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Inkster T. A narrative review and update on drain-related outbreaks. J Hosp Infect 2024; 151:33-44. [PMID: 38830539 DOI: 10.1016/j.jhin.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Outbreaks linked to hospital drainage systems are well reported, and continue to present challenges to incident management teams. Such outbreaks can be protracted and complex, with multi-modal strategies being required for remediation. AIM To summarize recent drain-related outbreaks, investigate whether multi-modal control measures are being implemented, and determine any antecedent factors. METHODS Databases were searched for drain-related outbreaks over a 5-year period. Search terms employed included 'healthcare drainage outbreaks', 'drain outbreaks', 'drainage system outbreaks', 'sink outbreaks' and 'shower outbreaks'. Information was collected on country of origin, pathogens involved, unit affected, drain types, patient numbers, drainage system interventions, type of drain disinfectant, infection control interventions, typing method, outcomes and any antecedent factors. FINDINGS Nineteen drain-related outbreak studies were reviewed. The majority of incidents were due to carbapenemase-producing Enterobacterales, and were from critical care settings. Most (16/19) studies recognized the need for a multi-modal approach. Information on the success of interventions was not documented for all incidents, but 13/19 studies reported no further cases after control measures. Variation in the choice of agent and frequency of application exists with regards to drain disinfection. Seven studies discussed antecedent factors. CONCLUSION Despite drain-related outbreaks being reported for the last 24 years and review articles on the subject, outbreaks continue to pose significant challenges. There is currently no UK guidance on the management of drain-related outbreaks or the design of new buildings to mitigate the risk. Addressing the challenges from hospital drainage systems should be considered a priority by agencies and guidance developers.
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Affiliation(s)
- T Inkster
- Antimicrobial Resistance and Healthcare Associated Infection, Glasgow, UK.
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2
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Kim UJ, Choi SM, Kim MJ, Kim S, Shin SU, Oh SR, Park JW, Shin HY, Kim YJ, Lee UH, Choi OJ, Park HY, Shin JH, Kim SE, Kang SJ, Jung SI, Park KH. Hospital water environment and antibiotic use: key factors in a nosocomial outbreak of carbapenemase-producing Serratia marcescens. J Hosp Infect 2024; 151:69-78. [PMID: 38740300 DOI: 10.1016/j.jhin.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The healthcare water environment is a potential reservoir of carbapenem-resistant organisms (CROs). AIM To report the role of the water environment as a reservoir and the infection control measures applied to suppress a prolonged outbreak of Klebsiella pneumoniae carbapenemase-producing Serratia marcescens (KPC-SM) in two intensive care units (ICUs). METHODS The outbreak occurred in the ICUs of a tertiary hospital from October 2020 to July 2021. Comprehensive patient contact tracing and environmental assessments were conducted, and a case-control study was performed to identify factors associated with the acquisition of KPC-SM. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). Antibiotic usage was analysed. FINDINGS The outbreak consisted of two waves involving a total of 30 patients with KPC-SM. Multiple environmental cultures identified KPC-SM in a sink, a dirty utility room, and a communal bathroom shared by the ICUs, together with the waste bucket of a continuous renal replacement therapy (CRRT) system. The genetic similarity of the KPC-SM isolates from patients and the environment was confirmed by PFGE. A retrospective review of 30 cases identified that the use of CRRT and antibiotics was associated with acquisition of KPC-SM (P < 0.05). There was a continuous increase in the use of carbapenems; notably, the use of colistin has increased since 2019. CONCLUSION Our study demonstrates that CRRT systems, along with other hospital water environments, are significant potential sources of resistant micro-organisms, underscoring the necessity of enhancing infection control practices in these areas.
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Affiliation(s)
- U J Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S-M Choi
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - M J Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S U Shin
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S-R Oh
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J-W Park
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H Y Shin
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Y J Kim
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - U H Lee
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - O-J Choi
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H-Y Park
- Department of Pharmacy, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J-H Shin
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S E Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S-J Kang
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S I Jung
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - K-H Park
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
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3
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Rickard H, Cloutman-Green E, Ciric L. A microbiological survey approach to understanding the virulence factors of Pseudomonas species in healthcare sinks. J Hosp Infect 2024; 151:84-91. [PMID: 38992838 DOI: 10.1016/j.jhin.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Hospital water is involved in both the prevention and spread of healthcare-associated infections (HCAIs). Handwashing is key to reducing the transmission of pathogens, yet numerous outbreaks have been found to be caused by organisms within sinks, taps and showers. Pseudomonas aeruginosa and increasingly non-aeruginosa Pseudomonas cause waterborne HCAI, however, little is known about the virulence potential of Pseudomonas species found within hospital environments. METHODS Swabs were taken from 62 sinks within two newly opened wards at Great Ormond Street Hospital, samples were taken before and after the wards opened to understand the impact of patient occupancy on sink micro-organisms. Culturable bacteria were identified by MALDI-TOF and virulence factors assessed through phenotypic methods. RESULTS A total of 106 bacterial isolates were recovered including 24 Pseudomonas isolates. Of these 25% were identified as P. oleovorans, 21% P. aeruginosa, 17% P. composti, 13% P. alicalipha, 8% P. monteilii, 4% P. putida, 4% P. stutzeri and 8% could only be identified to genus level by MALDI-TOF. Differences were seen in both the number of Pseudomonas isolates and virulence production between the two wards, overall 25% of the Pseudomonas isolates produced pigment, 58% were capable of haemolysis, 87.5% were able to swim, 83.3% were capable of twitching motility, 33.3% produced alkaline protease and 8.3% produced gelatinase. CONCLUSIONS Results suggest that patients may be back-contaminating sinks with colonizing organisms which has ongoing implications for infection prevention and control. Additionally, this work highlights the ability of non-aeruginosa Pseudomonas to produce virulence factors traditionally associated with P. aeruginosa.
