Control of an Outbreak of Burkholderia cepacia at a Large Acute Care Hospital

BACKGROUND/OBJECTIVES: In May 2005, an increase in the organism Burkholderia cepacia was noted at a 903-bed urban hospital. A similar increase was later noted at a second 302-bed facility that is part of the same hospital system. Control of this outbreak and identification of its source were the main objectives. B. cepacia is a gram negative organism that is similar to Pseudomonas, and is commonly found in soil and water. Though relatively rare in the hospital setting, it is an important pathogen in immunocompromised patients, especially those with Cystic Fibrosis. Hospital outbreaks have often been linked to common contaminated sources, such as disinfectants, IV solutions, nebulizer solutions, and medical devices. METHODS: All patients found positive for B. cepacia were placed into Contact Precautions with dedicated staff for the duration of admission, as well as any subsequent admissions. Hand hygiene and compliance with isolation practices were reinforced through in-person in services. Surveillance cultures were performed on two separate occasions to identify and isolate previously unidentified cases. A common source for the outbreak was sought by culturing available lots of common fluid-based products. Respiratory Therapy policies and procedures were also reviewed. All available isolates were saved, and compared using Pulse-Field Gel Electrophoresis (PFGE). RESULTS: Between May and October of 2005, 40 patients with B. cepacia were identified. No further cases were identified over the next two-month period. PFGE results confirmed 37 of the 40 patients to have a single, outbreak-related strain. Positive specimens included 9 respiratory, 8 blood, 24 urine, 3 intravascular catheter tips, and 1 bone marrow. No commonalities in terms of specific location, diagnosis, medications, or procedures were identified. Isolates from patients in the smaller facility were also typed using PFGE, and were found to be identical. All surveillance cultures of fluids-based products were negative. However, a recall notice in late August 2005 of a non-alcohol mouthwash contaminated with B. cepacia linked this outbreak to a larger national outbreak. This link was confirmed by showing the outbreak strain was identical to isolates from the contaminated mouthwash as confirmed by the Centers for Disease Control and Prevention using PFGE. Contaminated lots were not identified by either facility at the time of the recall, and additional cases of B. cepacia were felt to be due to cross-transmission between patients. CONCLUSIONS: Although introduction of B. cepacia into the hospital was by a common source, interruption of secondary transmission is needed. In these instances, implementation of comprehensive infection control measures, with multi-disciplinary cooperation, is essential.