Infection Clusters in Chemo Clinics 'Tip of the Iceberg,' Says CDC

The Centers for Disease Control and Prevention stepped in, too, investigating the Nebraska episode as well as several other oncology clinic outbreaks over the last decade. Those that received media attention include:

• A10-case cluster of Burkolderia cepacia bloodstream infections in a Georgia oncology clinic,
• 29 patients infected with hepatitis B in a clinic in New Jersey,
• 27 patients infected with Klebsiellea oxytoca and Enterobacter cloacae in an Illinois chemo center,
•  A variety of bacterial bloodstream infections in a clinic in Mississippi

Nearly 6,000 additional cancer patients treated at those clinics were called in for testing.

Alice Guh, MD, a CDC clinical epidemiologist, says these are "just the tip of the iceberg.

"We don't have a good handle on how just many of these outbreaks have occurred," she told me during an interview. The agency does know, however, that these clusters occurred because solid infection control practices were not in place. These were due to lapses in handling syringes or other types of injectable devices appropriately, she said.

That's because these procedures take place in largely unregulated, not-routinely inspected outpatient clinics, "pavilions," or offices, the places where most of the 650,000 chemotherapy patients a year receive their infusions.

"There have been situations where syringes of heparin were reused directly between patients to flush lines, and also situations where saline bags that should [have been] dedicated to an individual patient were instead shared among multiple patients," Guh says.