Outbreak of Septic Arthritis Associated with Intra-Articular Injections at an Outpatient Practice - New Jersey, 2017
Related Experiment Video
Updated: Feb 25, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Insights
Outbreaks of septic arthritis linked to knee injections highlight critical infection control failures. Implementing proper infection prevention practices is essential to prevent serious joint infections and surgical interventions.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare-Associated Infections
Background:
- A cluster of septic arthritis cases emerged following intra-articular injections for osteoarthritis.
- The New Jersey Department of Health (NJDOH) investigated a private outpatient practice due to patient infections.
Purpose of the Study:
- To investigate the outbreak of septic arthritis associated with intra-articular injections.
- To identify the root causes and contributing factors to the infections.
- To assess the effectiveness of implemented infection prevention recommendations.
Main Methods:
- Case finding and epidemiological investigation by NJDOH and local health departments.
- Infection prevention assessment of the outpatient practice's procedures.
- Bacterial culturing of synovial fluid and tissue samples from affected patients.
Main Results:
- 41 cases of septic arthritis were identified among 250 patient visits.
- 30 (73%) patients required surgical intervention.
- Bacterial cultures revealed oral flora in 37% of positive samples.
- Breaches in infection control included poor hand hygiene and improper handling of pharmacy bulk packaged (PBP) products.
Conclusions:
- Suboptimal infection prevention practices during intra-articular injections led to a significant outbreak of septic arthritis.
- Adherence to recommended infection control measures, including proper handling of medications and sterile techniques, is crucial.
- Implementing targeted infection prevention strategies effectively halted the spread of new cases.
Abstract:
On March 6, 2017, the New Jersey Department of Health (NJDOH) was notified of three cases of septic arthritis in patients who had received intra-articular injections for osteoarthritic knee pain at a private outpatient practice. The practice voluntarily closed the next day. NJDOH, in conjunction with the local health department and the New Jersey Board of Medical Examiners, conducted an investigation and identified 41 cases of septic arthritis associated with intra-articular injections administered during 250 patient visits at the same practice, including 30 (73%) patients who required surgery. Bacterial cultures of synovial fluid or tissue from 15 (37%) patients were positive; all recovered organisms were oral flora. An infection prevention assessment of the practice identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, inappropriate use of pharmacy bulk packaged (PBP) products as multiple-dose containers and handling PBP products outside of required pharmacy conditions, and preparation of syringes up to 4 days in advance of their intended use. No additional septic arthritis cases were identified after infection prevention recommendations were implemented within the practice.
More Related Videos
Related Concept Videos
01:25Endocarditis I: Introduction
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:25Endocarditis II: Clinical Features of Infective Endocarditis
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:18Endocarditis III: Medical Management