AGH Investigates Higher Incidence of Bacterial Infection Among Small Group of Critical Care Patients

PITTSBURGH -- Allegheny General Hospital (AGH) officials have confirmed an investigation aimed at determining the source of an increased incidence of Pseudomonas aeruginosa among a small group of patients being treated in its critical care areas.

Pseudomonas is a common bacterium that is often found in humans but typically does not cause illness unless a person is already sick or has a weakened immune system. At major academic medical centers such as AGH, which treat the highest volumes of critically ill patients, pseudomonas infections are not unusual in the critical care setting.

Based on its assessment to date, AGH believes the source of the recent pseudomonas transmission increase is tied to the use of bronchoscopes and the possibility of either defective equipment or failure of the bronchoscope sterilization technique.

"Patient safety and well-being is the absolute highest priority of this hospital, and we are taking every step possible to determine the precise cause of this increase in pseudomonas infection and make certain that it does not occur again. To that end, all existing bronchoscopes at the hospital have been taken out of service, new bronchoscopes have been purchased and an alternative sterilization process has been implemented," said Richard Shannon, MD, chairman of AGH's Department of Medicine. "Going forward, there is no risk for patients undergoing these procedures."

According to Shannon, AGH has identified 12 patients from whom Pseudomonas aeruginosa was cultured. Determining cause and effect, however, is complex in such critically ill patients, among whom some deaths are to be expected due to the severity of their illness. Although AGH's review has revealed infections that may be related to the contaminated bronchoscopes, further investigation is needed to ascertain the precise nature of the relationship.

AGH physicians also caution that even though patients may have been exposed to the bacteria through a bronchoscope, the overwhelming majority of them will not become infected. Furthermore, given the nature of their illnesses, some of the patients carried the pseudomonas bacteria before they underwent bronchoscopy.

Bronchoscopy is a procedure that allows direct visual examination of the upper airway and lungs. During the procedure, physicians insert a bronchoscope, a small, flexible tube about the width of a pencil, through the patient's nose or mouth and into the trachea.

AGH's divisions of infection control, infectious disease and pulmonology first began noticing unexpectedly high rates of Pseudomonas aeruginosa in the critical care setting the second week of October and immediately launched a comprehensive environmental and procedural assessment to determine the source of the bacterial exposure.

AGH's investigation is being conducted in conjunction with the Allegheny County Health Department and the hospital is also consulting with epidemiologists from both Johns Hopkins University, which recently experienced a similar pseudomonas outbreak related to contaminated bronchoscopes, and the Centers for Disease Control and Prevention (CDC) in Atlanta.

In order to address individuals who may have potentially been exposed to the pseudomonas bacteria receives proper notification and access to appropriate healthcare resources, if needed, AGH is contacting all former patients, or the families of such patients, who underwent a bronchoscopy procedure at the hospital between June 1, 2002 and October 1, 2002.

A hotline will be established to help educate such patients about their risk of exposure to the bacteria and provide them with appointments for free diagnostic follow-up care at the hospital, if necessary.

"Although we believe that the risk of pseudomonas transmission and complication is minimal for the vast majority of those we are contacting, we are committed to taking every measure necessary to help allay fears and afford prompt evaluation for patients who either are displaying symptoms consistent with such infection or are simply concerned about the potential for that," Shannon said.

Source: Allegheny General Hospital and PRNewswire

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