Outbreak of Multidrug-ResistantPseudomonas aeruginosaColonization and Infection Secondary to Imperfect Intensive Care Unit Room Design

Abstract

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.

Post-Outbreak Investigation of Pseudomonas aeruginosa Faucet Contamination by Quantitative Polymerase Chain Reaction and Environmental Factors Affecting Positivity

“…29 Previous P. aeruginosa outbreak investigations have also confirmed the waterborne source through the detection of P. aeruginosa in swabs from drains and faucets. 5,6,11,13,14,20 Notably, in this case and despite the established link between aerators and drains swabs and clinical cases, P. aeruginosa was not isolated from water by culture during the outbreak. The high level of aerator positivity (ie, 4 of the 5 positive aerators harbored strains shared with clinical isolates during the outbreak) led to the hypothesis of retrograde contamination from the drain.…”

“…1 Several of these outbreaks have been directly or indirectly linked to water distribution systems. [2][3][4][5][6][7][8][9][10][11][12][13][14] In ICUs, 30%-50% of P. aeruginosa infections have been associated with water. 15 A multicentric prospective study recently established tap contamination in patient rooms as an important environmental risk factor for P. aeruginosa acquisition.…”

“…16 Several factors promote water contamination, including the type of faucet, 9,17,18 the presence and type of aerator on the faucet, 19 the volume of mixed hot and cold water, 17 the alignment of the sink drain, 20 construction or renovation settings, and ICU vs non-ICU settings. 3,20 Once contaminated, eradication of P. aeruginosa in the water system is challenging and often results in replacing related devices 5,[7][8][9][10][11][12]14 or installing point-of-use 0.2-μm filters. 4,13,14 Although cultivation is the reference method, it may not reveal background contamination that may flare up when the environment becomes favorable for growth and culturability.…”

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

“…The newly renovated ICU in our hospital (with isolation rooms and a modern ventilation system) may have contributed to temporary control of the infection, as suboptimal ICU designs layouts such as our previous one have been associated with MR-PA infection outbreaks. 4 The organism's panantibioticresistance pattern and biofilm formation most likely played important roles in extending the outbreaks. 2 Also, hospital personnel shortage 30 or, as in our case, high hospital staff turnover may be related to MR-PA infection outbreaks or initial difficulty in controlling them.…”

“…[1][2][3][4][5][6][7][8] These infections are usually associated with high mortality rates. [1][2][3][4][5][6] Also, in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), authors have described persistent and recurrent infections caused by non-MR-PA strains. 9,10 Pulsed-field gel electrophoresis (PFGE) is the recommended technique for determining the genotypes of nosocomial pathogens.…”