pacemaker pocket infection due to environmental mycobacteria: successful management of an outbreak and steps for prevention in future
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2016
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Abstract
Background: An outbreak of surgical site infection (SSI) due to environmental mycobacteria (EMB) occurred in a hospital in Eastern India.
Method: A quality improvement project (QIP) was undertaken to analyze the causes and prevent further outbreak. Step (1) Proof of the need: Four patients who had undergone pacemaker implantation consecutively during a 10-day period developed SSI. Step (2) Diagnostic journey: Since all patients developed SSI within 2 months of implantation, a common source of infection was likely. Atypical mycobacteria (AMB) were grown from surgical sites as well as from the surface of operation table, image intensifier, and lead aprons. It was a rapid growing variety that lacked pigment, a characteristic of EMB with pathogenic potential. The EMB was finally traced to its source, the overhead water tank. Step (3) Remedial journey: By thorough cleaning of the water tank and enriching its chlorine content, the EMB was eliminated from its source. Step (4) Holding the gains: Protocol for cleaning the water tank once in 3 months was made. A checklist was prepared to ensure compliance to asepsis protocol in the operation theater. In the ensuing 5 years, the infection did not recur.
Result: The bacteria that caused SSI were identified as EMB that grew in the water tank and contaminated the operation room. It could be eliminated by appropriate measures.
Interpretation: Water is a potential reservoir for EMB. Use of the term ‘environmental mycobacteria’ instead of ‘atypical mycobacteria’ will generate awareness about contamination as the cause of SSI.
| Reference Key |
bharat2016indianpacemaker
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|---|---|
| Authors | ;Vijaya Bharat;Vivek Hittinahalli;Meenakshi Mishra;Sridhar Pradhan |
| Journal | renewable energy |
| Year | 2016 |
| DOI |
10.1016/j.ihj.2015.06.023
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| URL | |
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