Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit

Background: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. Methods: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. Results: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. Conclusion: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections

Control de calidad en los cuidados de enfermería en el post-cateterismo cardiaco

• Introduction: Quality control after cardiac catheterization is part of the continuity of nursing care, enabling the identification of complications. • Material and Methods: Prospective study of all catheterized patients hospitalized during at least 24 hours; classified according to type of procedure, vascular access and haemostatic method. Definitions: early complications, 3h. Major complications: haematoma >6cm, bleeding requiring blood transfusion and pseudo aneurysm. Minor complications: haematoma <6cm, bleeding without the need for transfusion, unsealed puncture site. Register of compliance with recommendations on artery compress withdrawal and patient mobilization times. • Results: Total 829 patients. 457 (55.1%) after coronary angiography and 372 (44.6%) after percutaneous coronary intervention. Vascular access: radial artery in 427 (51.5%), femoral artery in 395 (47.6) and humeral artery in 7 (0.8%). Haemostatic method: percutaneous closure device in 226 (26.6%), haemostatic wristlet in 351 (42.3%) and compress in 251 (30%). Early complications: 45 patients (5.5%). bleeding (3.5%) and haematoma <6cm (1.9%). Radial access was associated with fewer early complications (2.6 vs 8.9%; p<0.05). Late complications, all minor: 135 patients (16.3%), bleeding in 109 (13.2%), haematoma in 19 (2.3%), and pseudo aneurysm in 7 (0.8%). There was a delay in haemostatic method withdrawal and patient mobilization times as compared with the recommendation of <12 h (p<0.05). • Conclusions: Quality control allows registration of complications, according to access route and the haemostatic method used, as well as compliance with the recommendations. This should lead to improvements in patient care.• Introducción: Un control de calidad post-cateterismo responde a la continuidad en los cuidados de enfermería, permitiendo identificar las complicaciones. • Material y métodos: Estudio prospectivo con inclusión de todos los enfermos sometidos a cateterismo ingresados, al menos, 24 horas. Clasificación según tipo de procedimiento, acceso vascular y método de hemostasia. Definición de las complicaciones como inmediatas, 3 horas tras la finalización. Complicaciones mayores: hematoma >6 cm, sangrado con necesidad de transfusión y pseudoaneurisma. Menores: hematoma <6 cm y rezumo del punto de punción. Registro del cumplimiento con las recomendaciones sobre tiempos de retirada del compresivo y movilización. • Resultados: 829 enfermos, 457 (55,1%) con cateterismo diagnóstico y 372 (44,6%) con terapéutico. Acceso vascular: radial en 427 (51,5%), femoral en 395 (47,6%) y humeral en 7 (0,8%). A 220 enfermos (26,6%) se les colocó dispositivo de cierre, a 351 (42,3%) pulsera neumática y a 251 (30%) compresivo. Complicaciones inmediatas: 45 enfermos (5,5%), sangrado en el 3,5% y hematoma en el 1,9%. La punción radial se relacionó con menos complicaciones inmediatas (2,6% vs 8,9%, p<0,05). Complicaciones tardías: 135 enfermos (16,3%), sangrado en 109 (13,2%), hematoma en 19 (2,3%), pseudoaneurisma en 7 (0,8%). Todas menores. Se observó retraso en la retirada del compresivo o pulsera y la movilización cuando la recomendación fue <12h (p<0,05). • Conclusión: El control de calidad permite registrar las complicaciones, según vía de acceso y método de hemostasia utilizado, y el cumplimiento de las recomendaciones. Debería conllevar modificaciones que comporten una mejora en la atención al enfermo

Moisturizing body milk as a reservoir of Burkholderia cepacia : outbreak of nosocomial infection in a multidisciplinary intensive care unit

Background: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. Methods: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. Results: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. Conclusion: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections