%0 Journal Article
%T Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i> Following Arthroscopy in Texas
%A Lawrence F. Muscarella
%J Advances in Infectious Diseases
%P 134-145
%@ 2164-2656
%D 2013
%I Scientific Research Publishing
%R 10.4236/aid.2013.32021
%X <p style=\"text-align:justify;\">
	<b><span>B</span></b><b><span>ackground: </span></b><span>Seven
patients at a hospital in Houston,</span><span> </span><span>TX, were diagnosed during a two-week period in 2009 with joint space
infection of pansusceptible <i>P. aeruginosa </i>following arthroscopic procedures of the knee or shoulder. Tosh <i>et al.</i> (2011), who investigated and
published the principal report discussing this bacterial outbreak, conclude
that its most likely cause was the improper reprocessing of certain reusable,
physically-complex, heat-stable arthroscopic instruments</span><span> </span><span>used during these arthroscopic
procedures. These reusable instruments reportedly remained contaminated with
remnant tissue,</span><span> </span><span>despite
diligent efforts by the hospital to clean their internal structures.</span><span> </span><span>This retained bioburden presumably
shielded the outbreak¡¯s strain of embedded <i>P.
aeruginosa</i> from contact with the pressurized steam, reportedly resulting in
ineffective sterilization of these arthroscopic instruments and bacterial
transmission.</span><span> </span><b><span>Objectives: </span></b><span>First, to clarify which specific
sterilization methods, in addition to steam sterilization, Methodist Hospital
employed to process its reusable arthroscopic instrumentation at the time of
its outbreak, in 2009; second, to evaluate Tosh <i>et al.</i>¡¯s (2011) conclusion that ineffective steam sterilization due
to inadequate cleaning was the most likely cause of this hospital¡¯s outbreak;
third, to consider whether any other hitherto unrecognized factors could have
plausibly contributed to this outbreak; and, fourth, to assess whether any
additional recommendations might be warranted to prevent disease transmission
following arthroscopic procedures. <b>Methods:</b> The medical literature was reviewed; some of the principles of quality
assurance, engineering and a root-cause analysis were employed; and Tosh <i>et al.</i>¡¯s (2011) findings and conclusions
were reviewed and compared with those of other published reports that evaluated
the risk of disease transmission associated with the steam sterilization of
physically-complex,<span> heat-stable</span></span><span>,</span><span> soiled surgical i</span><span>nstruments. <b>Results and Conclusion:</b> Reports
documenting outbreaks of <i>P. aeruginosa </i>or
another vegetative bacterium associated with the steam </span><span>sterilization
of inadequately</span><span> </span><span>cleaned
surgical or arthroscopic instruments are scant. This
%K &lt
%K i&gt
%K Pseudomonas aeruginosa&lt
%K /i&gt
%K Arthroscopy
%K Disease Transmission
%K Healthcare-Associated Infection
%K Root Cause Analysis
%K Instrument Reprocessing
%K Bacterial Outbreak
%K Sterilization
%K Sterile Technique
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=32863