title: Cluster of tuberculosis cases in North Carolina: possible association with atomizer reuse.
abstract: BACKGROUND
  Three patients with identical strains of M tuberculosis (TB) underwent bronchoscopy on the same day at hospital A.
  
  
  METHODS
  We reviewed each patient's clinical history, hospital A's infection control practices for bronchoscopies, and specimen and isolate handling at each of 3 laboratories involved. We searched for possible community links between patients. Restriction fragment length polymorphism was performed on TB isolates.
  
  
  RESULTS
  The first patient who underwent bronchoscopy had biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the third patient 6 weeks after the bronchoscopy produced an isolate with an identical restriction fragment length polymorphism pattern to isolates collected during the bronchoscopies. No evidence existed for community transmission or laboratory contamination; the only common link was the bronchoscopy. Different bronchoscopes were used for each patient. Hospital ventilation and wall-suctioning were functioning well. Respiratory technicians reported sometimes reusing the nozzles of atomizers on more than one patient. A possible mechanism for transmission was contamination from the first patient of the atomizer if it was used to apply lidocaine to the pharynx and nasal passages of other patients.
  
  
  CONCLUSIONS
  A contaminated atomizer may have caused TB transmission during bronchoscopy. Hospital A changed to single-use atomizers after this investigation.
authors.affiliation: North Carolina Department of Health and Human Services, General Communicable Disease Control Section, the Epidemiology Program Office, Raleigh, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Southwick
authors.forename: K
authors.initials: K
authors.lastname: Hoffmann
authors.forename: K
authors.initials: K
authors.lastname: Ferree
authors.forename: J
authors.initials: J
authors.lastname: Matthews
authors.forename: M
authors.initials: M
authors.lastname: Salfinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020680:Bronchoscopes / Q000382:microbiology; D001999:Bronchoscopy; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics* / Q000302:isolation & purification; D009330:Nebulizers and Vaporizers / Q000382:microbiology*; D009657:North Carolina / Q000453:epidemiology; D012150:Polymorphism, Restriction Fragment Length; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*