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Sputum Induction Problems Identified Through Genetic Fingerprinting

Published online by Cambridge University Press:  02 January 2015

Beth Nivin ,
Tholief O'Flaherty ,
Eric Leibert ,
Ben Yang Zhao  and
Jeffrey Driscoll
Beth Nivin*
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Tholief O'Flaherty
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Eric Leibert
Affiliation:
New York City Department of Health, Tuberculosis Control Program, Wadsworth Center, New York, New York
Ben Yang Zhao
Affiliation:
New York City Department of Health, Public Health Laboratories, Wadsworth Center, New York, New York
Jeffrey Driscoll
Affiliation:
New York State Department of Health, Wadsworth Center, New York, New York
*
New York City Department of Health, 125 Worth Street, Room 225, New York, NY 10013
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Abstract

Objective:

To identify the contamination source of a cluster of eight positive Mycobacterium tuberculosis isolates from one laboratory session.

Methods:

Spoligotyping was performed on M. tuberculosis isolates processed during one laboratory session. Laboratory and sputum induction protocols and records were reviewed. Sputum induction staff were interviewed. An environmental assessment of the sputum induction booth was performed.

Results:

Spoligotyping identified a unique strain of susceptible M. tuberculosis from five induced sputa collected at Clinic A on the same day. Three specimens processed concurrently from other clinics had spoligotypes different from each other and from the cluster strain. A laboratory investigation revealed no procedural lapses. Sputum induction records from Clinic A indicated that patient 1 in the sputum induction booth had prior culture-confirmed tuberculosis. Patient 2 had a history of a drug-resistant strain. Patient 3 had completed tuberculosis treatment, with positive cultures 7 months earlier. Patients 4 and 5 were new to the clinic and had no subsequent positive M. tuberculosis specimens. The sputum induction booth was working within normal parameters. Sputum induction that day was overseen by a new employee with limited training and no supervision. A review of the sputum induction protocol identified ambiguity regarding care of the ultrasonic nebulizer between patients, which may have led to reuse of the discarded nebulizer solution from patient 1.

Conclusions:

A break in the sputum induction protocol may have contributed to contamination of patient specimens. Sputum induction is complicated, mandating adequate staff training and supervision and patient preparation. Spoligotyping identified a potential source of M. tuberculosis contamination.(Infect Control Hosp Epidemiol 2002;23:580-583).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 580 - 583
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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