Microbiology: A Systems Approach 4th Edition by Marjorie Kelly Cowan

Exercise 35

Contaminated Antiseptic
Microbial control is extremely important in a hospital setting. Hospitalized patients have numerous open portals where bacteria can enter and cause infection, from simple skin breaks due to injections or intravenous lines to surgical sites and open wounds. Extreme care needs to be taken when preparing skin for injections, IVs, and surgery. Sterile equipment and fluids must be used to ensure that no bacteria are introduced into these open portals.
In October 2010, a child at the Children's Hospital at Aurora, Colorado, was diagnosed with leukemia, and a vascular access device, or "port," was inserted to administer chemotherapy drugs. Twenty-four hours after the port was inserted, the child developed clinical sepsis , or bacteria in the blood, as well as cellulitis at the insertion site. The wound required surgical debridement , and extensive wound care post-surgery. The child also required antibiotics and outpatient treatment. Cultures were taken of the child's blood and tissues, and Bacillus cereus grew from the samples.
A month later at the same hospital, an infant with congenital heart disease received an internal jugular line. Four days after the line was placed, the infant became clinically septic and developed a fever and respiratory distress. The jugular line had to be removed, and the infant was treated with intravenous antibiotics over an extended period before being discharged from the hospital. Blood and tissue samples from the infant were also positive for B. cereu s.
What procedures are used to prepare skin for injections, IVs, and surgical procedures
How could B. cereus have been introduced into these patients
It is a standard procedure performed thousands, if not millions of times a day in hospitals, clinics, and doctors' offices: Before blood is drawn or an injection is given, the skin in the area is cleansed, usually with a small cotton wipe containing 70% isopropyl alcohol. The antiseptic action of 70% isopropyl alcohol dissolves bacterial membranes and coagulates cytoplasmic proteins. This can effectively kill bacteria, including Mycobacterium tuberculosis, vegetative fungal spores, and nonenveloped viruses. The second goal of this procedure is the physical removal of microbes and dead skin cells through scrubbing.
Several hospital items were investigated as the possible source of contamination in these patients:
1. Sterile syringes prefilled with sterile saline solution
2. Sterile applicators packaged with 2% chlorhexidinegluconate/70% alcohol solution for skin preparation
3. Cotton prep pads packaged with 70% isopropyl alcohol (The packaging for the alcohol prep pads was not labeled as "sterile" or "nonsterile.")Bacterial cultures taken from the sterile saline and sterile applicators were found to be negative for bacterial growth. Cultures taken from the alcohol prep pads showed growth of B. cereus in two-thirds of the pads, representing 8 out of 10 manufacturing lots from a single manufacturer. Contamination with B. cereus was found both on the inside and on the outside of the alcohol prep pad packages. When the contamination was found, the Colorado Department of Public Health and Environment and the Food and Drug Administration were notified, and the Children's Hospital immediately discontinued using that brand of alcohol prep pads. This led to a recall of the alcohol prep pads and eventual discontinuation of the brand.
Why were the children in this case at greater risk for infection with B. cereus
If 70% isopropyl alcohol is a disinfectant that kills bacteria, how were the alcohol prep pads contaminated
How can infections such as these be avoided in the future
Source: www.sciencedaily.com/releases/2012/06/120612144759.htm.