscopes and laryngoscopes, after reprocessing and prior to their use on patients (see reference # 1provided below). While wet instruments significantly increase the risk of transmission of microorganisms - specifically, of Pseudomonas aeruginosa - dry instruments all but completely prevent the transmission of this and other types of (Gram-negative) bacteria.
To indentify the cause and source of this specific outbreak, important aspects to investigate will be: (1) How were the blades reprocess? Were they steam sterilized (very unlikely), or where they immersed into a liquid chemical agent, such as peracetic acid or glutaraldehyde; (2) Was a liquid chemical agent used to reprocess the laryngoscopes' blades (and handles), which seems likely?
(3) Determine whether the handles to which the laryngoscope's blades attach (similar to a flashlight) might have been the source of this outbreak. Laryngoscope handles connect to the fiebroptic blade which is inserted into the infant's larynx.
Contrary to my published recommendations, some operating room guidelines do not recommend proper decontamination of the laryngoscope's handle, overlooking its potential contribution to nosocomial infections of, for example, Pseudomonas aeruginosa or tuberculosis; see reference #4 , below).
It is unclear whether any of these aforementioned factors may have been involved in this outbreak. But their consideration is warranted and advised.
Papers I wrote that are germane to and might explain the causes of this outbreak include:
(1) Muscarella LF. Inconsistencies in endoscope-reprocessing and infection-control guidelines: the importance of endoscope drying.
Am J Gastroenterol. 2006 Sep;101(9):2147-54;
(2) Muscarella LF. Contribution of tap water and environmental surfaces to nosocomial transmission of antibiotic-resistant Pseudomonas aeruginosa.
Infect Control Hosp Epidemiol. 2004 Apr;25(4):342-5.
(3) Muscarella LF. The importance of bronchoscope reprocessing guidelines: raising the standard of care.
Chest. 2004 Sep;126(3):1001-2; author reply 1002-3.
(4) Muscarella LF. Recommendations to resolve inconsistent guidelines for reprocessing sheathed and un-sheathed rigid laryngoscopes. In Press (see: (a) http://www.myendosite.com/htmlsite/2004/julyaug04.pdf; and (b) http://www.myendosite.com/htmlsite/2004/septoct04.pdf).
(5) Muscarella LF. Leading a horse to water: are crucial lessons in endoscopy and outbreak investigations being learned?
Infect Control Hosp Epidemiol. 2002 Jul;23(7):358-60; author reply 360.
Hope this infomration helps and can be used to prevent additional injuries.
Respectfully,
Lawrence F Muscarella, PhD
LFM@myendosite.com
T: 215-364-8577
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