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Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain—New Jersey, 2017

Published online by Cambridge University Press:  17 July 2019

Kathleen M. Ross Open the ORCID record for Kathleen M. Ross [Opens in a new window] ,
Jason S. Mehr ,
Barbara L. Carothers ,
Rebecca D. Greeley ,
Isaac Benowitz ,
David Henry ,
Lisa A. McHugh ,
Lisa DiFedele ,
Eric Adler  and
Shereen Naqvi
...Show all authors
Kathleen M. Ross*
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Jason S. Mehr
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Barbara L. Carothers
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Rebecca D. Greeley
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Isaac Benowitz
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Henry
Affiliation:
Monmouth County Regional Health Commission No. 1., Oceal Township, New Jersey
Lisa A. McHugh
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Lisa DiFedele
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Eric Adler
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Shereen Naqvi
Affiliation:
Monmouth County Regional Health Commission No. 1., Oceal Township, New Jersey
Laura Taylor
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Edward Lifshitz
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Christina Tan
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Barbara E. Montana
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
*
Author for correspondence: Kathleen M. Ross, E-mail: [email protected]
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Abstract

Background:

In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.

Methods:

An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.

Results:

We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.

Discussion:

Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.

Conclusions:

This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 1013 - 1018
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESETNATION: In July 2017, the authors published a CDC Morbidity and Mortality Weekly Report (MMWR) while the investigation was ongoing. The MMWR can be accessed at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6629a3.htm. Additionally, a coauthor gave an oral presentation of part of this study at the Association for Professionals in Infection Control and Epidemiology Annual Conference on June 13, 2018 in Minneapolis, Minnesota.

References

Klein, RS. Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection. Clin Geriatr Med 1988;4:375–394.CrossRefGoogle ScholarPubMed
Zeller, JL, Lynm, C, Glass, RM. Septic arthritis. JAMA 2007;297:1510–1510.CrossRefGoogle ScholarPubMed
Gray, RG, Gottlieb, NL. Intra-articular corticosteroids: an updated assessment. Clin Ortho Rel Res 1983;177:235–263.Google Scholar
Kaandorp, CJ, Van Schaardenburg, D, Krijnen, P, Habbema, JD, van de Laar, MA. Risk factors for septic arthritis in patients with joint disease: a prospective study. Arthritis Rheumatism 1995;38:1819–1825.Google ScholarPubMed
Brusch, JL. Septic arthritis. Medscape website. https://emedicine.medscape.com/article/236299-overview. Published 2018. Accessed June 3, 2019.Google Scholar
Goldenberg, DL, Cohen, AS. Acute infectious arthritis: a review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 1976;60:369–377.CrossRefGoogle Scholar
Archer, WR, Arduino, M, Arnold, K, et al. Methicillin-Susceptible Staphylococcus aureus Infections After Intra-articular Injections. Arlington, VA: Infectious Diseases Society of America; 2009.Google Scholar
Goodman, RA, Solomon, SL. Transmission of infectious diseases in outpatient healthcare settings. JAMA 1991;265:2377–2381.CrossRefGoogle Scholar
Thompson, ND, Perz, JF, Moorman, AC, Holmberg, SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998–2008. Ann Intern Med 2009;150:33–39.CrossRefGoogle Scholar
Centers for Disease Control and Prevention. Outbreaks and Patient Notifications in Outpatient Settings, Selected Examples, 2010–2014. Atlanta, GA: Centers for Disease Control and Prevention; 2015.Google Scholar
Ross, K, Mehr, J, Carothers, B, et al. Outbreak of septic arthritis associated with intra-articular injections at an outpatient practice—New Jersey, 2017. Morbid Mortal Wkly Rept 2017;66:777–779.Google ScholarPubMed
Aas, JA, Paster, BJ, Stokes, LN, Olsen, I, Dewhirst, FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol 2005;43:5721–5732.CrossRefGoogle ScholarPubMed
Bosch, AATM, Biesbroek, G, Trzcinski, K, Sanders, EAM, Bogaert, D. Viral and bacterial interactions in the upper respiratory tract. PLOS Pathogen 2013;9(1). doi: 10.1371/journal.ppat.1003057.CrossRefGoogle Scholar
Siegel, J, Rhinehart, E, Jackson, M, Chiarello, L, Commitee HICPA. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/niosh/docket/archive/pdfs/NIOSH-219/0219-010107-siegel.pdf. Published 2007. Accessed June 3, 2019.Google Scholar
Dolan, SA, Arias, KM, Felizardo, G, et al. APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control 2016;44:750–757.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Guide to Infection Prevention for Outpatient Settings: Minimum Expectation for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention; 2016.Google Scholar
Grissinger, M. Inappropriate use of pharmacy bulk packages of IV contrast media increases the risk of infections. P&T 2015;40:306–307.Google ScholarPubMed
USP Compounding Compendium. General Chapter 797: Pharmaceutical Compounding. United States Pharmacopeia website. https://www.usp.org/compounding/general-chapter-797. Published 2015. Accessed June 3, 2019.Google Scholar
Iwamoto, P, Post, M. Aseptic technique. In APIC Text of Infection Control and Epidemiology, 4th ed. Arlington, CA: APIC; 2014.Google Scholar
Centers for Disease Control and Prevention. Frequently Asked Questions (FAQs) Regarding Safe Practices for Medical Injections. Atlanta, GA: CDC; 2010.Google Scholar
Centers for Disease Control and Prevention. Single-Dose/Single-Use Vial Position and Messages. CDC’s Position: Protect Patients Against Preventable Harm From Improper Use of Single-Dose/Single-Use Vials. Atlanta, GA: CDC; 2012.Google Scholar
Centers for Disease Control and Prevention. Protect Patients Against Preventable Harm from Improper Use of Single-dose/Single-use Vials. Atlanta, GA: CDC; 2012.Google Scholar
de Fijter, S, DiOrio, M, Carmean, J, et al. Bacterial meningitis after intrapartum spinal anesthesia—New York and Ohio, 2008–2009. Morbid Mortal Wkly Rept 2010;59:65–69.Google Scholar