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The impact of an intervention to reduce dispersal from wastewater drain sites on carbapenem-resistant Pseudomonas aeruginosa colonization and bloodstream infection on a hematopoietic cell transplant and hematologic malignancy unit
Published online by Cambridge University Press: 22 February 2024
Abstract
Objective:
To evaluate the impact of an intervention to limit dispersal from wastewater drain (WWD) sites on meropenem-nonsusceptible Pseudomonas aeruginosa patient and environmental colonization and bloodstream infection (BSI) on a hematopoietic cell transplant (HCT) and hematologic malignancy (HM) unit.
Design:
This quasi-experimental study included pre/postintervention point-prevalence surveys in July 2019 and June 2020, respectively. The retrospective cohort included HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.
Setting:
Adult HCT/HM unit at an academic center.
Participants:
This study included consenting HCT/HM patients on the unit at the time of the point-prevalence surveys. HCT/HM patients with P. aeruginosa BSI between 2012 and 2022.
Methods:
A quality improvement intervention targeting WWD sites was conceived and implemented on a HCT/HM unit. Pre and postintervention colonization samples were obtained from patients and environmental sites, cultivated on selective media, then characterized by susceptibility testing. Whole-genome sequencing and phylogenetic analysis were performed on select isolates. The impact of the intervention on colonization and BSI was evaluated, as was relatedness among isolates.
Results:
Although colonization of WWD sites with meropenem-nonsusceptible P. aeruginosa was widespread before and after this intervention, we observed a substantial decline in patient colonization (prevalence rate ratio, 0.35; 95% confidence interval [CI], 0.04–3.12) and BSI (incidence rate ratio, 0.67; 95% CI, 0.31–1.42) after the intervention. Among 3 predominant sequence types (ST-111, ST-446, and ST-308), there was striking genetic conservation within groups and among environmental colonization, patient colonization, and BSI isolates.
Conclusions:
An intervention targeting WWD sites on a HCT/HM unit had a meaningful impact on meropenem-nonsusceptible P. aeruginosa patient colonization and BSI.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Footnotes
PREVIOUS PRESENTATION: Initial findings from this work were presented at IDWeek 2021, September 29 - October 3, 2021 (virtual conference): Fontana L, Hakki M, Zhang R, Messer W, Walker-Stevenson G, Laird A, Strasfeld L. The impact of bundled interventions to decrease transmission of drug-resistant Pseudomonas aeruginosa from wastewater drain sites on a hematologic malignancy/hematopoietic stem cell transplant unit.
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