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Affiliation(s)
- H Rickard
- Healthy Infrastructure Research Group, Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK.
| | - E Cloutman-Green
- Healthy Infrastructure Research Group, Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK; Camelia Botnar Laboratories, Department of Microbiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - L Ciric
- Healthy Infrastructure Research Group, Department of Civil, Environmental and Geomatic Engineering, University College London, London, UK
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Pybus S, Inkster T. Implementation and barriers to waterless care: a questionnaire study of infection prevention and control practitioners, clinicians, and engineers. J Hosp Infect 2024; 152:122-125. [PMID: 39154899 DOI: 10.1016/j.jhin.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/28/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Water and wastewater in healthcare settings are recognized to represent a risk to patients. However, waterless care has not been widely implemented in UK healthcare settings. AIM To identify barriers to implementation of waterless care. METHODS A questionnaire study of infection prevention and control (IPC) practitioners, non-IPC clinicians, and estates managers and engineers was undertaken. FINDINGS Alternatives to water present challenges in perceived acceptability to patients, particularly cleansing wipes for bathing and dry shampoo. There are concerns about cleansing wipes in terms of storage, disposal, sustainability and contamination during manufacture. Estates and engineering concerns include relative water tank size for water turnover and clinical disruption due to works. CONCLUSION Further work is required on acceptability of reduced water scenarios and patient views but the results of this questionnaire provide a grounding for sentiment from healthcare workers on waterless care.
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Affiliation(s)
- S Pybus
- ARHAI Scotland, NHS National Services Scotland, Glasgow, UK.
| | - T Inkster
- ARHAI Scotland, NHS National Services Scotland, Glasgow, UK
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Mizuno S, Kasai M. Inhibition of bacterial growth on sinks of a paediatric intensive care unit using a 222-nm far ultraviolet irradiation device (Care222). J Hosp Infect 2024; 149:206-208. [PMID: 38649120 DOI: 10.1016/j.jhin.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Affiliation(s)
- S Mizuno
- Division of Infectious Disease, Department of Paediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe City, Hyogo, Japan.
| | - M Kasai
- Division of Infectious Disease, Department of Paediatrics, Hyogo Prefectural Kobe Children's Hospital, Kobe City, Hyogo, Japan
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Shikama Y, Yokoya C, Ohara A, Yamashita M, Shimizu Y, Imagawa T. Carbapenemase-producing Enterobacterales isolated from hospital sinks: molecular relationships with isolates from patients and the change in contamination status after daily disinfection with sodium hypochlorite. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e98. [PMID: 38836042 PMCID: PMC11149038 DOI: 10.1017/ash.2024.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
Objective This study aimed to investigate the contamination status of hospital sinks with carbapenemase-producing Enterobacterales (CPE), the efficacy of daily cleaning with sodium hypochlorite, and the relationships between CPEs isolated from contaminated sinks and patients. Design Pre/postintervention surveys of the CPE-contaminated sinks. Setting Hospital wards including pediatric intensive care unit in a children's hospital. Participants Consenting CPE-colonized patients admitted between November 2018 and June 2021 in our hospital. Methods Environmental culture of 180 sinks from nine wards in our hospital was performed three times with an interval of 2 years (2019, 2021, 2023). Molecular typing of the isolated strains from the sinks and patients was performed. After the first surveillance culture, we initiated daily disinfection of the sinks using sodium hypochlorite. Results Before the intervention, we detected 30 CPE-positive sinks in 2019. After the intervention with sodium hypochlorite, we observed a substantial decline in the number of sinks contaminated with CPE; 13 in 2021 and 6 in 2023. However, the intervention did not significantly reduce the number of CPE-contaminated sinks used for the disposal of nutrition-rich substances. The CPE isolates from the patients and those from the sinks of the wards or floors where they were admitted tended to have similar pulse-field gel electrophoresis patterns. Conclusion Contaminated sinks could be reservoirs of disseminating CPE to the patients. Daily disinfection of sinks with sodium hypochlorite may be effective in eliminating CPE, although the effect could be weaker in sinks with a greater risk of contact with nutrition-rich substances.
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Affiliation(s)
- Yoshiaki Shikama
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Infectious Disease and Immunology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Chiemi Yokoya
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Akira Ohara
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Megumi Yamashita
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Clinical Laboratory, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yuichi Shimizu
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Pharmacy, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tomoyuki Imagawa
- Infection Control and Prevention Service, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Infectious Disease and Immunology, Kanagawa Children's Medical Center, Yokohama, Japan
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7
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Volling C, Mataseje L, Graña-Miraglia L, Hu X, Anceva-Sami S, Coleman BL, Downing M, Hota S, Jamal AJ, Johnstone J, Katz K, Leis JA, Li A, Mahesh V, Melano R, Muller M, Nayani S, Patel S, Paterson A, Pejkovska M, Ricciuto D, Sultana A, Vikulova T, Zhong Z, McGeer A, Guttman DS, Mulvey MR. Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: are sink drains to blame? J Hosp Infect 2024; 148:77-86. [PMID: 38554807 DOI: 10.1016/j.jhin.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU). AIM To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission. METHODS This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen. FINDINGS Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. CONCLUSION Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.
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Affiliation(s)
- C Volling
- Department of Microbiology, Sinai Health, Toronto, Canada.
| | - L Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - L Graña-Miraglia
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - X Hu
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - S Anceva-Sami
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - B L Coleman
- Department of Microbiology, Sinai Health, Toronto, Canada
| | | | - S Hota
- Department of Medicine, University Health Network, Toronto, Canada
| | - A J Jamal
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - J Johnstone
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - K Katz
- Department of Medicine, North York General Hospital, Toronto, Canada
| | - J A Leis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Li
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - V Mahesh
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - R Melano
- Pan American Health Organization, Washington, USA
| | - M Muller
- Department of Medicine, Unity Health Toronto, Toronto, Canada
| | - S Nayani
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - S Patel
- Public Health Ontario Laboratory, Toronto, Canada
| | - A Paterson
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - M Pejkovska
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - D Ricciuto
- Department of Medicine, Lakeridge Health, Oshawa, Canada
| | - A Sultana
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - T Vikulova
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Z Zhong
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - A McGeer
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - D S Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada; Centre for the Analysis of Genome Evolution and Function, Department of Cell and Systems Biology, University of Toronto, Toronto, Canada
| | - M R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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Baba H, Kanamori H, Nakayama A, Sato T, Katsumi M, Chida T, Ikeda S, Seki R, Arai T, Kamei K, Tokuda K. A cluster of Candida parapsilosis displaying fluconazole-trailing in a neonatal intensive care unit successfully contained by multiple infection-control interventions. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e86. [PMID: 38774118 PMCID: PMC11106732 DOI: 10.1017/ash.2024.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/24/2024]
Abstract
Objective This study aimed to investigate and contain a cluster of invasive candidiasis cases caused by fluconazole-resistant Candida parapsilosis (FRC) in a neonatal intensive care unit. Methods Active surveillance was initiated. Direct observations of hand-hygiene compliance (HHC) among staff were conducted before and after the implementation of hand-hygiene (HH) education. Thirty-five environmental cultures were obtained. Phylogenetic analysis of FRC was performed using Fourier-transform infrared spectroscopy and microsatellite genotyping. Results A total of 14 patients (mean birth weight = 860 g, gestational age = 25 weeks) infected with FRC were identified using the fully automated analyzer, including 5 with clinical infection (three with catheter-related bloodstream infection, one with cutaneous infection, and one with fatal peritonitis) and 9 with colonization. The HHC rate in nurses before performing a sterile or aseptic procedure significantly improved after the HH education (P < .05). Sinks near the patients were contaminated with FRC. All FRC strains were confirmed to be susceptible to fluconazole using the CLSI method, and the microdilution procedure indicated a trailing effect. Phylogenetic analysis showed that all the fluconazole-trailing isolates from patients were clustered together and had the same genotype. Sinks were successfully decontaminated using accelerated hydrogen peroxide and drainage pipes were replaced. Ultraviolet-C decontamination was applied in the milk preparation room. No new cases were detected after the education and disinfection interventions. Conclusions Sinks are an important reservoir of C. parapsilosis. Active surveillance, environmental hygiene, and constant staff education on maintaining a high level of HHC are necessary to limit the spread of C. parapsilosis.
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Affiliation(s)
- Hiroaki Baba
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Asami Nakayama
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takami Sato
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takae Chida
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinobu Ikeda
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Rio Seki
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Teppei Arai
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
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Regad M, Lizon J, Alauzet C, Roth-Guepin G, Bonmati C, Pagliuca S, Lozniewski A, Florentin A. Outbreak of carbapenemase-producing Citrobacter farmeri in an intensive care haematology department linked to a persistent wastewater reservoir in one hospital room, France, 2019 to 2022. Euro Surveill 2024; 29:2300386. [PMID: 38577805 PMCID: PMC11004594 DOI: 10.2807/1560-7917.es.2024.29.14.2300386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/18/2024] [Indexed: 04/06/2024] Open
Abstract
In 2019-2022, a prolonged outbreak of oxacillinase (OXA)-48-producing Citrobacter farmeri due to a persistent environmental contamination, occurred in our haematology intensive care unit. In April 2019, we isolated OXA-48-producing C. farmeri from rectal samples of two patients in weekly screenings. The cases had stayed in the same hospital room but 4 months apart. We screened five patients who had stayed in this room between the two cases and identified a third case. Over the following 3 years, five other cases were detected, the last case in September 2022. In total, eight cases were detected: seven colonised with the bacterium and one infected with a lethal outcome. All cases stayed in the same hospital room. We detected OXA-48-producing C. farmeri from a shower, washbasin drains and wastewater drainage of the bathroom of the hospital room. Molecular typing confirmed that all C. farmeri isolates from the environment and the cases were indistinguishable. Despite bundle measures to control the outbreak, the bacterium persisted in the system, which resulted in transmission to new patients. A design defect in the placement of wastewater drains contributed to the persistence and proliferation of the bacterium. The room was closed after the last case and the bathroom rebuilt.
