Purpose Hospital outbreaks are observed increasingly worldwide with various organisms from different sources such as contaminated ultrasound gel, intravenous (IV) fluids and IV medications. Among these, ultrasound gel is one of the most commonly reported sources for Burkholderia cepacia complex (Bcc) outbreaks. In this study, we describe our experience on investigation and the management of Bcc bacteraemia outbreak due to contaminated ultrasound gel from a tertiary care centre, South India. Materials and Methods Over a 10-day period in October 2016, seven children in our Paediatric intensive care unit (ICU) were found to have bacteraemia with Bcc isolated from their blood culture. Repeated isolation of the same organism with similar antimicrobial susceptibility pattern over a short incubation period from the same location, confirmed the outbreak. An active outbreak investigation, including environmental surveillance, was carried out to find the source and control the outbreak. Isolates were subjected to multi-locus sequence typing (MLST) and global eBURST (goeBURST) analysis. Results Environmental surveillance revealed contaminated ultrasound gel as the source of infection. MLST and goeBURST analysis confirmed that the outbreak was caused by a novel sequence type 1362 with the same clonal complex CC517. The outbreak was controlled by stringent infection control measures, withdrawal of contaminated ultrasound gel from regular usage and implementing the practice of using ultrasonogram (USG) probe cover for USG screening and guided procedures. Conclusion This report highlights the importance of early identification of an outbreak, prompt response of the ICU and infection control teams, sound environmental and epidemiological surveillance methods to identify the source and stringent infection control measures to control the outbreak. Contaminated ultrasound gel can be a potential source for healthcare-associated infection, which cannot be overlooked.

中文翻译：

---

超声凝胶作为医院暴发的来源：印度经验和文献综述。


目的 全球范围内越来越多地观察到来自不同来源的各种生物体的医院暴发，例如受污染的超声凝胶、静脉 (IV) 液体和静脉注射药物。其中，超声凝胶是洋葱伯克霍尔德菌复合体 (Bcc) 爆发最常见的来源之一。在这项研究中，我们描述了印度南部一家三级护理中心因超声凝胶污染而导致 Bcc 菌血症爆发的调查和管理经验。材料和方法 2016 年 10 月的 10 天内，我们儿科重症监护病房 (ICU) 的 7 名儿童被发现患有菌血症，并从他们的血培养中分离出 Bcc。在短时间内从同一地点重复分离出具有相似抗菌药物敏感性模式的同一微生物，证实了疫情的爆发。积极开展疫情调查，包括环境监测，以寻找源头并控制疫情。对分离株进行多位点序列分型 (MLST) 和全局 eBURST (goeBURST) 分析。结果环境监测发现受污染的超声凝胶是感染源。 MLST 和 goeBURST 分析证实，此次疫情是由具有相同克隆复合物 CC517 的新序列类型 1362 引起的。通过严格的感染控制措施、停止使用受污染的超声凝胶以及实施使用超声检查 (USG) 探头套进行超声检查和引导程序的做法，控制了疫情的爆发。 结论 本报告强调了早期发现疫情、重症监护病房和感染控制团队迅速反应、健全的环境和流行病学监测方法以确定来源以及严格的感染控制措施来控制疫情的重要性。受污染的超声凝胶可能是医疗相关感染的潜在来源，这一点不容忽视。