title: Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012.
abstract: OBJECTIVE
  To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility.
  
  
  METHODS
  Epidemiologic investigation of the outbreak with a case-control study.
  
  
  METHODS
  A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.
  
  
  RESULTS
  Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.
  
  
  CONCLUSIONS
  Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.
authors: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Isaac
authors: I
authors: See
authors: Duc B
authors: DB
authors: Nguyen
authors: Somu
authors: S
authors: Chatterjee
authors: Thein
authors: T
authors: Shwe
authors: Melissa
authors: M
authors: Scott
authors: Sherif
authors: S
authors: Ibrahim
authors: Heather
authors: H
authors: Moulton-Meissner
authors: Steven
authors: S
authors: McNulty
authors: Judith
authors: J
authors: Noble-Wang
authors: Cindy
authors: C
authors: Price
authors: Kim
authors: K
authors: Schramm
authors: Danae
authors: D
authors: Bixler
authors: Alice Y
authors: AY
authors: Guh
mesh_terms: D000192:Actinomycetales; D000193:Actinomycetales Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D012307:Risk Factors; D014903:West Virginia / Q000453:epidemiology