Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.
Intensive Care, Theatres, Anaesthetics, Pain & Sleep, University Hospitals of Leicester NHS Trust, Leicester, UK.
J Hosp Infect. 2023 Oct;140:110-116. doi: 10.1016/j.jhin.2023.08.003. Epub 2023 Aug 9.
Outbreaks of infection related to flexible endoscopes are well described. However, flexible endoscopy also requires the use of ancillary equipment such as irrigation plugs. These are potential vectors of infection but are infrequently highlighted in the literature. This paper reports a cystoscopy-associated outbreak of Pseudomonas aeruginosa from contaminated irrigation plugs in a UK tertiary care centre.
Laboratory, clinical and decontamination unit records were reviewed, and audits of the decontamination unit were performed. Flexible cystoscopes and irrigation plugs were assessed for contamination. Retrospective and prospective case finding was performed utilizing the microbiology laboratory information management system. Available P. aeruginosa isolates underwent variable nucleotide tandem repeat (VNTR) typing. Confirmed cases were defined as P. aeruginosa infection with an identical VNTR profile to an outbreak strain.
Three strains of P. aeruginosa were isolated from five irrigation plugs but none of the flexible cystoscopes. No acquired resistance mechanisms were detected. Fifteen confirmed infections occurred, including bacteraemia, septic arthritis and urinary tract infection. While failure of decontamination likely occurred because the plugs were not dismantled prior to reprocessing, the manufacturer's reprocessing instructions were also incompatible with standard UK practice. The Medicines and Healthcare Products Regulatory Agency was informed. A field safety notice was issued, and the manufacturer issued updated reprocessing instructions.
Ancillary equipment can represent an important vector for infection, and should be considered during outbreak investigations. Users should review the manufacturer's instructions for reprocessing ancillary equipment to ensure that they are compatible with available procedures.
已充分描述与软性内镜相关的感染暴发事件。然而，软性内镜还需要使用冲洗塞等辅助设备。这些是潜在的感染媒介，但在文献中很少被强调。本文报告了英国一家三级保健中心因污染的冲洗塞导致铜绿假单胞菌的膀胱镜相关暴发事件。
回顾了实验室、临床和去污单元记录，并对去污单元进行了审核。对软性膀胱镜和冲洗塞进行了污染评估。利用微生物实验室信息管理系统进行回顾性和前瞻性病例发现。对可用的铜绿假单胞菌分离株进行可变数串联重复（VNTR）分型。确诊病例定义为与暴发株具有相同 VNTR 图谱的铜绿假单胞菌感染。
从五个冲洗塞中分离出三株铜绿假单胞菌，但没有从软性膀胱镜中分离出。未检测到获得性耐药机制。发生了 15 例确诊感染，包括菌血症、化脓性关节炎和尿路感染。尽管去污失败可能是因为在重新处理之前未拆卸冲洗塞造成的，但制造商的重新处理说明也与英国的标准做法不兼容。已通知药品和保健品管理局。发布了现场安全通知，并由制造商发布了更新的重新处理说明。
辅助设备可能是感染的一个重要媒介，应在暴发调查中加以考虑。用户应审查制造商的重新处理辅助设备说明，以确保其与现有程序兼容。
