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Pseudomonas aeruginosa contamination of mouth swabs during production causing a major outbreak

Bjørn G Iversen1, Hanne-Merete Eriksen, Gjermund Bø

  • 1Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. bjiv@fhi.no

Annals of Clinical Microbiology and Antimicrobials
|March 16, 2007
PubMed
Abstract

Insights

Contaminated mouth swabs caused a Pseudomonas aeruginosa outbreak in Norway. Biofilm formation in production led to widespread contamination, highlighting the need for strict adherence to regulations to prevent patient harm.

Area of Science:

  • Microbiology
  • Infectious Disease Epidemiology
  • Public Health

Background:

  • An outbreak in 2002 involving 231 patients in Norway was linked to Pseudomonas aeruginosa in contaminated mouth swabs (Dent-O-Sept).
  • This study investigates the extent of swab contamination and identifies critical production failures contributing to the outbreak.

Purpose of the Study:

  • To determine the level of microbial contamination in Dent-O-Sept mouth swabs.
  • To identify critical control points in the manufacturing process that allowed for contamination.
  • To provide recommendations for preventing future outbreaks.

Main Methods:

  • Environmental investigation including microbiological examination of production, ingredients, and the final product.
  • Molecular typing of bacterial isolates to confirm strain identity.
  • A system audit of the production process and review of healthcare institution practices.

Main Results:

  • Pseudomonas aeruginosa (P. aeruginosa) outbreak strain found in 76 of 1565 swabs from 12 batches produced in 2001-2002.
  • Over 250 swabs showed contamination with various microbial species.
  • Production audit revealed significant breaches of regulations; healthcare facilities reported improper swab usage and purchasing weaknesses.

Conclusions:

  • Biofilm formation in the wet sections of the production line is the likely cause of continuous P. aeruginosa contamination for at least 30 weeks.
  • Failure to adhere to production regulations can lead to severe patient consequences.
  • High-level disinfected, quality-controlled products are essential for vulnerable patients receiving oropharyngeal care.

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