Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-13T12:54:07.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Multidrug-Resistant Pseudomonas aeruginosa Colonization and Infection Secondary to Imperfect Intensive Care Unit Room Design

Published online by Cambridge University Press:  02 January 2015

Susy Hota ,
Zahir Hirji ,
Karen Stockton ,
Camille Lemieux ,
Helen Dedier ,
Gideon Wolfaardt  and
Michael A. Gardam
Susy Hota*
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Zahir Hirji
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
Karen Stockton
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
Camille Lemieux
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
Helen Dedier
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
Gideon Wolfaardt
Affiliation:
Department of Chemistry and Biology, Ryerson University, Toronto, Ontario, Canada
Michael A. Gardam
Affiliation:
Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada Department of Medicine, University of Toronto, Toronto, Ontario, Canada
*
Infection Prevention and Control, Toronto General Hospital, 9th floor, New Clinical Services Building, 200 Elizabeth Street, Toronto, Ontario M5G 2C4 (susy.hota@uhn.on.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Pseudomonas aeruginosa has been increasingly recognized for its ability to cause significant hospital-associated outbreaks, particularly since the emergence of multidrug-resistant strains. Biofilm formation allows the pathogen to persist in environmental reservoirs. Thus, multiple hospital room design elements, including sink placement and design, can impact nosocomial transmission of P. aeruginosa and other pathogens.

Methods.

From December 2004 through March 2006, 36 patients exposed to the intensive care unit or transplant units of a tertiary care hospital were infected with a multidrug-resistant strain of P. aeruginosa. All phenotypically similar isolates were examined for genetic relatedness by means of pulsed-field gel electrophoresis. Clinical characteristics of the affected patients were collected, and a detailed epidemiological and environmental investigation of potential sources was carried out.

Results.

Seventeen of the infected patients died within 3 months; for 12 (71%) of these patients, infection with the outbreak organism contributed to or directly caused death. The source of the outbreak was traced to hand hygiene sink drains, where biofilms containing viable organisms were found. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least 1 meter from the sink. Various attempts were made to disinfect the drains, but it was only when the sinks were renovated to prevent splashing onto surrounding areas that the outbreak was terminated.

Conclusion.

