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

  • Kathleen M. Ross (a1), Jason S. Mehr (a1), Barbara L. Carothers (a1), Rebecca D. Greeley (a1), Isaac Benowitz (a2), David Henry (a3), Lisa A. McHugh (a1), Lisa DiFedele (a1), Eric Adler (a1), Shereen Naqvi (a3), Laura Taylor (a1), Edward Lifshitz (a1), Christina Tan (a1) and Barbara E. Montana (a1)...

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.

Copyright

Corresponding author

Author for correspondence: Kathleen M. Ross, E-mail: Kathleen.Ross@doh.nj.gov

Footnotes

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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.

Footnotes

References

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