Hostname: page-component-f554764f5-qhdkw Total loading time: 0 Render date: 2025-04-13T12:22:48.817Z Has data issue: false hasContentIssue false
  • English
  • Français

Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit Attributed to Hospital Tap Water

Published online by Cambridge University Press:  18 May 2017

Cara Bicking Kinsey ,
Samir Koirala ,
Benjamin Solomon ,
Jon Rosenberg ,
Byron F. Robinson ,
Antonio Neri ,
Alison Laufer Halpin ,
Matthew J. Arduino ,
Heather Moulton-Meissner  and
Judith Noble-Wang
...Show all authors
Cara Bicking Kinsey*
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Samir Koirala
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Benjamin Solomon
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Jon Rosenberg
Affiliation:
Healthcare-Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
Byron F. Robinson
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Antonio Neri
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Alison Laufer Halpin
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew J. Arduino
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Heather Moulton-Meissner
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Judith Noble-Wang
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Nora Chea
Affiliation:
Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Carolyn V. Gould
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Cara Bicking Kinsey, 625 Forster Street, Room 933, Harrisburg, PA 17120 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit.

DESIGN

Infection control assessment, environmental evaluation, and case-control study.

SETTING

Newly built community-based hospital, 28-bed neonatal intensive care unit.

PATIENTS

Neonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014.

METHODS

Case finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness.

RESULTS

In total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16–∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75–37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39–30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms.

CONCLUSIONS

This outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities.