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Affiliation(s)
- Marie Regad
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Département d'Hygiène, des Risques Environnementaux et Associés aux Soins (DHREAS), Faculté de Médecine, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Institut national de la santé et de la recherche médicale (Inserm), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes (INSPIIRE), Nancy, France
| | - Julie Lizon
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
| | - Corentine Alauzet
- CHRU-Nancy, Laboratoire de microbiologie, Vandœuvre-lès-Nancy, France
| | | | | | - Simona Pagliuca
- CHRU-Nancy, Service d'hématologie, Vandœuvre-lès-Nancy, France
| | - Alain Lozniewski
- CHRU-Nancy, Laboratoire de microbiologie, Vandœuvre-lès-Nancy, France
- CHRU-Nancy, Laboratoire de microbiologie environnementale, Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Département d'Hygiène, des Risques Environnementaux et Associés aux Soins (DHREAS), Faculté de Médecine, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Institut national de la santé et de la recherche médicale (Inserm), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes (INSPIIRE), Nancy, France
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10
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Aranega-Bou P, Cornbill C, Rodger G, Bird M, Moore G, Roohi A, Hopkins KL, Hopkins S, Ribeca P, Stoesser N, Lipworth SI. WITHDRAWN: Evaluation of Fourier Transform Infrared spectroscopy (IR Biotyper) as a complement to Whole genome sequencing (WGS) to characterise Enterobacter cloacae , Citrobacter freundii and Klebsiella pneumoniae isolates recovered from hospital sinks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.04.24.23289028. [PMID: 37214917 PMCID: PMC10193520 DOI: 10.1101/2023.04.24.23289028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The authors have withdrawn their manuscript due to becoming aware of methodology issues related to the curation of the training set used to determine cut-off values for Biotyper cluster assignation and lack of replicate measurements on different days for the isolates analysed. It is therefore unclear whether the conclusions of the manuscript are founded and no further work is possible to correct these issues as the instrument is no longer available to the authors. If you have any questions, please contact the corresponding author.
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11
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Anantharajah A, Goormaghtigh F, Nguvuyla Mantu E, Güler B, Bearzatto B, Momal A, Werion A, Hantson P, Kabamba-Mukadi B, Van Bambeke F, Rodriguez-Villalobos H, Verroken A. Long-term intensive care unit outbreak of carbapenemase-producing organisms associated with contaminated sink drains. J Hosp Infect 2024; 143:38-47. [PMID: 38295006 DOI: 10.1016/j.jhin.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Between 2018 and 2022, a Belgian tertiary care hospital faced a growing issue with acquiring carbapenemase-producing organisms (CPO), mainly VIM-producing P. aeruginosa (PA-VIM) and NDM-producing Enterobacterales (CPE-NDM) among hospitalized patients in the adult intensive care unit (ICU). AIM To investigate this ICU long-term CPO outbreak involving multiple species and a persistent environmental reservoir. METHODS Active case finding, environmental sampling, whole-genome sequencing (WGS) analysis of patient and environmental strains, and implemented control strategies were described in this study. FINDINGS From 2018 to 2022, 37 patients became colonized or infected with PA-VIM and/or CPE-NDM during their ICU stay. WGS confirmed the epidemiological link between clinical and environmental strains collected from the sink drains with clonal strain dissemination and horizontal gene transfer mediated by plasmid conjugation and/or transposon jumps. Environmental disinfection by quaternary ammonium-based disinfectant and replacement of contaminated equipment failed to eradicate environmental sources. Interestingly, efflux pump genes conferring resistance to quaternary ammonium compounds were widespread in the isolates. As removing sinks was not feasible, a combination of a foaming product degrading the biofilm and foaming disinfectant based on peracetic acid and hydrogen peroxide has been evaluated and has so far prevented recolonization of the proximal sink drain by CPO. CONCLUSION The persistence in the hospital environment of antibiotic- and disinfectant-resistant bacteria with the ability to transfer mobile genetic elements poses a serious threat to ICU patients with a risk of shifting towards an endemicity scenario. Innovative strategies are needed to address persistent environmental reservoirs and prevent CPO transmission.
