Highlights
- •Patients on mechanical ventilation are at risk for ventilator-associated pneumonia.
- •An outbreak of ventilator-associated pneumonia occurred in our surgical intensive care unit.
- •Burkholderia cepacia was confirmed as the causative pathogen.
- •Immediate ventilator cleaning and treatment after use was instituted.
- •The highest standards of hygiene are required in the health care environment.
Background
We reviewed Burkholderia cepacia infections in a hospital from 2013-2016 to report a suspicious outbreak that occurred
in a surgical intensive care unit in 2015, and to outline the infection control measures
adopted thereafter.
Methods
Review of the health care–associated infection data regarding B cepacia via the surveillance system, hospital information system, electronic medical records,
and laboratory information system together with the outbreak investigation was managed
by the health care–associated infection control team.
Results
During June 1-14, 2015, 4 cases of ventilator-associated pneumonia (VAP) were identified;
B cepacia was isolated from endotracheal aspirate samples. On June 16, 120 environmental samples
were collected and analyzed for microbiologic differentiation. Thirteen strains of
B cepacia were prominently found in the expiratory blocks of ventilators, revealing the biocontamination
source. After chemical disinfection without damaging ventilator components, repeat
microbiologic testing of random ventilator samples yielded negative results until
July 30, 2015. Retrospective data showed that isolation rates of B cepacia strains had increased since 2014. Although the resistance phenotype of these strains
varied slightly, they exhibited similar patterns of antibiotic susceptibility.
Conclusions
Routine cleaning and disinfection of ventilators, in addition to an intervention bundle,
should form part of an integrated VAP prevention and management approach.
Key Words
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References
- Incidence and characteristics of ventilator-associated events reported to the National Healthcare Safety Network in 2014.Crit Care Med. 2016; 44: 2154-2162
- An outbreak of Burkholderia cepacia bacteremia in hospitalized hematology patients selectively affecting those with acute myeloid leukemia.Am J Infect Control. 2013; 41: 312-316
- National Healthcare Safety Network (NHSN) Report, Data Summary for 2012, Device-associated Module.Am J Infect Control. 2013; 41: 1148-1166
- A multicenter prospective monitoring on incidences of ventilator associated pneumonia in 46 hospitals in China.Chin Infect Control. 2015; 14: 540-543
- Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit.Diagn Microbiol Infect Dis. 2011; 70: 260-266
- Burkholderia sepsis in children as a hospital-acquired infection.Yonsei Med J. 2016; 57: 97-102
- Chinese guideline for the construction and management in ICU.2009
- Exploitation and application of Beijing nosocomial infection surveillance and management system.Chin J Noso. 2008; 18: 985-987
- Guidelines for preventing health-care-associated pneumonia, 2003.Respir Care. 2004; 49: 926-939
- Impact of the ventilator bundle on ventilator associated pneumonia in intensive care unit.Int J Qual Health Care. 2011; 23: 538-544
- Impact of surveillance of hospital-acquired infections on the incidence of ventilator-associated pneumonia in intensive care units: a quasi-experimental study.Crit Care. 2012; 16: 1-8
- Criteria of diagnosis of nosocomial infection, hospital infection or hospital acquired infection.2001
- Chinese nosocomial infection management regulations.2006
- Performance standards for antimicrobial susceptibility testing, 25th informational supplement. M100-S25.(Wayne (PA))2015
- Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash.Int J Infect Dis. 2014; 29: 96-99
- Hospital-wide outbreak of Burkholderia contaminans caused by prefabricated moist washcloths.J Hosp Infect. 2011; 77: 267-270
- Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of a nosocomial infection in a multidisciplinary intensive care unit.Crit Care. 2008; 12: R10
- Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist.Infect Control Hosp Epidemiol. 2001; 22: 423-426
- Case-crossover study of Burkholderia cepacia complex bloodstream infection associated with contaminated intravenous bromopride.Infect Control Hosp Epidemiol. 2010; 31: 516-521
- Hospital outbreak of Burkholderia stabilis bacteraemia related to contaminated chlorhexidine in haematological malignancy patients with indwelling catheters.J Hosp Infect. 2008; 70: 241-245
- Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic.Infect Control Hosp Epidemiol. 2004; 25: 231-239
- Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks.Am J Infect Control. 2011; 39: 775-778
Ministry of Health of the People's Republic of China. Notification of issues about antimicrobials usage management in clinical settings. 2001.
- Isolation from clinical sources of Burkholderia cepacia possessing characteristics of Burkholderia gladioli.J Antimicrob Chemother. 1997; 39: 169-175
- Cross-resistance to nalidixic acid, trimethoprim, and chloramphenicol associated with alterations in outer membrane proteins of Klebsiella, Enterobacter, and Serratia.J Infect Dis. 1985; 151: 501-507
- Improving ventilator-associated event surveillance in the National Healthcare Safety Network and addressing knowledge gaps: update and review.Curr Opin Infect Dis. 2014; 27: 394-400
Article info
Publication history
Published online: March 20, 2017
Footnotes
Funding/support: Supported by a grant from China-Japan Friendship Hospital and National Science Grant for Distinguished Young Scholars (81425001/H0104).
Conflicts of interest: None to report.
Identification
Copyright
© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
