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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)
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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

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