Cargando…

Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention

BACKGROUND: Non tuberculous mycobacteria (NTM) are widely distributed in soil and water. NTM/Mycobacterium tuberculosis complex (MTBC) mixes may yield positive AFB smears falsely attributed to tuberculosis (TB) and false-resistance profiles for TB due to contaminated diagnostic samples. This as well...

Descripción completa

Detalles Bibliográficos
Autores principales: Kizilbash, Quratulain, Jost, Kenneth, Armitige, Lisa, Griffith, David E, Dunbar, Denise, Seaworth, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631281/
http://dx.doi.org/10.1093/ofid/ofx163.1802
_version_ 1783269429365178368
author Kizilbash, Quratulain
Jost, Kenneth
Armitige, Lisa
Griffith, David E
Dunbar, Denise
Seaworth, Barbara
author_facet Kizilbash, Quratulain
Jost, Kenneth
Armitige, Lisa
Griffith, David E
Dunbar, Denise
Seaworth, Barbara
author_sort Kizilbash, Quratulain
collection PubMed
description BACKGROUND: Non tuberculous mycobacteria (NTM) are widely distributed in soil and water. NTM/Mycobacterium tuberculosis complex (MTBC) mixes may yield positive AFB smears falsely attributed to tuberculosis (TB) and false-resistance profiles for TB due to contaminated diagnostic samples. This as well as isolation of NTM may pose diagnostic and management problems. Texas Center for Infectious Disease (TCID) is a hospital for patients with confirmed TB. After a cluster of isolates of Mycobacterium gordonae was identified, a quality assurance review found inadequate protocols which included eating and drinking prior to collection. Changes made to the sputum collection protocol included reeducation of respiratory therapists and a sterile saline rinse intervention prior to sputum collection. METHODS: All sputa collected for AFB culture from diagnosed TB patients at TCID from January 1st, 2014 to December 31(st), 2014 prior to the intervention and from August 1(st), 2016 to January 31(st), 2017, the 6 months following the quality assurance intervention were included. Sputum samples were processed at the Texas Department of State and Health Services (DSHS) Laboratory. RESULTS: A total of 1,853 sputum samples were processed; 1,288 from 2014 and 565 following the intervention. NTM decreased from 56 (4.3%) to 7 (1.2%) after the quality assurance intervention was instituted for a NTM decrease of 75.0%. M. gordonae decreased by 78.6%. No patients had evidence of NTM disease. CONCLUSION: A breach in sputum collection protocols at TCID accounted for the increase in NTM isolation in 2014, half of which were M. gordonae. The reeducation of respiratory therapy staff and initiation of sterile saline rinse prior to sputum collection resulted in a significant reduction in the overall NTM rate. M. gordonae was isolated only three times following the intervention. At TCID, a location where tap water and bottled water contains NTM, drinking these prior to sputum collection possibly contributed to the cluster for NTM, especially M. gordonae. We recommend rinsing the mouth with sterile saline or water prior to sputum collection to decrease isolation of rarely pathogenic NTM. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-5631281
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-56312812017-11-07 Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention Kizilbash, Quratulain Jost, Kenneth Armitige, Lisa Griffith, David E Dunbar, Denise Seaworth, Barbara Open Forum Infect Dis Abstracts BACKGROUND: Non tuberculous mycobacteria (NTM) are widely distributed in soil and water. NTM/Mycobacterium tuberculosis complex (MTBC) mixes may yield positive AFB smears falsely attributed to tuberculosis (TB) and false-resistance profiles for TB due to contaminated diagnostic samples. This as well as isolation of NTM may pose diagnostic and management problems. Texas Center for Infectious Disease (TCID) is a hospital for patients with confirmed TB. After a cluster of isolates of Mycobacterium gordonae was identified, a quality assurance review found inadequate protocols which included eating and drinking prior to collection. Changes made to the sputum collection protocol included reeducation of respiratory therapists and a sterile saline rinse intervention prior to sputum collection. METHODS: All sputa collected for AFB culture from diagnosed TB patients at TCID from January 1st, 2014 to December 31(st), 2014 prior to the intervention and from August 1(st), 2016 to January 31(st), 2017, the 6 months following the quality assurance intervention were included. Sputum samples were processed at the Texas Department of State and Health Services (DSHS) Laboratory. RESULTS: A total of 1,853 sputum samples were processed; 1,288 from 2014 and 565 following the intervention. NTM decreased from 56 (4.3%) to 7 (1.2%) after the quality assurance intervention was instituted for a NTM decrease of 75.0%. M. gordonae decreased by 78.6%. No patients had evidence of NTM disease. CONCLUSION: A breach in sputum collection protocols at TCID accounted for the increase in NTM isolation in 2014, half of which were M. gordonae. The reeducation of respiratory therapy staff and initiation of sterile saline rinse prior to sputum collection resulted in a significant reduction in the overall NTM rate. M. gordonae was isolated only three times following the intervention. At TCID, a location where tap water and bottled water contains NTM, drinking these prior to sputum collection possibly contributed to the cluster for NTM, especially M. gordonae. We recommend rinsing the mouth with sterile saline or water prior to sputum collection to decrease isolation of rarely pathogenic NTM. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5631281/ http://dx.doi.org/10.1093/ofid/ofx163.1802 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Kizilbash, Quratulain
Jost, Kenneth
Armitige, Lisa
Griffith, David E
Dunbar, Denise
Seaworth, Barbara
Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title_full Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title_fullStr Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title_full_unstemmed Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title_short Reduction in Nontuberculous Mycobacteria at a Tuberculosis Hospital Following a Quality Assurance Intervention
title_sort reduction in nontuberculous mycobacteria at a tuberculosis hospital following a quality assurance intervention
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631281/
http://dx.doi.org/10.1093/ofid/ofx163.1802
work_keys_str_mv AT kizilbashquratulain reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention
AT jostkenneth reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention
AT armitigelisa reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention
AT griffithdavide reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention
AT dunbardenise reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention
AT seaworthbarbara reductioninnontuberculousmycobacteriaatatuberculosishospitalfollowingaqualityassuranceintervention