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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.
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.
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.
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.
Gideon M. Wolfaardt, Department of Microbiology, University of Stellenbosch, Private Bag X1, 7602 Stellenbosch, South Africa,
Darren R. Korber, Department of Applied Microbiology & Food Science, University of Saskatchewan,Saskatoon, SK, Canada S7N 5A8,
Subramanian Karthikeyan, Department of Applied Microbiology & Food Science, University of Saskatchewan,Saskatoon, SK, Canada S7N 5A8,
Douglas E. Caldwell, Department of Applied Microbiology & Food Science, University of Saskatchewan,Saskatoon, SK, Canada S7N 5A8
It has been shown that microbial communities contribute extensively to the attenuation, mineralization and transport of both organic and inorganic contaminants in the environment. The development of biofilms by microbial communities is often a key factor contributing to the overall efficiency of these processes (Rothemund et al., 1996). For instance, bacterial biofilms are able to accumulate metals through various mechanisms (Marques et al., 1991; Sillitoe et al., 1994). Liehr et al. (1994) showed that biofilms formed by algae could concentrate metals at levels more than four orders of magnitude higher than those in the surrounding water.
The potential of bioremediation as an alternative to physical and chemical remediation strategies has resulted in a significant amount of research effort on degradative biofilms. Although much emphasis has been placed on the degradation of xenobiotic compounds, the knowledge gained through these studies has also contributed to an improved understanding of processes involved in the degradation of naturally occurring molecules as well as nutrient cycling in general. Tank & Webster (1998) suggested that competition for nutrients might regulate heterotrophic microbial processes in natural streams. In their study, they found that nutrient immobilization by leaves partially inhibited other heterotrophic processes, as evidenced by low microbial respiration, fungal biomass and extracellular enzyme activity among wood biofilms in the presence of leaf litter. Lawrence et al. (1998) stressed the applicability of knowledge gained through the study of naturally occurring attenuation mechanisms to remediating contaminated environments. Clearly, the study of degradative biofilms is of both fundamental and applied interest.
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