Background: Seven
patients at a hospital in Houston,TX, were diagnosed during a two-week period in 2009 with joint space
infection of pansusceptible P. aeruginosa following arthroscopic procedures of the knee or shoulder. Tosh et al. (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 instrumentsused during these arthroscopic
procedures. These reusable instruments reportedly remained contaminated with
remnant tissue,despite
diligent efforts by the hospital to clean their internal structures.This retained bioburden presumably
shielded the outbreak’s strain of embedded P.
aeruginosa from contact with the pressurized steam, reportedly resulting in
ineffective sterilization of these arthroscopic instruments and bacterial
transmission.Objectives: 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 et al.’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. Methods: The medical literature was reviewed; some of the principles of quality
assurance, engineering and a root-cause analysis were employed; and Tosh et al.’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, heat-stable, soiled surgical instruments. Results and Conclusion: Reports
documenting outbreaks of P. aeruginosa or
another vegetative bacterium associated with the steam sterilization
of inadequatelycleaned
surgical or arthroscopic instruments are scant. This
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