Sustained endemicity of Burkholderia cepacia complex in a pediatric institution, associated with contaminated ultrasound gel.
OBJECTIVE
To determine whether contaminated ultrasound gel is the source of intermittent outbreaks of nosocomial infection due to Burkholderia cepacia complex in patients without cystic fibrosis since 1992.


METHODS
A prospective clinical and in vitro study of all in-use bottles of ultrasound gel, as well as a retrospective analysis of archived bacterial strains, were performed. Handling of gel for clinical purposes throughout the hospital was evaluated. Gel and archived clinical isolates of B. cepacia complex were speciated to genomovar level and characterized by pulsed-field gel electrophoresis, and the pulsed-field gel electrophoresis patterns were compared.


METHODS
The Hospital for Sick Children, a 300-bed, tertiary care, pediatric academic health sciences center in Toronto, Canada.


METHODS
All patients without cystic fibrosis from whom B. cepacia complex was recovered at the Hospital for Sick Children since 1992.


RESULTS
No standardized protocol for storage or handling of ultrasound gel was found. Gel from 39% of bottles grew either B. cepacia (genomovar I) or Burkholderia stabilis (genomovar IV). These isolates had pulsed-field gel electrophoresis patterns identical to 2 of the 7 clinical pulsed-field gel electrophoresis types that are responsible for 88% of clinical isolates.


CONCLUSIONS
Contaminated ultrasound gel contributed to nosocomial infection due to B. cepacia complex in this institution over the course of 10 years. Suggested guidelines for the handling of ultrasound gel are provided.
Jacobson
Michelle
M
Hospital for Sick Children, Toronto, Ontario, Canada.
Wray
Rick
R
Kovach
Danuta
D
Henry
Deborah
D
Speert
David
D
Matlow
Anne
A
D000046:Academic Medical Centers; D019121:Burkholderia Infections / Q000453:epidemiology* / Q000382:microbiology; D016956:Burkholderia cepacia / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004340:Drug Contamination; D004349:Drug Packaging / Q000592:standards; D016521:Electrophoresis, Gel, Pulsed-Field; D019353:Endemic Diseases; D005782:Gels / Q000009:adverse effects*; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D014463:Ultrasonography / Q000009:adverse effects*
D005782:Gels