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Affiliation(s)
- A Anantharajah
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
| | - F Goormaghtigh
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - E Nguvuyla Mantu
- Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - B Güler
- Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - B Bearzatto
- Center for Applied Molecular Technologies, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Momal
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - A Werion
- Department of Intensive Care, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - P Hantson
- Department of Intensive Care, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - B Kabamba-Mukadi
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - F Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - H Rodriguez-Villalobos
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Verroken
- Department of Clinical Microbiology, Cliniques universitaires Saint-Luc, Brussels, Belgium; Medical Microbiology Unit, Institute of Experimental and Clinical Research, Université catholique de Louvain (UCLouvain), Brussels, Belgium; Department of Prevention and Control Infection, Cliniques universitaires Saint-Luc, Brussels, Belgium
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12
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Donskey CJ. Update on potential interventions to reduce the risk for transmission of health care-associated pathogens from floors and sinks. Am J Infect Control 2023; 51:A120-A125. [PMID: 37890941 DOI: 10.1016/j.ajic.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 10/29/2023]
Abstract
Health care facility floors and sink drains and other wastewater drainage sites are universally contaminated with potential pathogens and there are plausible mechanisms by which organisms can be disseminated from these sites. However, floors and sink drains are not addressed as potential sources of pathogen transmission in most health care facilities. One factor that has hindered progress in addressing floors and sinks has been the lack of practical and effective measures to reduce the risk for dissemination of organisms from these sites. This article provides an update on some of the potential interventions being used to reduce the risk for transmission of health care-associated pathogens from floors and sinks. Practical approaches to address these sites of contamination are emphasized.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
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13
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Kearney A, Humphreys H, Fitzgerald-Hughes D. Nutritional drinks and enteral feeds promote the growth of carbapenemase-producing Enterobacterales in conditions that simulate disposal in hospital sinks. J Hosp Infect 2023; 139:74-81. [PMID: 37271316 DOI: 10.1016/j.jhin.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Studies have shown that nutritional products are discarded via handwash sinks by healthcare workers, and this practice may promote bacterial growth, including growth of pathogens such as carbapenemase-producing Enterobacterales (CPE). Outbreaks and acquisition of CPE in nosocomial settings are associated with negative outcomes for patients and hospitals. OBJECTIVES To investigate the potential growth-promoting effect of nutritional support drinks (NSDs) and enteral tube-feed products (ETFPs) on CPE. METHODS Six different CPE strains were grown in five different diluted NSDs, five different diluted ETFPs, Mueller-Hinton broth (MHB) and M9 minimal salts media to simulate discarding a small volume of nutritional product in a u-bend, already containing liquid. CPE were enumerated at 0 h, 6 h and 24 h, and compared using two-way analysis of variance and Dunett test, with confidence levels at 95%. Spearman's r was used to measure the strength of correlation between component concentrations in nutritional products and CPE growth. RESULTS All NSDs and ETFPs promoted CPE growth that exceeded both M9 (negative growth control) and MHB (positive growth control). In several cases, growth in NSDs/ETFPs was significantly greater compared with growth in MHB. CONCLUSION Nutritional products support CPE growth under in-vitro conditions. The propensity of CPE to survive in drain pipework suggests that inappropriate product disposal may further nourish established CPE in these environmental reservoirs. The growth observed in diluted NSDs and ETFPs shows that modifiable practices should be optimized to mitigate the potential risk of CPE transmission from these reservoirs.
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Affiliation(s)
- A Kearney
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - D Fitzgerald-Hughes
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
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14
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Dheda KR, Centner CM, Wilson L, Pooran A, Grimwood S, Ghebrekristos YT, Oelofse S, Joubert IA, Esmail A, Tomasicchio M. Intensive Care Unit Sluice Room Sinks as Reservoirs and Sources of Potential Transmission of Carbapenem-Resistant Bacteria in a South African Tertiary Care Hospital. Infect Drug Resist 2023; 16:5427-5432. [PMID: 37638062 PMCID: PMC10455775 DOI: 10.2147/idr.s418620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose Carbapenem-resistant bacteria (CRB) pose a major health risk to patients in intensive care units (ICU) across African hospitals. There are hardly any data about the role of hospital sinks as reservoirs of CRB in resource-poor African settings. Furthermore, the specific within-sink location of the highest concentration of pathogens and the role of splash back as a transmission mechanism remains poorly clarified. Methods We swabbed ICU sluice room sinks in a tertiary hospital in Cape Town, South Africa. Swabs were taken from four different parts of the sluice room sinks (tap-opening, trap, below the trap, and u-bend). Dilutions were prepared and plated on carbapenem-infused agar. Colonies were identified and drug resistance profiles were determined using a biochemical analyser. To evaluate the potential transmission from the sink, similar plates were placed at fixed distances from the sink when the tap was turned on and off. Results CRB were isolated from the trap, water interface below the trap, and the u-bend (the latter harboured the highest density of CRB species). Five CRB, resistant to at least 7 antibiotic classes, were isolated including Pseudomonas, Klebsiella, Citrobacter, Serratia, and Providencia. CRB could be cultured from droplets that fell on agar-containing plates placed at a varying distance from the trap. Conclusion There is a higher density of CRB in the u-bend of ICU sluice room sinks which can act as a potential source of transmission. The data inform targeted CRB transmission-interruption strategies in resource-poor settings.
