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Outbreak of Burkholderia cepacia Bacteremia Traced to Contaminated Hospital Water Used for Dilution of an Alcohol Skin Antiseptic

Show simple item record Nasser R.M. Rahi A.C. Haddad M.F. Daoud Z. Irani-Hakime N. Almawi W.Y.
dc.contributor.editor 2004 2017-10-18T13:33:46Z 2017-10-18T13:33:46Z 2004
dc.identifier 10.1086/502384
dc.description.abstract OBJECTIVE: To identify the source of an epidemic of Burkholderia cepacia bloodstream infections during 7 years (411 episodes in 361 patients). DESIGN: Outbreak investigation. SETTING: A 250-bed university hospital in Beirut, Lebanon. METHODS: Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction-restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions. RESULTS: In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98percent, intravenous phlebitis in 44percent, and recurrent bacteremia in 20percent. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction-restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for skin antisepsis and for decontamination of the caps of heparin vials. Only sporadic cases directly attributable to breach of protocol were reported after single-use alcohol swabs were substituted. CONCLUSION: This is potentially the largest single-source nosocomial bloodstream infection outbreak ever reported, and the first report of an alcohol skin antiseptic contaminated by tap water as a source for nosocomial bacteremia.
dc.format.extent Pages: (231-239)
dc.language English
dc.publisher THOROFARE
dc.relation.ispartof Publication Name: Infection Control and Hospital Epidemiology; Publication Year: 2004; Volume: 25; no. 3; Pages: (231-239);
dc.source Scopus
dc.title Outbreak of Burkholderia cepacia Bacteremia Traced to Contaminated Hospital Water Used for Dilution of an Alcohol Skin Antiseptic
dc.type Article
dc.contributor.affiliation Nasser, R.M., Department of Infection Control, Saint George Hospital, Beirut, Lebanon, Department of Infectious Diseases, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, United States
dc.contributor.affiliation Rahi, A.C., Dept. of Epidemiol. and Biostatist., American University of Beirut, Beirut, Lebanon
dc.contributor.affiliation Haddad, M.F., Department of Infection Control, Saint George Hospital, Beirut, Lebanon, Department of Laboratory Medicine, Saint George Hospital, Beirut, Lebanon
dc.contributor.affiliation Daoud, Z., Department of Laboratory Medicine, Saint George Hospital, Beirut, Lebanon, Faculty of Health Sciences, Balamand University, Beirut, Lebanon
dc.contributor.affiliation Irani-Hakime, N., Department of Laboratory Medicine, Saint George Hospital, Beirut, Lebanon, Department of Pathology, Saint George Hospital, Beirut, Lebanon
dc.contributor.affiliation Almawi, W.Y., Department of Laboratory Medicine, Saint George Hospital, Beirut, Lebanon
dc.contributor.authorAddress Nasser, R.M.; Department of Infectious Diseases, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, United States
dc.contributor.authorCorporate University: American University of Beirut; Faculty: Faculty of Health Sciences; Department: Epidemiology and Population Health;
dc.contributor.authorDepartment Epidemiology and Population Health
dc.contributor.authorFaculty Faculty of Health Sciences
dc.contributor.authorInitials Nasser, RM
dc.contributor.authorInitials Rahi, AC
dc.contributor.authorInitials Haddad, MF
dc.contributor.authorInitials Daoud, Z
dc.contributor.authorInitials Irani-Hakime, N
dc.contributor.authorInitials Almawi, WY
dc.contributor.authorReprintAddress Nasser, RM (reprint author), Marshfiled Clin, Dept Infect Dis, 1000 N Oak Ave, Marshfield, WI 54449 USA.
dc.contributor.authorUniversity American University of Beirut
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dc.description.citedCount 44
dc.description.citedTotWOSCount 37
dc.description.citedWOSCount 37
dc.format.extentCount 9
dc.identifier.coden ICEPE
dc.identifier.pubmedID 15061416
dc.identifier.scopusID 1542510111
dc.publisher.address 6900 GROVE RD, THOROFARE, NJ 08086 USA
dc.relation.ispartOfISOAbbr Infect. Control Hosp. Epidemiol.
dc.relation.ispartOfIssue 3
dc.relation.ispartofPubTitle Infection Control and Hospital Epidemiology
dc.relation.ispartofPubTitleAbbr Infect. Control Hosp. Epidemiol.
dc.relation.ispartOfVolume 25
dc.source.ID WOS:000220205700012
dc.type.publication Journal
dc.subject.otherChemCAS alcohol, 64-17-5
dc.subject.otherChemCAS heparin, 37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5
dc.subject.otherChemCAS Alcohols
dc.subject.otherChemCAS Anti-Infective Agents, Local
dc.subject.otherIndex alcohol
dc.subject.otherIndex antiinfective agent
dc.subject.otherIndex heparin
dc.subject.otherIndex antisepsis
dc.subject.otherIndex article
dc.subject.otherIndex bacteremia
dc.subject.otherIndex bacterial strain
dc.subject.otherIndex bacterium isolate
dc.subject.otherIndex blood culture
dc.subject.otherIndex Burkholderia cepacia
dc.subject.otherIndex clinical article
dc.subject.otherIndex controlled study
dc.subject.otherIndex culture medium
dc.subject.otherIndex epidemic
dc.subject.otherIndex fever
dc.subject.otherIndex hospital infection
dc.subject.otherIndex human
dc.subject.otherIndex intravenous catheter
dc.subject.otherIndex Lebanon
dc.subject.otherIndex phlebitis
dc.subject.otherIndex polymerase chain reaction
dc.subject.otherIndex restriction fragment length polymorphism
dc.subject.otherIndex water contamination
dc.subject.otherIndex Alcohols
dc.subject.otherIndex Anti-Infective Agents, Local
dc.subject.otherIndex Blood-Borne Pathogens
dc.subject.otherIndex Burkholderia cepacia
dc.subject.otherIndex Burkholderia Infections
dc.subject.otherIndex Catheters, Indwelling
dc.subject.otherIndex Cross Infection
dc.subject.otherIndex Disease Outbreaks
dc.subject.otherIndex Disease Transmission, Professional-to-Patient
dc.subject.otherIndex Equipment Contamination
dc.subject.otherIndex Female
dc.subject.otherIndex Hospitals, University
dc.subject.otherIndex Humans
dc.subject.otherIndex Infusions, Intravenous
dc.subject.otherIndex Lebanon
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Polymerase Chain Reaction
dc.subject.otherIndex Skin
dc.subject.otherIndex Water Microbiology
dc.subject.otherKeywordPlus GRAM-NEGATIVE BACTEREMIA
dc.subject.otherKeywordPlus CYSTIC-FIBROSIS PATIENTS
dc.subject.otherKeywordPlus PSEUDOMONAS-CEPACIA
dc.subject.otherKeywordPlus INFECTION
dc.subject.otherKeywordPlus COMPLEX
dc.subject.otherKeywordPlus PSEUDOBACTEREMIA
dc.subject.otherKeywordPlus GENOMOVARS
dc.subject.otherKeywordPlus LEBANON
dc.subject.otherKeywordPlus IMPACT
dc.subject.otherKeywordPlus BEIRUT
dc.subject.otherWOS Public, Environmental and Occupational Health
dc.subject.otherWOS Infectious Diseases

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