Hostname: page-component-848d4c4894-xfwgj Total loading time: 0 Render date: 2024-06-30T09:57:29.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Mycobacterium tuberculosis Specimen Contamination Revisited: The Role of Laboratory Environmental Control in a Pseudo-outbreak

Published online by Cambridge University Press:  02 January 2015

Sorana Segal-Maurer ,
Barry N. Kreiswirth ,
Janice M. Burns ,
Sol Lavie ,
Mimi Lim ,
Carl Urban  and
James J. Rahal Jr
Sorana Segal-Maurer*
Affiliation:
Division of Infectious Diseases, the Department of Medicine, New York City, New York Department of New York Hospital Medical Center of Queens, Flushing, New York; and the Medicine, New York City, New York
Barry N. Kreiswirth
Affiliation:
Cornell University Medical College, Public Health Research Institute, Tuberculosis Center, New York City, New York
Janice M. Burns
Affiliation:
Department of Nursing, New York City, New York
Sol Lavie
Affiliation:
Department of Pathology, Microbiology Laboratory, New York City, New York
Mimi Lim
Affiliation:
Department of Nursing, New York City, New York
Carl Urban
Affiliation:
Division of Infectious Diseases, the Department of Medicine, New York City, New York Microbiology, New York City, New York
James J. Rahal Jr
Affiliation:
Division of Infectious Diseases, the Department of Medicine, New York City, New York Department of New York Hospital Medical Center of Queens, Flushing, New York; and the Medicine, New York City, New York
*
Division of Infectious Diseases, New York Hospital Medical Center of Queens, 56-45 Main St, Flushing, NY 11355
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate suspected pseudo-outbreaks of Mycobacterium tuberculosis (MTB) during August 1994 and July 1995 among patients who did not have clinical findings consistent with tuberculosis.

Design:

Retrospective and prospective surveys of all clinical and laboratory data using standard epidemiological tools and DNA fingerprinting.

Setting:

A university-affiliated community hospital.

Patients:

Those with positive MTB cultures during periods when we noted that the number of MTB positive cultures greatly outnumbered the usual monthly average (retrospective analysis, 1994) and patients with positive MTB cultures without clinical findings consistent with tuberculosis (prospective survey, 1995).

Results:

Epidemiological and molecular studies revealed specimen cross-contamination in the laboratory due to a faulty exhaust hood. Improvement in laboratory ventilation and change of the implicated hood prevented further specimen contamination.

Conclusions:

The identification of positive MTB cultures from patients without clinical evidence of tuberculosis should be a signal to suspect laboratory contamination and implement control measures. These should include a thorough epidemiological investigation, DNA fingerprint analysis, and an environmental inspection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 2 , February 1998 , pp. 101 - 105
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Tenover, FC, Crawford, JT, Huebner, RE, Geiter, LJ, Horsburgh, CR Jr, Good, RC. The resurgence of tuberculosis: is your laboratory ready? J Clin Microbiol 1993;31:767–770.Google Scholar
2. Tokars, JI, Rudnick, JR, Kroc, K, Manangan, L, Pugliese, G, Hudoner, RE, et al. US hospital mycobacteriology laboratories: status and comparison with state public health department laboratories. J Clin Microbiol 1996;34:680–685.Google Scholar
3. Jones, WD. Bacteriophage typing of Mycobacterium tuberculosis cultures from incidents of suspected laboratory cross-contamination. Tubercle 1988;69:43–46.Google Scholar
4. Vannier, AM, Tarrand, JJ, Murray, PR. Mycobacterial cross contamination during radiometric culturing. J Clin Microbiol 1988;26:1867–1868.Google Scholar
5. Small, PM, McClenny, NB, Singh, SP, Schoolnik, GK, Tompkins, LS, Mickelsen, PA. Molecular strain typing of Mycobacterium tuberculosis to confirm cross-contamination in the mycobacteri-ology laboratory and modification of procedures to minimize occurrence of false-positive cultures. J Clin Microbiol 1993;31:1677–1682.Google Scholar
6. Dunlap, NE, Harris, RH, Benjamin, WH Jr, Harden, JW, Hafner, D. Laboratory contamination of Mycobacterium tuberculosis cultures. Am J Respir Crit Care Med 1995;152:1702–1704.Google Scholar
7. Wurtz, R, Demarais, P, Trainor, W, McAuley, J, Kocka, F, Mosher, L, et al. Specimen contamination in mycobacteriology laboratory detected by pseudo-outbreak of multidrug-resistant tuberculosis: analysis by routine epidemiology and confirmation by molecular technique. J Clin Microbiol 1996;34:1017–1019.Google Scholar
8. Braden, CR, Templeton, GL, Stead, WW, Bates, JH, Cave, MD, Valway, SE. Retrospective detection of laboratory cross-contamination of Mycobacterium tuberculosis cultures with the use of DNA fingerprint analysis. Clin Infect Dis 1997;24:35–40.Google Scholar
9. Maurer, JR, Desmond, EP, Lesser, MD, Jones, WD Jr. Falsepositive cultures of Mycobacterium tuberculosis . Chest 1984;86:439–443.Google Scholar
10. Smith, WB, Vance, DW Jr. Specimen cross-contamination by a strain of Mycobacterium tuberculosis lacking nitrate reductase activity. Diagn Microbiol Infect Dis 1991;14:523–526.Google Scholar
11. van Embden, JDA, Cave, MD, Crawford, JT, Dale, JW, Eisenach, KD, Gicquel, B, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–409.Google Scholar
12. MacGregor, RR, Clark, LW, Bass, F. The significance of isolating low numbers of Mycobacterium tuberculosis in culture of sputum specimens. Chest 1975;68:518–523.Google Scholar
13. Eisenberg, HD. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology; 1992:3.1.1–3.16.4.Google Scholar
14. Bifani, PJ, Plikaytis, BB, Kapur, V, et al. Origin and interstate spread of a New York City multidrug-resistant Mycobacterium tuberculosis clone family. JAMA 1996;275:452–457.Google Scholar
15. Bird, BR, Denniston, MM, Huebner, RE, Good, RC. Changing practices in mycobacteriology: a follow-up survey of state and territorial public health laboratories. J Clin Microbiol 1996;34:554–559.Google Scholar
16. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):51,69–102.Google Scholar
17. Centers for Disease Control and Prevention and National Institutes of Health. Agent: Mycobacterium tuberculosis, M. bovis. In: Biosafety in Microbiological and Biomedical Laboratories. Atlanta, GA: US Department of Health and Human Services; 1993:6-43,95,96.Google Scholar
18. American Society of Heating, Refrigerating, and AirConditioning Engineers. HVAC-1991 Applications. Atlanta, GA: ASHRAE; 1991;14.1–14.17.Google Scholar
19. American Institute of Architects, Committee on Architecture for Health. Guidelines for Construction and Equipment of Hospital and Medical Facilities, 1992-1993. Washington, DC: AIA Press; 1993:7.12, 7.31.Google Scholar
20. American Thoracic Society. Levels of laboratory services for mycobacterial diseases. Am Rev Respir Dis 1983;128:213.Google Scholar