Cluster of tuberculosis cases in North Carolina: Possible association withatomizer reuse

Background: Three patients with identical strains of M tuberculosis (TB) un derwent bronchoscopy on the same day at hospital A. Methods: We reviewed each patient's clinical history, hospital A's infectio n control practices for bronchoscopies, and specimen and isolate handling a t each of 3 laboratories involved. We searched for possible community links between patients. Restriction fragment length polymorphism was performed o n TB isolates. Results: The first patient who underwent bronchoscopy had biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the third patien t 6 weeks after the bronchoscopy produced an isolate with an identical rest riction fragment length polymorphism pattern to isolates collected during t he bronchoscopies. No evidence existed for community transmission or labora tory contamination; the only common link was the bronchoscopy. Different br onchoscopes were used for each patient. Hospital ventilation and wall-sucti oning were functioning well. Respiratory technicians reported sometimes reu sing the nozzles of atomizers on more than one patient. A possible mechanis m for transmission was contamination from the first patient of the atomizer ii it was used to apply lidocaine to the pharynx and nasal passages of oth er patients. Conclusions: A contaminated atomizer may have caused TB transmission during bronchoscopy. Hospital A changed to single-use atomizers after this invest igation.