Quaternary Ammonium Compounds Case Study

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1. A large hospital washes burn patients in a stainless steel tub. After each patient, the tub is cleaned with a quaternary ammonium compound. In March, 14 out of 20 burn patients who used this tub acquired Pseudomonas infections after being bathed. Explain this situation. Quaternary ammonium compounds are typically used to disinfect medical supplies, such as the stainless steel tubs. They are able to disinfect by inactivating enzymes that are energy-producing, disrupt the cell membrane, and denature cell proteins that are essential to the cell’s life. These quaternary ammonium compounds are typically virucidal, bactericidal, and fungicidal against enveloped viruses but are not tuberculocidal, sporicidal, and sometimes not virucidal against …show more content…
You are a physician assistant working for an orthopedic surgeon. Over a one week period in April, eleven of your patients who received injections of methylprednisone and lidocaine for arthritis pain relief developed septic arthritis due to Serratia marcescens. Upon investigation, all unopened bottles of methylprednisone from the same lot numbers tested sterile (these bottles contained a quaternary ammonium compound as a preservative). At the office, cotton balls soaked in benzalkonium chloride were used to wipe multi-use injection vials before use and to prepare the injection site on each patient. Fresh cotton balls were added to the jar as it was emptied. Opened vials of methylprednisone containers and the jar of cotton balls tested positive for S. marcescens.

a. How was this infection transmitted?

This infection can be transmitted by a fomite or physical contact with a person that has touched something that was infected with S. marcescens. Distilled water, antiseptics, and disinfectants have shown to be good areas where S. marcescens grows and survives (Currey, 2011). In this case, the infection was transmitted when the physician assistant cleaned and prepared the injection site with the cotton balls that were contaminated. This strain of S. marcescens was resistant to benzalkonium chloride, so while the benzalkonium chloride was supposed to kill the bacteria, it did not (Nakashima et al., (n.d.)).

b. What part of the procedure caused the
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