Bacterial Outbreak Tied to Wound Cleaning

Hospital device infected patients, study says

WEDNESDAY, Dec. 22, 2004 (HealthDayNews) -- An outbreak of an antibiotic-resistant bacterial infection at a major hospital has been traced to equipment commonly used to clean wounds, and a new study says stricter infection-control measures are needed to prevent future outbreaks.

At least one of the three makers of the device has agreed to include infection-control instructions with the equipment, according to study author Dr. Lisa Maragakis, a clinical fellow at Johns Hopkins University School of Medicine. Officials at Hopkins, where the outbreak took place, have also stepped up infection-control practices when using the devices.

The outbreak surfaced in October 2003, the researchers report. "We saw within a very short time frame -- over a seven-day period -- five strains of a highly resistant bacteria, Acinetobacter baumannii," said study senior author Dr. Trish Perl, an associate professor of medicine and pathology at Hopkins.

The report appears in the Dec. 22/29 issue of the Journal of the American Medical Association.

In investigating the source, Perl and her team started with what they knew about Acinetobacter, one of several pathogens causing problems recently in hospitals.

"We knew it was a water bug," Perl said, and the team went over the records of all the infected patients.

In all, 11 patients had cultures that grew the resistant bacteria during the outbreak period; eight had received pulsatile lavage treatment, a common wound-cleansing therapy. Seven of these were found to have the same strain of Acinetobacter. They were compared with 28 control patients randomly selected from a list of patients who didn't have the bacterial infection but did have a wound care consultation. Two patients with the infection died, but it's not clear if infection was the cause, the authors wrote.

The battery-operated device, made by several manufacturers, "looks like a water gun," Perl said. Health-care providers such as physical therapists shoot water, under pressure, into the wound to clean it. "It's not exactly clear to us how [the device] got contaminated," Perl said.

"You have water spraying all over the place, and at the end of the gun there is a suction cup to cover the wound," Perl said. But the contour of wounds can be uneven, she said, and often don't fit under the cups. "So all this water is spraying under pressure, and people are breathing in the water. The physical therapists are wearing gloves and gowns and masks." But until recently, patients did not. Perl's team concluded that the bacteria was becoming aerosolized and caused infections after patients inhaled it.

In the wake of the investigation, Hopkins professionals now perform the technique under stricter infection-control measures. "We now do it in single rooms," Perl said. The patients wear a mask, Maragakis said, and all of the IV lines are covered with a towel.

The devices are exempt from premarket notification or approval by the U.S. Food and Drug Administration. But the FDA encouraged C.R. Bard Inc. -- whose Bard-Davol subsidiary makes a device used at Hopkins -- to include infection-control information on the label, and the company agreed, Maragakis said. In the United States, at least three manufacturers distribute the devices, she said.

Holly Glass, a spokeswoman for Bard-Davol, said infection-control precautions are currently packaged with the device.

Perl's advice to patients who have to have wounds cleaned is to "ask for a mask and wash your hands afterwards."

More information

To learn more about wounds, visit the National Library of Medicine.

SOURCES: Trish Perl, M.D., M.Sc., associate professor, medicine and pathology, Johns Hopkins University School of Medicine, Baltimore; Lisa Maragakis, M.D., clinical fellow, Johns Hopkins University School of Medicine, Baltimore; Holly Glass, spokeswoman, Bard-Davol, Cranston, R.I.; Dec. 22/29, 2004, Journal of the American Medical Association
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