title: Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic.
abstract: BACKGROUND
  Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic.
  
  
  METHODS
  We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis.
  
  
  RESULTS
  Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis.
  
  
  CONCLUSIONS
  Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. Rachel.Radcliffe@wv.gov
authors.forename: Rachel
authors.initials: R
authors.lastname: Radcliffe
authors.forename: Elissa
authors.initials: E
authors.lastname: Meites
authors.forename: Janet
authors.initials: J
authors.lastname: Briscoe
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.forename: Gregory
authors.initials: G
authors.lastname: Fosheim
authors.forename: Sigrid K
authors.initials: SK
authors.lastname: McAllister
authors.forename: Bette
authors.initials: B
authors.lastname: Jensen
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: Maria
authors.initials: M
authors.lastname: del Rosario
authors.forename: Jeff
authors.initials: J
authors.lastname: Hageman
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D004196:Disease Outbreaks; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000592:standards*; D007268:Injections, Epidural; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D010146:Pain / Q000188:drug therapy; D018710:Pain Clinics; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D013594:Syringes / Q000382:microbiology*
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents