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Cluster of tuberculosis cases in North Carolina: possible association with atomizer reuse
K L Southwick1, K Hoffmann, K Ferree
1North Carolina Department of Health and Human Services, General Communicable Disease Control Section, the Epidemiology Program Office, Raleigh, USA.
Background:
Three patients with identical strains of M tuberculosis (TB) underwent bronchoscopy on the same day at hospital A.
Methods:
We reviewed each patient's clinical history, hospital A's infection control practices for bronchoscopies, and specimen and isolate handling at each of 3 laboratories involved. We searched for possible community links between patients. Restriction fragment length polymorphism was performed on TB isolates.
Results:
The first patient who underwent bronchoscopy had biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the third patient 6 weeks after the bronchoscopy produced an isolate with an identical restriction fragment length polymorphism pattern to isolates collected during the bronchoscopies. No evidence existed for community transmission or laboratory contamination; the only common link was the bronchoscopy. Different bronchoscopes were used for each patient. Hospital ventilation and wall-suctioning were functioning well. Respiratory technicians reported sometimes reusing the nozzles of atomizers on more than one patient. A possible mechanism for transmission was contamination from the first patient of the atomizer if it was used to apply lidocaine to the pharynx and nasal passages of other patients.
Conclusions:
A contaminated atomizer may have caused TB transmission during bronchoscopy. Hospital A changed to single-use atomizers after this investigation.