A systematic review was conducted to identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. The review reinforced the importance of continued vigilance in bronchoscopy disinfection practices and quality control measures, as outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care.
A 5-month long multi-unit outbreak of C. auris occurred in a 600-bed adult academic tertiary care hospital. Contact tracing was started immediately after identifying the index case, and surveillance testing for C. auris was performed for patients exposed to the index case. The secondary attack rate determined from cultures was 6.8%, and the 30-day all-cause mortality rate for patients who tested positive for C. auris was 9.7%. The authors concluded that state health department collaboration is essential to controlling these outbreaks and preventing spread to other institutions.
A response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent outbreaks at a long-term acute-care hospital. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.
56 patients developed Burkholderia cenocepacia bacteremia in an oncology setting in India. Whole genome sequencing and epidemiologic analyses of patients’ physicians and drug exposures revealed all infected patients had received the antiemetic drug palonosetron from a contaminated batch. Once removed, the outbreak terminated, and the findings were promptly reported to regulatory authorities.
An outbreak with multidrug-resistant Acinetobacter baumannii was identified in 27 patients hospitalized at a burn center. Transmission was likely propagated by direct transmission and indirect transmission (from temporarily contaminated surfaces); environmental sampling did not suggest a common source. Acquisition of the outbreak strain was associated with larger burn lesions, and inversely associated with higher nurse-to-patient ratio.
Investigation of a case of nontuberculous mycobacteria infection in a patient who received a cosmetic surgical procedure in Florida identified a total of 15 cases in nine states in patients who received cosmetic surgical procedures at the same facility. Multiple lapses in infection control and prevention were found at an outpatient cosmetic surgery clinic.
A Hepatitis C virus (HCV) outbreak associated with an independent pain management clinic was identified in Los Angeles County, prompting a public health investigation to identify the outbreak source, associated HCV cases and prevent further infections. While a specific source of HCV transmission was unable to be identified, evidence supports the possibility that a multidose medication vial was contaminated by reuse of a needle or syringe and may have contributed to the outbreak.
An outbreak of CRAB was detected in nine patients across three wards at a tertiary-care hospital, prompting infection prevention measures and targeted screening. The cases reflected ongoing community transmission from high-risk facilities and highlighted the necessity of a robust surveillance system and mitigation efforts.
Outbreaks involving duodenoscopes have been gaining attention across the healthcare field, broader community, and lay press. Their complex design may contribute to high risk of infection, and other types of endoscopes are also frequently implicated in outbreak investigations. This podcast episode discusses bronchoscopy-associated outbreaks and pseudo-outbreaks, as demonstrated in a recently published study in ICHE, and how listeners can identify these events and key prevention strategies to reduce risk of such outbreaks and pseudo-outbreaks.
Despite adhering to cleaning and disinfection strategies meeting or exceeding manufacturer’s instructions for use, various water-based heater-cooler devices have been implicated in nontuberculous mycobacteria (NTM) outbreaks. Ongoing rigorous surveillance for healthcare-associated NTM alerted investigators to a cluster of three extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery. This outbreak investigation highlighted the need for additional heater-cooler device design modifications to better contain aerosols or filter exhaust during device operation to prevent NTM transmission.
