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Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain—New Jersey, 2017

Published online by Cambridge University Press:  17 July 2019

Kathleen M. Ross*
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Jason S. Mehr
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Barbara L. Carothers
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Rebecca D. Greeley
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Isaac Benowitz
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Henry
Affiliation:
Monmouth County Regional Health Commission No. 1., Oceal Township, New Jersey
Lisa A. McHugh
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Lisa DiFedele
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Eric Adler
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Shereen Naqvi
Affiliation:
Monmouth County Regional Health Commission No. 1., Oceal Township, New Jersey
Laura Taylor
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Edward Lifshitz
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Christina Tan
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
Barbara E. Montana
Affiliation:
New Jersey Department of Health, Trenton, New Jersey
*
Author for correspondence: Kathleen M. Ross, E-mail: Kathleen.Ross@doh.nj.gov

Abstract

Background:

In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.

Methods:

An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.

Results:

We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.

Discussion:

Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.

Conclusions:

This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESETNATION: In July 2017, the authors published a CDC Morbidity and Mortality Weekly Report (MMWR) while the investigation was ongoing. The MMWR can be accessed at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6629a3.htm. Additionally, a coauthor gave an oral presentation of part of this study at the Association for Professionals in Infection Control and Epidemiology Annual Conference on June 13, 2018 in Minneapolis, Minnesota.

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