An investigation on surgical-site infection among post cesarean section patients with Burkholderia cepacia contaminated ultrasonic couplant / 中华流行病学杂志

ABSTRACT

Objective In May 2013,an abnormal increase of surgical-site infection among post cesarean section patients was reported at one hospital in Zhongshan. An investigation was conducted to identify the risk factors and related control measures. Methods All the reported surgical-site infection records among post cesarean section patients were checked. A review of cesarean section schedules of health workers was also performed. An 1∶2 case-control study was conducted among surgical-site infection cases in May 2013. Microbiologic cultures were performed on 2 surgical site secretion samples and 12 samples from the environment. All the positive isolates were molecular typed by pulsed field gel electrophoresis(PFGE). Results In May 2013,4 post cesarean section patients who developed surgical-site infection symptom at one hospital in Zhongshan were reported,with an attack rate as 10.3%(4/39). The emergence time of symptom was 2-3 days after operation. All of the 4 cases underwent an emergency operation. The median time interval for cases from admission to operation was 7.2 hours(ranged from 2 to 9 hours),lower than that seen in the controls,with a median time of 20.8 hours (Z=5.50,P=0.03). Two of the 4 cases took type-B ultrasonic inspection 1.4 h and 8.4 h before the operation,and the other two cases took continuous fetal heart monitoring 2 hours before the operation. Skin of the operation area on the 4 cases had been exposed to ultrasonic couplant,without a thorough clean. The proportion of type-B ultrasonic inspection or continuous fetal heart monitoring was much higher in cases than in controls(χ2=5.19, P=0.01). Burkholderia cepacia (BC) isolates were discovered fromone surgical site secretion,2 type-B ultrasonic probe samples,one ultrasonic couplant in use and one ultrasonic couplant unopened. All the isolates were identified as 100%identical by PFGE. Conclusion The skin of operation area of cesarean section patients had been exposed to BC contaminated ultrasonic couplant without thorough cleaning,which seemed to be related to the outbreak of surgical-site infection,in our case.