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A Bundle of Measures to Control an Outbreak of Pseudomonas aeruginosa Associated With P-Trap Contamination

Published online by Cambridge University Press:  08 February 2018

Houssein Gbaguidi-Haore ,
Amélie Varin ,
Pascal Cholley ,
Michelle Thouverez ,
Didier Hocquet  and
Xavier Bertrand
Houssein Gbaguidi-Haore
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
Amélie Varin
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France
Pascal Cholley
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
Michelle Thouverez
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
Didier Hocquet
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France Centre de Ressources Biologiques–Filière Microbiologique de Besançon, Centre Hospitalier Régional Universitaire, Besançon, France
Xavier Bertrand*
Affiliation:
Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
*
Address correspondence to Xavier Bertrand, Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, 3 boulevard Fleming, Besançon, Cedex 25030, France (xbertrand@chu-besancon.fr).
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Abstract

OBJECTIVE

To describe an outbreak of multidrug-resistant Pseudomonas aeruginosa in which the hospital waste-pipe system was the likely source of contamination and to report the bundle of measures that facilitated the long-term control of the outbreak.

DESIGN

Outbreak investigation.

SETTING

The hematology unit of a tertiary-care referral center.

PATIENTS

Patients who were colonized or infected with P. aeruginosa belonging to the clonal outbreak.

METHODS

Patients admitted to our 15-bed stem-cell transplantation hematology unit were screened for P. aeruginosa carriage. Pseudomonas aeruginosa isolates were also obtained from diagnostic samples. We assessed the microbiological contamination of P-traps, water and toilets for 42 months. Extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) were screened and identified by polymerase chain reaction (PCR) and sequencing. Molecular typing of ESBL- or MBL-producing isolates was carried out using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).

RESULTS

From 2009 to 2013, a biclonal outbreak of IMP-19–producing ST235 (11 cases) and IMP-29–producing ST111 (10 cases) of P. aeruginosa occurred. The environmental investigation strongly suggested that P-traps were the reservoirs for the outbreak strains. A bundle of infection control measures, including engineering interventions on water outlets and disinfection of P-traps, controlled the outbreak.

CONCLUSIONS

We report a prolonged outbreak of IMP-producing high-risk clones of P. aeruginosa, for which P-traps seems to play a major role in cross-transmission. It appears essential to implement proactive measures to limit the bacterial load in water fittings of high-risk units.

Infect Control Hosp Epidemiol 2018;39:164–169

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 2 , February 2018 , pp. 164 - 169
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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