Abstract
On March 6, 2017, the New Jersey Department of Health (NJDOH) was notified of three cases of septic arthritis in patients who had received intra-articular injections for osteoarthritic knee pain at a private outpatient practice. The practice voluntarily closed the next day. NJDOH, in conjunction with the local health department and the New Jersey Board of Medical Examiners, conducted an investigation and identified 41 cases of septic arthritis associated with intra-articular injections administered during 250 patient visits at the same practice, including 30 (73%) patients who required surgery. Bacterial cultures of synovial fluid or tissue from 15 (37%) patients were positive; all recovered organisms were oral flora. An infection prevention assessment of the practice identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, inappropriate use of pharmacy bulk packaged (PBP) products as multiple-dose containers and handling PBP products outside of required pharmacy conditions, and preparation of syringes up to 4 days in advance of their intended use. No additional septic arthritis cases were identified after infection prevention recommendations were implemented within the practice.
Highlights
In March 2017, an outbreak of 41 cases of septic arthritis associated with intra-articular injections administered at an outpatient practice occurred in New Jersey
A public health investigation identified multiple breaches of recommended infection prevention practices during the preparation and administration of pharmacy bulk packaged (PBP) products, which are intended for single-use, in accordance with standards outlined by the United States Pharmacopeial Convention
No additional septic arthritis cases were identified after infection prevention recommendations were implemented within the practice
Summary
On March 6, 2017, Monmouth County Regional Health Commission No 1 (MCRHC) notified NJDOH that three patients were hospitalized for septic arthritis after receiving intra-articular injections for osteoarthritis pain relief at practice A, a private outpatient facility where procedures were performed by two staff physicians with the aid of two medical assistants. Among 250 patient visits involving knee intra-articular injections at practice A during March 1–6, NJDOH identified 41 confirmed cases (16%) of septic arthritis. In addition to bacteria recovered from culture of synovial fluid or tissue, Staphylococcus aureus was isolated from the blood of two patients. On March 13, MCRHC, NJDOH, and the New Jersey Division of Consumer Affairs representing the New Jersey Board of Medical Examiners conducted an unannounced visit to practice A to inspect the premises, interview staff members, observe infection prevention practices, and review records.
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