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Affiliation(s)
- Khelan R Dheda
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chad M Centner
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Lindsay Wilson
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Anil Pooran
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Shireen Grimwood
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Yonas T Ghebrekristos
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Suzette Oelofse
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Ivan A Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Michele Tomasicchio
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
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15
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Cahill ME, Jaworski M, Harcy V, Young E, Ham DC, Gable P, Carter KK. Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit - Idaho, 2021-2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:844-846. [PMID: 37535466 PMCID: PMC10414995 DOI: 10.15585/mmwr.mm7231a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Treatment of carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) infections is challenging because of antibiotic resistance. CP-CRPA infections are highly transmissible in health care settings because they can spread from person to person and from environmental sources such as sink drains and toilets. During September 2021-January 2022, an Idaho hospital (hospital A) isolated CP-CRPA from sputum of two patients who stayed in the same intensive care unit (ICU) room (room X), 4 months apart. Both isolates had active-on-imipenem metallo-beta-lactamase (IMP) carbapenemase gene type 84 (blaIMP-84) and were characterized as multilocus sequence type 235 (ST235). A health care-associated infections team from the Idaho Division of Public Health visited hospital A during March 21-22, 2022, to discuss the cluster investigation with hospital A staff members and to collect environmental samples. CP-CRPA ST235 with blaIMP-84 was isolated from swab samples of one sink in room X, suggesting it was the likely environmental source of transmission. Recommended prevention and control measures included application of drain biofilm disinfectant, screening of future patients who stay in room X (e.g., the next 10 occupants) upon reopening, and continuing submission of carbapenem-resistant P. aeruginosa (CRPA) isolates to public health laboratories. Repeat environmental sampling did not detect any CRPA. As of December 2022, no additional CP-CRPA isolates had been reported by hospital A. Collaboration between health care facilities and public health agencies, including testing of CRPA isolates for carbapenemase genes and implementation of sink hygiene interventions, was critical in the identification of and response to this CP-CRPA cluster in a health care setting.
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16
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Zeng M, Xia J, Zong Z, Shi Y, Ni Y, Hu F, Chen Y, Zhuo C, Hu B, Lv X, Li J, Liu Z, Zhang J, Yang W, Yang F, Yang Q, Zhou H, Li X, Wang J, Li Y, Ren J, Chen B, Chen D, Wu A, Guan X, Qu J, Wu D, Huang X, Qiu H, Xu Y, Yu Y, Wang M. Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:653-671. [PMID: 36868960 DOI: 10.1016/j.jmii.2023.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 02/19/2023]
Abstract
The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.
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Affiliation(s)
- Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 200032, China
| | - Jun Xia
- The Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Ningbo, China; Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Yuxing Ni
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Fupin Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai 200040, China
| | - Yijian Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai 200040, China
| | - Chao Zhuo
- Department of Infectious Diseases, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoju Lv
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
| | - Zhengyin Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai 200040, China
| | - Wenjie Yang
- Department of Infectious Diseases, Tianjin First Center Hospital, Tianjin 300192, China
| | - Fan Yang
- Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai 200040, China
| | - Qiwen Yang
- Department and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xin Li
- Department of Pharmacy, The Third Hospital of Changsha, Changsha 410015, China
| | - Jianhua Wang
- Pharmaceutical Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Yimin Li
- Department of Critical Care Medicine,State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jian'an Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Baiyi Chen
- Divison of Infectious Diseases, The First Hospital of China Medical University, Shenyang 110001, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Beijing 100044, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yingchun Xu
- Department and State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, And Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission of People's Republic of China, Shanghai 200040, China.
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17
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Hamerlinck H, Aerssens A, Boelens J, Dehaene A, McMahon M, Messiaen AS, Vandendriessche S, Velghe A, Leroux-Roels I, Verhasselt B. Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting. Antimicrob Resist Infect Control 2023; 12:58. [PMID: 37337245 DOI: 10.1186/s13756-023-01261-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Accumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures. METHODS Environmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci. RESULTS The CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms. CONCLUSIONS Our findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.
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Affiliation(s)
- Hannelore Hamerlinck
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
| | - Annelies Aerssens
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Andrea Dehaene
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Michael McMahon
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | | | | | - Anja Velghe
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Isabel Leroux-Roels
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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18
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Chan A, Thure K, Tobey K, Shugart A, Schmedes S, Burks JA, Hardin H, Moore C, Carpenter T, Brooks S, Gable P, Moulton Meissner H, McAllister G, Lawsin A, Laufer Halpin A, Spalding Walters M, Keaton A. Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020. Open Forum Infect Dis 2023; 10:ofad194. [PMID: 37180588 PMCID: PMC10173543 DOI: 10.1093/ofid/ofad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation. Methods A case was defined as polymerase chain reaction detection of blaVIM in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS). Results In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring blaVIM-1 and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions. Conclusions A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients.
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Affiliation(s)
- Allison Chan
- Correspondence: Allison Chan, MPH, Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, 2525 West End Avenue, Suite 600, Nashville, TN 37203 (); Present Affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katie Thure
- Present Affiliation: David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelley Tobey
- Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Sarah Schmedes
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - James Albert Burks
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Henrietta Hardin
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Christina Moore
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Tina Carpenter
- North Knoxville Medical Center, Knoxville, Tennessee, USA
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Heather Moulton Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Amelia Keaton
- Present Affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
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19
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Methods of Cleaning Taps to Prevent Hospital-Associated Infections: An Environmental Survey-Based Study. Infect Dis Rep 2023; 15:142-149. [PMID: 36826355 PMCID: PMC9957207 DOI: 10.3390/idr15010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
In hospitals, outbreaks can occur due to pathogens accumulating in the areas around the wards' washbasins. Carbapenem-resistant Enterobacterales (CRE) was detected in an environmental survey in the high-care unit of a university hospital in Isehara, Japan, and effective cleaning methods were investigated. This study investigated methods of cleaning taps using commonly used detergents and disinfectants, and it assessed their effectiveness in removing hard scale and pathogens, including CRE. The taps were cleaned using various methods and cleaning agents, including environmentally neutral detergent, citric acid, baking soda, cleanser, 80% ethanol, 0.1% sodium hypochlorite, and a phosphoric acid-based environmental detergent (Space Shot). The cleaning effect was assessed based on the agent's effectiveness at removing hard scale from taps. Biofilms and scale were identified on taps, and several bacterial species were cultured. Only phosphoric acid-based detergent was effective at removing hard scale. After cleaning with the phosphoric acid-based detergent, the bacterial count decreased, and no CRE or other pathogens were detected. These results provide a reference for other facilities considering introducing this cleaning method.
