Document Detail


Investigation and Control of an Outbreak of Achromobacter xylosoxidans Bacteremia.
MedLine Citation:
PMID:  22227988     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective. To define the extent of an outbreak of Achromobacter xylosoxidans bacteremia, determine the source of the outbreak, and implement control measures. Design. An outbreak investigation, including environmental and infection control assessment, and evaluation of hypotheses using the binomial distribution and case control studies. Setting. A 50-bed medical surgical unit in a hospital in Illinois during the period January 1-July 15, 2006. Interventions. Discontinuation of use of opioid delivery via patient-controlled analgesia (PCA) until the source of the outbreak was identified and implementation of new protocols to ensure more rigorous observation of PCA pump cartridge manipulations. Results. Calculations based on the binomial distribution indicated the probability that all 9 patients with A. xylosoxidans bacteremia were PCA pump users by chance alone was <.001. A subsequent case control study identified PCA pump use for administration of morphine as a risk factor for A. xylosoxidans bacteremia (odds ratio, undefined; [Formula: see text]). Having a PCA pump cartridge with morphine started by nurse C was significantly associated with becoming a case-patient (odds ratio, 46; 95% confidence interval, 4.0-525.0; [Formula: see text]). Conclusions. We hypothesize that actions related to diversion of morphine by nurse C were the likely cause of the outbreak. An aggressive pain control program involving the use of opioid medication warrants an equally aggressive policy to prevent diversion of medication by staff.
Authors:
Brie Behrens-Muller; Judith Conway; Jonathan Yoder; Craig S Conover
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America     Volume:  33     ISSN:  1559-6834     ISO Abbreviation:  Infect Control Hosp Epidemiol     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804099     Medline TA:  Infect Control Hosp Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  180-4     Citation Subset:  IM; N    
Affiliation:
Illinois Department of Public Health, Springfield, Illinois.
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