Infect Control Hosp Epidemiol 2017;38:801–808

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 801 - 808
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1. Centers for Disease Control and Prevention. Pseudomonas aeruginosa in Healthcare Settings. http://www.cdc.gov/hai/organisms/pseudomonas.html. Published 2014. Accessed February 8, 2017.Google Scholar
2. Trautmann, M, Lepper, PM, Haller, M. Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism. Am J Infect Control 2005;33:S41–S49.CrossRefGoogle ScholarPubMed
3. Polin, RA, Denson, S, Brady, MT. Strategies for prevention of health care-associated infections in the NICU. Pediatrics 2012;129:e1085–e1093.CrossRefGoogle ScholarPubMed
4. Crivaro, V, Di Popolo, A, Caprio, A, et al. Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures. BMC Infect Dis 2009;9:70.CrossRefGoogle Scholar
5. Foca, MD. Pseudomonas aeruginosa infections in the neonatal intensive care unit. Semin Perinatol 2002;26:332–339.CrossRefGoogle ScholarPubMed
6. Jefferies, JM, Cooper, T, Yam, T, Clarke, SC. Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit—a systematic review of risk factors and environmental sources. J Med Microbiol 2012;61:1052–1061.CrossRefGoogle ScholarPubMed
7. Moolenaar, RL, Crutcher, JM, San Joaquin, VH, et al. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 2000;21:80–85.CrossRefGoogle Scholar
8. Sanchez-Carrillo, C, Padilla, B, Marin, M, et al. Contaminated feeding bottles: the source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit. Am J Infect Control 2009;37:150–154.CrossRefGoogle Scholar
9. Yapicioglu, H, Gokmen, TG, Yildizdas, D, et al. Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit. J Paediatr Child Health 2012;48:430–434.CrossRefGoogle Scholar
10. Zafar, AB, Sylvester, LK, Beidas, SO. Pseudomonas aeruginosa infections in a neonatal intensive care unit. Am J Infect Control 2002;30:425–429.CrossRefGoogle Scholar
11. Molina-Cabrillana, J, Artiles-Campelo, F, Dorta-Hung, E, et al. Outbreak of Pseudomonas aeruginosa infections in a neonatal care unit associated with feeding bottles heaters. Am J Infect Control 2013;41:e7–e9.CrossRefGoogle Scholar
12. Davis, RJ, Jensen, SO, Van Hal, S, et al. Whole-genome sequencing in real-time investigation and management of a Pseudomonas aeruginosa outbreak on a neonatal intensive care unit. Infect Control Hosp Epidemiol 2015;36:1058–1064.CrossRefGoogle ScholarPubMed
13. Bert, F, Maubec, E, Bruneau, B, Berry, P, Lambert-Zechovsky, N. Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998;39:53–62.CrossRefGoogle Scholar
14. Rogues, AM, Boulestreau, H, Lasheras, A, et al. Contribution of tap water to patient colonisation with Pseudomonas aeruginosa in a medical intensive care unit. J Hosp Infect 2007;67:72–78.CrossRefGoogle Scholar
15. Williams, M, CR, A, MJ, A. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. Biofouling 2013;29:147–162.CrossRefGoogle ScholarPubMed
16. Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep 2002;51:1–45.Google ScholarPubMed
17. Centers for Disease Control and Prevention. Checklist for prevention of central line associated blood stream infections. http://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdf. Published 2011. Accessed February 8, 2017.Google Scholar
18. Kleinbaum, DG, Klein, M. Logistic Regression: A Self-Learning Text. 3rd ed. New York, NY: Springer; 2010.CrossRefGoogle Scholar
19. Fenton, TR, Kim, JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013;13:59.CrossRefGoogle ScholarPubMed
20. Boles, BR, Thoendel, M, Singh, PK. Self-generated diversity produces “insurance effects” in biofilm communities. Proc Natl Acad Sci U S A 2004;101:16630–16635.CrossRefGoogle Scholar
21. Cooksey, RC, Jhung, MA, Yakrus, MA, et al. Multiphasic approach reveals genetic diversity of environmental and patient isolates of Mycobacterium mucogenicum and Mycobacterium phocaicum associated with an outbreak of bacteremias at a Texas Hospital. Appl Environ Microbiol 2008;74:2480–2487.CrossRefGoogle Scholar
22. Favero, M, Petersen, N, Boyer, K, Carson, L, Bond, W. Microbial contamination of renal dialysis systems and associated health risks. Trans Am Soc Artif Intern Organs 1974;20A:175–183.Google ScholarPubMed
23. Favero, M, Petersen, N, Carson, LA, Bond, W, Hindman, S. Gram-negative water bacteria in hemodialysis systems. Health Lab Sci 1975;12:321–334.Google ScholarPubMed
24. Bland, L, Favero, M. Microbial contamination control strategies for hemodialysis systems Plant, Technology & Safety Management Series. Vol 3. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1989.Google Scholar
25. UK Department of Health. Safe water in healthcare premises: Part C: Pseudomonas aeruginosa—advice for augmented care units. https://www.gov.uk/government/publications/hot-and-cold-water-supply-storage-and-distribution-systems-for-healthcare-premises. Accessed February 8, 2017.Google Scholar
26. Mermel, LA, McKay, M, Dempsey, J, Parenteau, S. Pseudomonas surgical-site infections linked to a healthcare worker with onychomycosis. Infect Control Hosp Epidemiol 2003;24:749–752.CrossRefGoogle ScholarPubMed
27. Zawacki, A, O’Rourke, E, Potter-Bynoe, G, Macone, A, Harbarth, S, Goldmann, D. An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker. Infect Control Hosp Epidemiol 2004;25:1083–1089.CrossRefGoogle Scholar
28. Trautmann, M, Halder, S, Hoegel, J, Royer, H, Haller, M. Point-of-use water filtration reduces endemic Pseudomonas aeruginosa infections on a surgical intensive care unit. Am J Infect Control 2008;36:421–429.CrossRefGoogle ScholarPubMed
29. Vianelli, N, Giannini, MB, Quarti, C, et al. Resolution of a Pseudomonas aeruginosa outbreak in a hematology unit with the use of disposable sterile water filters. Haematologica 2006;91:983–985.Google Scholar
30. Hall, J, Hodgson, G, Kerr, KG. Provision of safe potable water for immunocompromised patients in hospital. J Hosp Infect 2004;58:155–158.CrossRefGoogle ScholarPubMed
31. Safe water in healthcare premises: Part B: Operational management. UK Department of Health website. https://www.gov.uk/government/publications/hot-and-cold-water-supply-storage-and-distribution-systems-for-healthcare-premises. Accessed February 8, 2017.Google Scholar
32. 2012 Edition of the Drinking Water Standards and Health Advisories. Environmental Protection Agency website. https://www.epa.gov/dwstandardsregulations/drinking-water-contaminant-human-health-effects-information. Published 2012. Accessed February 8, 2017.Google Scholar