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20
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Peters A, Parneix P, Kiernan M, Severin JA, Gauci T, Pittet D. New frontiers in healthcare environmental hygiene: thoughts from the 2022 healthcare cleaning forum. Antimicrob Resist Infect Control 2023; 12:7. [PMID: 36750872 PMCID: PMC9902814 DOI: 10.1186/s13756-022-01185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 02/09/2023] Open
Abstract
Healthcare environmental hygiene (HEH) has become recognized as being increasingly important for patient safety and the prevention of healthcare-associated infections. At the 2022 Healthcare Cleaning Forum at Interclean in Amsterdam, the academic lectures focused on a series of main areas of interest. These areas are indicative of some of the main trends and avenues for research in the coming years. Both industry and academia need to take steps to continue the momentum of HEH as we transition out of the acute phase of the Covid-19 pandemic. There is a need for new ways to facilitate collaboration between the academic and private sectors. The Clean Hospitals® network was presented in the context of the need for both cross-disciplinarity and evidence-based interventions in HEH. Governmental bodies have also become more involved in the field, and both the German DIN 13603 standard and the UK NHS Cleaning Standards were analyzed and compared. The challenge of environmental pathogens was explored through the example of how P. aeruginosa persists in the healthcare environment. New innovations in HEH were presented, from digitalization to tracking, and automated disinfection to antimicrobial surfaces. The need for sustainability in HEH was also explored, focusing on the burden of waste, the need for a circular economy, and trends towards increasingly local provision of goods and services. The continued focus on and expansion of these areas of HEH will result in safer patient care and contribute to better health systems.
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Affiliation(s)
- Alexandra Peters
- grid.8591.50000 0001 2322 4988Infection Control Programme and WHO Collaborating Center On Infection Prevention and Control and Antimicrobial Resistance, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Parneix
- grid.42399.350000 0004 0593 7118Nouvelle Aquitaine Health Care-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - Martin Kiernan
- grid.81800.310000 0001 2185 7124Richard Wells Research Centre, University of West London, London, UK
| | - Juliëtte A. Severin
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tracey Gauci
- grid.428852.10000 0001 0449 3568Hywel Dda University Health Board, NHS Wales, Carmarthen, UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center On Infection Prevention and Control and Antimicrobial Resistance, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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21
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Rice W, Martin J, Hodgkin M, Carter J, Barrasa A, Sweeting K, Johnson R, Best E, Nahl J, Denton M, Hughes GJ. A protracted outbreak of difficult-to-treat resistant Pseudomonas aeruginosa in a haematology unit: a matched case-control study demonstrating increased risk with use of fluoroquinolone. J Hosp Infect 2023; 132:52-61. [PMID: 36563938 DOI: 10.1016/j.jhin.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Between September 2016 and November 2020, 17 cases of difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) were reported in haematology patients at a tertiary referral hospital in the North of England. AIM A retrospective case-control study was conducted to investigate the association between DTR-PA infection and clinical interventions, patient movement, antimicrobial use and comorbidities. METHODS Cases were patients colonized or infected with the outbreak strain of DTR-PA who had been admitted to hospital prior to their positive specimen. Exposures were extracted from medical records, and cases were compared with controls using conditional logistic regression. Environmental and microbiological investigations were also conducted. FINDINGS Seventeen cases and 51 controls were included. The final model included age [>65 years, adjusted OR (aOR) 6.85, P=0.232], sex (aOR 0.60, P=0.688), admission under the transplant team (aOR 14.27, P=0.43) and use of ciprofloxacin (aOR 102.13, P=0.030). Investigations did not indicate case-to-case transmission or a point source, although a common environmental source was highly likely. CONCLUSION This study found that the use of fluoroquinolones is an independent risk factor for DTR-PA in haematology patients. Antimicrobial stewardship and review of fluoroquinolone prophylaxis should be considered as part of PA outbreak investigations in addition to standard infection control interventions.
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Affiliation(s)
- W Rice
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK; Field Service, United Kingdom Health Security Agency, Leeds, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - M Hodgkin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Carter
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Barrasa
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK
| | - K Sweeting
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Best
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Nahl
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Denton
- Field Service, United Kingdom Health Security Agency, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G J Hughes
- Field Service, United Kingdom Health Security Agency, Leeds, UK.
