<i>Burkholderia cepacia</i> Infections Associated With Intrinsically Contaminated Ultrasound Gel: The Role of Microbial Degradation of Parabens

Hutchinson, Jim; Runge, Wendy; Mulvey, Mike; Norris, Gail; Yetman, Marion; Valkova, Nelly; Villemur, Richard; Lépine, François

doi:10.1086/502394

Cited by 95 publications

(67 citation statements)

References 26 publications

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“…342,343 Many healthcareassociated outbreaks of Burkholderia infections associated with contaminated skin antiseptics, mouthwashes, ultrasound gels, medications, and medical devices have been described. [344][345][346][347][348][349][350][351][352][353][354][355][356][357][358][359][360][361][362] Other products that have become contaminated during use include nasal irrigation bottles contaminated with P. aeruginosa, 363,364 multiuse albuterol vials contaminated with B. cepacia, 348,357 acupuncture devices disinfected with glutaraldehyde contaminated with M. abscessus, 365 cosmetic surgical supplies contaminated with mycobacterial spp., and supplies used for liposuction. 366 Outbreaks of Achromobacter spp.…”

Section: Iiid2 Healthcare Sources: Water Surfaces Equipment Airmentioning

confidence: 99%

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Saiman

Siegel

LiPuma

et al. 2014

Infect. Control Hosp. Epidemiol.

352

382

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The 2013 Infection Prevention and Control (IP&C) Guideline for Cystic Fibrosis (CF) was commissioned by the CF Foundation as an update of the 2003 Infection Control Guideline for CF. During the past decade, new knowledge and new challenges provided the following rationale to develop updated IP&C strategies for this unique population:1. The need to integrate relevant recommendations from evidence-based guidelines published since 2003 into IP&C practices for CF. These included guidelines from the Centers for Disease Control and Prevention (CDC)/Healthcare Infection Control Practices Advisory Committee (HICPAC), the World Health Organization (WHO), and key professional societies, including the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). During the past decade, new evidence has led to a renewed emphasis on source containment of potential pathogens and the role played by the contaminated healthcare environment in the transmission of infectious agents. Furthermore, an increased understanding of the importance of the application of implementation science, monitoring adherence, and feedback principles has been shown to increase the effectiveness of IP&C guideline recommendations.2. Experience with emerging pathogens in the non-CF population has expanded our understanding of droplet transmission of respiratory pathogens and can inform IP&C strategies for CF. These pathogens include severe acute respiratory syndrome coronavirus and the 2009 influenza A H1N1. Lessons learned about preventing transmission of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative pathogens in non-CF patient populations also can inform IP&C strategies for CF.

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Section: Iiid2 Healthcare Sources: Water Surfaces Equipment Airmentioning

confidence: 99%

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Saiman

Siegel

LiPuma

et al. 2014

Infect. Control Hosp. Epidemiol.

352

382

View full text Add to dashboard Cite

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“…These include contamination of ultrasound gel, albuterol solution for nebulization, water for injection, moisturizing body milk and IV bromopride, and antiemetic drug granisetron. [12,[16][17][18][19][20] Despite the fact that no source could specifically be found as the cause of this pseudo-outbreak, some infection control measures were implemented which included the following: Hand hygiene, chlorination of water supplied to ICUs and OTs, and proper cleaning of ICUs and OTs. Another practice which was specifically targeted was the use of a common needle inserted into rubber caps of multidose heparin vials through which separate sterile syringes were loaded.…”

Section: Discussionmentioning

confidence: 99%

Pseudo-outbreak of Burkholderia cepacia blood stream infections in intensive care units of a super-speciality hospital: A cross-sectional study

Bhatia¹,

Loomba²,

Mishra³

et al. 2017

Int J Med Sci Public Health

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“…Although these gels possess parabens and methyl benzoate that inhibit bacterial growth, they do not kill bacteria and potentially can be a medium for bacterial proliferation [18 19]. Additionally, certain bacterial species may possess an intrinsic ability to degrade parabens, rendering them nonfunctional [13]. This is an important consideration as use of ultrasound guidance requires transmission gel in close proximity, if not over, the injection site [8].…”

Section: Discussionmentioning

confidence: 99%

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

Sherman

Ferguson

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Therapeutic musculoskeletal injections require a clean or sterile skin preparation to minimize the risk of infections. Ultrasound guidance for this procedure requires the use of transmission gel in proximity to the injection site, and its effect on maintaining sterility is unknown. Questions/purposes We asked: (1) Does sterile ultrasound transmission gel increase skin contamination during therapeutic orthopaedic injections? (2) Does nonsterile gel application result in increased contamination? (3) Does a manufacturer-approved ultrasound probe disinfecting agent in the form of 17.2% isopropanol and 0.28% diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride wipes adequately decontaminate the ultrasound transducer? (4) Does 70% isopropyl alcohol effectively decontaminate skin for administration of musculoskeletal injections? Methods Twenty-six healthy volunteers in an outpatient orthopaedic clinical setting were recruited. The subjects' skin was prepared to simulate a therapeutic intraarticular shoulder injection under ultrasound guidance. Four skin swabs for culture from each subject were taken: one sample before preparation with isopropyl alcohol, one sample after skin preparation, one after simulated injection procedure with sterile ultrasound transmission gel using the transducer, and one after mock procedure with nonsterile ultrasound transmission gel. In addition, samples were taken from the nonsterile ultrasound transmission gel and the transducer for culture analysis. Aerobic and anaerobic cultures were incubated during a 5-day period for bacterial species identification. Results Sterile ultrasound gel use results in an increase in skin contamination (odds ratio [OR], 9; 95% CI, 1.4-57.1; p = 0.005). Compared with sterile gel use, application of nonsterile gel did not increase contamination proportion (OR, 1.1; 95% CI, 0.8-1.7; p = 0.56). All cultures from nonsterile gel were negative. None of the samples cultured directly from the ultrasound probe were positive for bacteria (0%). Skin preparation with 70% alcohol decreased the proportion of contamination when compared with unprepared skin (OR, 21.0; 95% CI, 3.1-142.2; p = 0.001). Conclusions Use of ultrasound probes and transmission gel results in greater contamination in simulated intraarticular injections of the shoulder. As such, sterile preparation of the entire injection field, including the

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Burkholderia cepacia Infections Associated With Intrinsically Contaminated Ultrasound Gel: The Role of Microbial Degradation of Parabens

Abstract: Ultrasound gel is a potential source of infection. Contamination occurs at the time of manufacture, with organisms that degrade parabens, which are commonly used as stabilizing agents. There are far-reaching implications for the infection control community.

Cited by 95 publications

References 26 publications

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Pseudo-outbreak of Burkholderia cepacia blood stream infections in intensive care units of a super-speciality hospital: A cross-sectional study

Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?

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