By: Lawrence F Muscarella PhD; posted 6-12-2013, updated 8-5-2014

An article by Lawrence F Muscarella, PhD, entitled article “Other Possible Causes of a Well-Publicized Outbreak of Pseudomonas aeruginosa Following Arthroscopy in Texas” appears in the June, 2013, issue of the peer-reviewed medical journal Advances in Infectious Diseases.

Click here to visit a webpage that provides the abstract of Dr. Muscarella’s article. Once on that webpage, CLICK the red “PDF” link to download a free copy of the complete article.

Dr. Muscarella’s article provides not just a root cause analysis (RCA) of an outbreak of pan-susceptible Pseudomonas aeruginosa that was identified in 2009 following arthroscopic procedures performed at a hospital in Texas, but also a comprehensive review of the details and conclusions of this outbreak’s investigation, which was performed by, among others, the Centers for Disease Control and Prevention (CDC).

The CDC’s investigation

The CDC’s published investigation that Dr. Muscarella’s article reviews is referred to as the Tosh et al. (2011) study.

NBC Nightly News 

NBC Nightly News produced a report about this outbreak in Texas in 2009.

But, did NBC get it right? Were dirty surgical instruments the most likely cause of this bacterial outbreak? Might another unrecognized factor have been more responsible for this bacterial outbreak in 2009? — Lawrence F Muscarella, PhD

Read Dr. Muscarella’s article (click here) for insight into the answers to these questions.

The Center for Public Integrity

Similarly, The Center for Public Integrity wrote a popular report about this outbreak entitled, “Filthy surgical instruments: The hidden threat in America’s operating rooms” (by Joe Eaton).

Click here to read a related article by Dr. Muscarella that discusses a study that evaluated the effectiveness of steam sterilization in the presence of hydraulic fluid.

Food and Drug Administration

In response to this bacterial outbreak in Texas, the Food and Drug Administration (FDA) published a statement entitled, “Ongoing Safety Review of Arthroscopic Shavers.”


Dr. Muscarella is an independent infection-prevention consultant. Click here to read a brochure that describes a number of his services, which include confidential audits of the infection-control practices of GI endoscopy departments.

Article by: Lawrence F Muscarella PhD, posted 6-12-2013; updated 8-5-2014.

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