A pseudo-outbreak of Burkholderia cepacia complex in a Kentucky hospital

Details

• Alternative Title:
  Am J Infect Control
• Personal Author:
  Eldridge, Chad C. ; Flinchum, Andrea H. ; Thoroughman, Doug ; Spicer, Kevin B.
• Description:
  A cluster of Burkholderia cepacia complex cases from January to October 2020 among outpatients undergoing urologic procedures within a Kentucky hospital's operating rooms was investigated. This investigation included a laboratory look-back, chart reviews, exposure tracing, staff interviews, and direct observation of infection prevention and control practices. A significant protocol breach in a laboratory procedure led to contamination of surgical specimens submitted for culture with nonsterile saline. Pseudo-outbreaks often highlight gaps in infection control processes. Healthcare facilities can make substantial improvements in patient care quality and safety as they respond to identified gaps and improve systems and protocols.
• Subjects:
  • Burkholderia Infections
  • Burkholderia cepacia complex
  • Cross Infection
  • Disease Outbreaks
  • Hospitals
  • Humans
  • Kentucky
• Keywords:
  • Infection prevention and control
  • Laboratory
  • Surgical specimen
  • Investigation
  • Culture of safety
  • Policy and procedure
• Source:
  Am J Infect Control. 50(3):342-344
• Pubmed ID:
  34742748
• Pubmed Central ID:
  PMC8924913
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  50
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/115498/cdc_115498_DS1.pdf
• File Type:
  [PDF - 291.30 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ea315fa7493623c088867dd7d425402da63c10afcc1eb86ed5b98554b25a65ac0b82f11e182026289ba2bce1f939d98c6246e05be15f0184ba71673502378b4e