Illinois Department of Public Health, Springfield, Illinois, USA.
Infect Control Hosp Epidemiol. 2012 Feb;33(2):180-4. doi: 10.1086/663710.
To define the extent of an outbreak of Achromobacter xylosoxidans bacteremia, determine the source of the outbreak, and implement control measures.
An outbreak investigation, including environmental and infection control assessment, and evaluation of hypotheses using the binomial distribution and case control studies.
A 50-bed medical surgical unit in a hospital in Illinois during the period January 1-July 15, 2006.
Discontinuation of use of opioid delivery via patient-controlled analgesia (PCA) until the source of the outbreak was identified and implementation of new protocols to ensure more rigorous observation of PCA pump cartridge manipulations.
Calculations based on the binomial distribution indicated the probability that all 9 patients with A. xylosoxidans bacteremia were PCA pump users by chance alone was <.001. A subsequent case control study identified PCA pump use for administration of morphine as a risk factor for A. xylosoxidans bacteremia (odds ratio, undefined; P < .001). Having a PCA pump cartridge with morphine started by nurse C was significantly associated with becoming a case-patient (odds ratio, 46; 95% confidence interval, 4.0-525.0; P < .001).
We hypothesize that actions related to diversion of morphine by nurse C were the likely cause of the outbreak. An aggressive pain control program involving the use of opioid medication warrants an equally aggressive policy to prevent diversion of medication by staff.
确定木糖氧化无色杆菌菌血症爆发的范围，确定爆发源，并实施控制措施。
爆发调查，包括环境和感染控制评估，以及使用二项分布和病例对照研究评估假设。
2006 年 1 月 1 日至 7 月 15 日期间，伊利诺伊州一家 50 床的医疗外科病房。
停止使用患者自控镇痛（PCA）输送阿片类药物，直到确定爆发源，并实施新的方案，以确保更严格地观察 PCA 泵药筒操作。
基于二项分布的计算表明，所有 9 例木糖氧化无色杆菌菌血症患者碰巧都是 PCA 泵使用者的概率<0.001。随后的病例对照研究确定，PCA 泵用于输注吗啡是导致木糖氧化无色杆菌菌血症的一个危险因素（比值比，未定义；P<0.001）。使用由护士 C 启动的 PCA 泵药筒与成为病例患者显著相关（比值比，46；95%置信区间，4.0-525.0；P<0.001）。
我们假设，与护士 C 转移吗啡有关的行动是此次爆发的可能原因。一项涉及使用阿片类药物的积极疼痛控制计划需要同样积极的政策来防止工作人员转移药物。