This report highlights the importance of biofilms and of sink and patient room design in the propagation of an outbreak and suggests some strategies to reduce the risks associated with hospital sinks.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 1 , January 2009 , pp. 25 - 33
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gillespie, TA, Johnson, PRE, Notman, AW, Coia, JE, Hanson, MF. Eradication of resistant Pseudomonas aeruginosa strain after a cluster of infections in a hematology/oncology unit. Clin Microbiol Infect 2000;6:125–130.CrossRefGoogle Scholar
2.Pena, C, Dominguez, MA, Pujol, M, Verdaguer, R, Gudiol, F, Ariza, J. An outbreak of carbapenem-resistant Pseudomonas aeruginosa in a urology ward. Clin Microbiol Infect 2003;9:938–943.CrossRefGoogle Scholar
3.Bert, F, Maubec, E, Bruneau, B, Berry, P, Lambert-Zechovsky, N. Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998;39:53–62.CrossRefGoogle Scholar
4.Ferroni, A, Nguyen, L, Pron, B, Quesne, G, Brusset, MC, Berche, P. Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a pediatric surgical unit associated with tap-water contamination. J Hosp Infect 1998;39:301–307.CrossRefGoogle Scholar
5.Bukholm, G, Tannaes, T, Kjelsberg, ABB, Smith-Erichsen, N. An outbreak of multidrug-resistant Pseudomonas aeruginosa associated with increased risk of patient death in an intensive care unit. Infect Control Hosp Epidemiol 2002;23:441–446.CrossRefGoogle Scholar
6.Aumeran, C, Paillard, C, Robin, F, et al. Pseudomonas aeruginosa and Pseudomonas putida outbreak associated with contaminated water outlets in an oncohaematology pediatric unit. J Hosp Infect 2007;65:47–53.CrossRefGoogle Scholar
7.Vianelli, N, Giannini, MB, Quarti, C, et al. Resolution of a Pseudomonas aeruginosa outbreak in a hematology unit with the use of disposable sterile water filters. Haematologica 2006;91:983–985.Google Scholar
8.Douglas, MW, Mulholland, K, Denyer, V, Gottlieb, T. Multi-drug resistant Pseudomonas aeruginosa outbreak in a burns unit—an infection control study. Burns 2001;27:131–135.CrossRefGoogle Scholar
9.Silva, CV, Magalhaes, VD, Pereira, CR, Kawagoe, JY, Ikura, C, Ganc, AJ. Pseudo-outbreak of Pseudomonas aeruginosa and Serratia marcescens related to bronchoscopes. Infect Control Hosp Epidemiol 2003;24:195–197.CrossRefGoogle ScholarPubMed
10.Engelhart, S, Krizek, L, Glasmacher, A, Fischnaller, E, Marklein, G, Exner, M. Pseudomonas aeruginosa outbreak in a hematology-oncology unit associated with contaminated surface cleaning equipment. J Hosp Infect 2002;52:93–98.Google Scholar
11.Becks, VE, Lorenzoni, NM. Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: a possible link to contaminated hand lotion. Am J Infect Control 1995;23:396–398.CrossRefGoogle Scholar
12.Iversen, BG, Jacobsen, T, Hanne-Merete, E, et al. An outbreak of Pseudomonas aeruginosa infection caused by contaminated mouth swabs. Clin Infect Dis 2007;44:794–801.CrossRefGoogle ScholarPubMed
13.Cobben, NAM, Drent, M, Jonkers, M, Wouters, EFM, Vaneechoutte, M, Stobberingh, EE. Outbreak of severe Pseudomonas aeruginosa respiratory infections due to contaminated nebulizers. J Hosp Infect 1996;33:63–70.CrossRefGoogle ScholarPubMed
14. Mount Sinai Hospital/Toronto Medical Laboratories Online Microbiology Lab Manual. Available at: http://microbiology.mtsinai.on.ca/manual/default.asp. Accessed March 28, 2008.Google Scholar
15.Gales, AC, Reis, AO, Jones, RN. Contemporary assessment of antimicrobial susceptibility testing methods for polymyxin B and colistin: review of available interpretative criteria and quality control guidelines. J Clin Microbiol 2001;39:183–190.Google Scholar
16.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
17.2006 Guidelines for Design and Construction of Health Care Facilities. 3.4.2 Critical Care Units (General). Washington, DC: American Institute of Architects; 2006:50.Google Scholar
18.Clark, JA. Plumbing Engineer: plumbing fixture selections for health care facilities. Available at: http://www.plumbingengineer.com/oct_06/fixtures.php. Accessed March 28, 2008.Google Scholar
19.Levin, MH, Olson, B, Nathan, C, Kabine, SA, Weinstein, RA. Pseudomonas in the sinks of an intensive care unit: relation to patients. J Clin Pathol 1984;37:424–427.CrossRefGoogle ScholarPubMed
20.Muscarella, LF. Contribution of tap water and environmental surfaces to nosocomial transmission of antibiotic-resistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 2004;25:342–345.CrossRefGoogle ScholarPubMed
21.Pitten, FA, Panzig, B, Schroder, G, Tietze, K, Kramer, A. Transmission of a multiresistant Pseudomonas aeruginosa at a German university hospital. J Hosp Infect 2001;47:125–130.CrossRefGoogle ScholarPubMed
22.Reuter, S, Sigge, A, Wiedeck, H, Trautmann, M. Analysis of transmission pathways of Pseudomonas aeruginosa between patients and tap water outlets. Crit Care Med 2002;30:2222–2228.Google Scholar
23.Trautmann, M, Michalsky, T, Wiedeck, H, Radosavijevic, V, Ruhnke, M. Tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit and relation to Pseudomonas infections of ICU patients. Infect Control Hosp Epidemiol 2001;22:49–52.Google Scholar
24.Bonten, MJM, Weinstein, RA. Transmission pathways of Pseudomonas aeruginosa in intensive care units: don't go near the water. Crit Care Med 2002;30:2384–2385.Google Scholar
25.Berrouanne, YF, NcNutt, LA, Buschelman, BJ, et al. Outbreak of severe Pseudomonas aeruginosa infections caused by contaminated drain in a whirlpool bathtub. Clin Infect Dis 2000;31:1331–1337.Google Scholar
26.Presteri, E, Suchomel, M, Eder, M, et al. Effects of alcohols, povidone-iodine, and hydrogen peroxide on biofilms of Staphylococcus epidermidis. J Antimicrob Chemother 2007;60:417–420.Google Scholar
27.Buckingham-Meyer, K, Goeres, DM, Hamilton, MA. Comparative evaluation of biofilm disinfectant efficacy tests. J Microbiol Methods 2007;70:236–244.Google Scholar
28.Pitt, TL. Epidemiological typing of Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 1988;7:238–247.CrossRefGoogle ScholarPubMed