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Pandora’s box in the dental clinic

Published online by Cambridge University Press:  20 May 2021

Debby Ben-David Open the ORCID record for Debby Ben-David [Opens in a new window] ,
Azza Vaturi ,
Ester Solter ,
Bina Rubinovitch ,
Jonathan Lellouche ,
David Schwartz ,
Vered Schechner ,
Yehuda Carmeli  and
Mitchell J. Schwaber
Debby Ben-David*
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Azza Vaturi
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Ester Solter
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Bina Rubinovitch
Affiliation:
Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
Jonathan Lellouche
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
David Schwartz
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
Vered Schechner
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Yehuda Carmeli
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Mitchell J. Schwaber
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
*
Author for correspondence: Debby Ben-David, E-mail: debbybd@tlvmc.gov.il
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Abstract

Background:

In June 2018, the Ministry of Health received notification from 2 hospitals about 2 patients who presented with overwhelming Enterobacter kobei sepsis that developed within 24 hours after a dental procedure. We describe the investigation of this outbreak.

Methods:

The epidemiologic investigation included site visits in 2 dental clinics and interviews with all involved healthcare workers. Chart reviews were conducted for case and control subjects. Samples were taken from medications and antiseptics, environmental surfaces, dental water systems, and from the involved healthcare professionals. Isolate similarity was assessed using repetitive element sequence-based polymerase chain reaction (REP-PCR).

Results:

The 2 procedures were conducted in different dental clinics by different surgeons and dental technicians. A single anesthesiologist administered the systemic anesthetic in both cases. Cultures from medications, fluids and healthcare workers’ hands were negative, but E. kobei was detected from the anesthesiologist’s portable medication cart. The 2 human isolates and the environmental isolate shared the same REP-PCR fingerprinting profile. None of the 21 patients treated by the anesthesiologist in a general hospital during the same period, using the hospital’s medications, developed infection following surgery.

Conclusions:

An outbreak of post–dental-procedure sepsis was linked to a contaminated medication cart, emphasizing the importance of medication storage standards and strict aseptic technique when preparing intravenous drugs during anesthesia. Immediate reporting of sepsis following these outpatient procedures enabled early identification and termination of the outbreak.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 6 , June 2022 , pp. 742 - 746
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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