An Outbreak of Burkholderia cepacia Bacteremia in a Tertiary Care Cardiac Hospital Associated with Contaminated Medication Vials

Background:

Burkholderia cepacia is a gram-negative bacillus commonly found in soil and moist environments and capable of surviving and growing in nutrient-poor water. Small hospital outbreaks of B. cepacia due to a single contaminated source such as disinfectants, intravenous solutions, nebulizer solutions, and medical devices have been documented in multiple studies.

Objective:

To determine the source and mode of transmission of Burkholderia cepacia bacteremia associated with an outbreak that occurred at a tertiary care cardiac hospital in New Delhi, India and describe the measures taken to control the outbreak.

Methods:

An epidemiological investigation was carried out to identify the possible source of Burkholderia cepacia in patients who had positive blood cultures with this organism with no other source of infection. Extensive sampling of environmental surfaces, disinfectants, medication vials (both multi dose and single dose vials), infusions, water, humidifier fluids, and equipment were done in all the operating rooms and post- operative areas to determine the source of contamination. Hand swabs of the health care personnel were also taken.

Results:

A total of 59 patients grew B. cepacia in the blood culture. Out of the 606 samples taken from operating rooms and post- operative areas, only one multi dose vial of 2% Lignocaine grew B. cepacia. The outbreak was controlled after all the opened and unopened medication vials were removed simultaneously from these areas (9 operating rooms and post operative areas) on the same day.

Conclusions:

It is possible to avoid and control outbreaks if we follow standard precautions and aseptic techniques while handling medication vials.