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Outbreak of Pseudomonas aeruginosa Ventriculitis Among Patients in a Neurosurgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

William E. Trick ,
Clare M. Kioski ,
Kathleen M. Howard ,
Gary D. Cage ,
Jerome I. Tokars ,
Bertina M. Yen  and
William R. Jarvis
William E. Trick*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office; Phoenix, Arizona
Clare M. Kioski
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona
Kathleen M. Howard
Affiliation:
St Joseph’s Hospital, and Medical Center, Phoenix, Arizona
Gary D. Cage
Affiliation:
Arizona Department of Health Services, Phoenix, Arizona
Jerome I. Tokars
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Bertina M. Yen
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-69, Atlanta, GA 30333
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Abstract

Objective:

To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure.

Methods:

Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates.

Results:

P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P = 002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P = .004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P = .02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns.

Conclusions:

These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 3 , March 2000 , pp. 204 - 208
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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