An ounce of prevention is worth a pound of cure

By Dr Geethika​​ Patabendige

Hospital outbreaks​​ of​​ Burkholderia​​ cepacia​​ complex (BCC)​​ have​​ been​​ described globally due to contaminated solutions and medical devices​​ in different parts of the world while there have been no reported outbreaks of in Sri Lanka in the past.​​ 

However, during July and August 2017, an outbreak of BCC was noted in three major hospitals in Sri Lanka. At NHSL, the number of BCC remained static up to mid August.​​ In​​ mid​​ ​​ August, there was a sudden augmentation in number of blood culture isolates of BCC from ICUs to 10 within 6 days with same antibiotic susceptibility pattern.This was a definite outbreak with number of positives increased​​ up to​​ 27 within one month. Finding out the common source was essential to control​​ the ongoing​​ outbreak and​​ also to prevent​​ such outbreaks in​​ the​​ future.​​ 

Firstly​​ we tested​​ medical devices such as IV cannulae, syringes and burettes and common possible solutions namely normal saline, 5% dextrose and antiseptics for bacterial contamination. They were sterile. So we decided to look for other possible sources. Salbutamol​​ and​​ ipratropium bromide nebulizer solutions were tested under strict aseptic methods. We could isolate​​ Burkholderia​​ cepacia​​ complex (BCC) from​​ a​​ particular brand of ipratropium bromide which was available in the hospital.​​ Organism identificationand AST were done by using​​ BD PhoenixTM..​​ National Hospital of Sri Lanka had started​​ using​​ that​​ particular​​ brand just two​​ week prior to the onset of the outbreak.​​ 

After defining the source of outbreak, prompt​​ actions were taken to control further spread. Relevant authorities such as the National Medicines Regulatory Authority (NMRA),​​ Medical Supplies Division ( MSD) and the Deputy Director General of​​ NHSL were informed​​ with the recommendation for an alternative ipratropium nebulizer solution. The samples of the unopened nebulizer solution of particular brand were sent to NMQAL too. The consultant microbiologists of other hospitals were also alerted. Nebulizer solutions tested in other hospitals​​ too​​ were positive for the same organism. There was a clear decline in number of cases in all hospitals after withdrawing the particular brand.​​ 

Sensible​​ detection, timely investigation and prompt​​ actions are very useful in controlling​​ outbreaks in​​ health sector.​​ 

Microbiology team/NHSL