Reference no: EM133695519

Investigators began the environmental health assessment by speaking with the director of the pain management clinic and reviewing the case-patient's medical charts. The patients had received lumbar epidural injections with methylprednisolone acetate for chronic lower back pain. The first patient received injections on March 27 and May 31 (100 and 35 days before hospital admission). The second patient received injections on May 22 and July 12 (84 and 34 days before hospital admission). Physician A administered the injections to the first patient and Physician B to the second patient. The physicians were assisted by a different nurse during each of these four procedures. The investigators then observed epidural injections performed by Physician A and B on other patients from the clinic. The following flow diagram of an epidural injection is based on those observations.

Question : Identify possible sources of contamination during the lumbar epidural injection procedure.