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22
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Ababneh Q, Abu Laila S, Jaradat Z. Prevalence, genetic diversity, antibiotic resistance and biofilm formation of Acinetobacter baumannii isolated from urban environments. J Appl Microbiol 2022; 133:3617-3633. [PMID: 36002793 DOI: 10.1111/jam.15795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/27/2022]
Abstract
AIM Acinetobacter baumannii is a well-known nosocomial pathogen that has been isolated from different clinical sources. This pathogen also causes community-acquired infections, with mortality rates as high as 64%. The exact natural habitat of this bacterium is still unknown. In this study, we investigated the prevalence of A. baumannii in diverse soil and high-touch surface samples collected from a university campus, malls, parks, hypermarkets and produce markets, roundabout playground slides, and bank ATMs. METHODS AND RESULTS All obtained isolates were characterized for their antibiotic susceptibility, biofilm formation capacities, and were typed by multi-locus sequence analysis. A total of 63 A. baumannii isolates were recovered, along with 46 A. pittii and 8 A. nosocomialis isolates. Sequence typing revealed that 25 A. baumannii isolates are novel strains. Toilets and sink washing basins were the most contaminated surfaces, accounting for almost 50% of the recovered isolates. A number of A. baumannii (n=10), A. pittii (n=19) and A. nosocomialis (n=5) isolates were recovered from handles of shopping carts and baskets. The majority of isolates were strong biofilm formers and 4 exhibited a multi-drug resistant (MDR) phenotype. CONCLUSIONS Our study is the first to highlight community restrooms and shopping carts as potential reservoirs for pathogenic Acinetobacter species. Further studies are required to identify the reasons associated with the occurrence of A. baumannii inside restrooms. Proper disinfection of community environmental surfaces and spreading awareness about the importance of hand hygiene may prevent the dissemination of pathogenic bacteria within the community. SIGNIFICANCE AND IMPACT OF STUDY Serious gaps remain in our knowledge of how A. baumannii spreads to cause disease. This study will advance our understanding of how this pathogen spreads between healthcare and community environments. In addition, our findings will help healthcare decision makers implement better measures to control and limit further transmission of A. baumannii.
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Affiliation(s)
- Qutaiba Ababneh
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Sally Abu Laila
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Jaradat
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
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23
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Zhang HL, Kelly BJ, David MZ, Lautenbach E, Huang E, Bekele S, Tolomeo P, Reesey E, Loughrey S, Pegues D, Ziegler MJ. SARS-CoV-2 RNA persists on surfaces following terminal disinfection of COVID-19 hospital isolation rooms. Am J Infect Control 2022; 50:462-464. [PMID: 35108581 PMCID: PMC8801058 DOI: 10.1016/j.ajic.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/01/2023]
Abstract
We evaluated the effect of terminal cleaning on SARS-CoV-2 RNA contamination of COVID-19 isolation rooms in an acute care hospital. SARS-CoV-2 RNA was detected on 32.1% of room surfaces after cleaning; the odds of contamination increased with month. The prevalence of elevated high-touch surface contamination was lower in terminally cleaned rooms than patient-occupied rooms.
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Affiliation(s)
- Helen L Zhang
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Brendan J Kelly
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Elizabeth Huang
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Selamawit Bekele
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Pam Tolomeo
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Emily Reesey
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sean Loughrey
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - David Pegues
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Health Care Epidemiology, Infection Prevention and Control, University of Pennsylvania Health System, Philadelphia, PA
| | - Matthew J Ziegler
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Health Care Epidemiology, Infection Prevention and Control, University of Pennsylvania Health System, Philadelphia, PA
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24
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van der Zwet W, Nijsen I, Jamin C, van Alphen L, von Wintersdorff C, Demandt A, Savelkoul P. Role of the environment in transmission of Gram-negative bacteria in two consecutive outbreaks in a haematology-oncology department. Infect Prev Pract 2022; 4:100209. [PMID: 35295671 PMCID: PMC8918851 DOI: 10.1016/j.infpip.2022.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/09/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- W.C. van der Zwet
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Corresponding author.
| | - I.E.J. Nijsen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C. Jamin
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L.B. van Alphen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C.J.H. von Wintersdorff
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A.M.P. Demandt
- Dept. Haematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P.H.M. Savelkoul
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
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25
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Perez-Palacios P, Delgado-Valverde M, Gual-de-Torrella A, Oteo-Iglesias J, Pascual Á, Fernández-Cuenca F. Co-transfer of plasmid-encoded bla carbapenemases genes and mercury resistance operon in high-risk clones of Klebsiella pneumoniae. Appl Microbiol Biotechnol 2021; 105:9231-9242. [PMID: 34846573 DOI: 10.1007/s00253-021-11684-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) is a real global health threat. Environmental reservoirs of resistance gene determinats, such as effluents of hospital wastewaters, are acquiring increased relevance in the selection of plasmid-encoded carbapenemase genes. The presence of Hg in environmental reservoirs may exert a positive selective pressure on tolerant bacteria, favoring the co-transfer of carbapenemase genes and mer operons. In our study, 63 CP-Kp isolates were screened for mer operons by whole genome sequencing (MySeq). Conjugation assays were performed with 24 out of 63 CP-Kp isolates harboring the mer operon. Ten transconjugants (Tc-Kp) were selected with Hg. Plasmid DNA of Tc-Kp was extracted and sequenced using single-molecule real-time (SMRT) technology (PacBio, Sequel II system) with later annotation. Plasmid analysis revealed that Tc-Kp from blaIMP-like (n = 3) showed a single plasmid belonging to IncC group with two complete mer operon next to blaIMP-like. Tc-Kp from blaVIM-1 (n = 2) harbored two plasmids, one with blaVIM-1 in an IncL, and mer operon was in an IncFIB plasmid. Tc-Kp from blaOXA-48-like (n = 5) showed 2 plasmids. blaOXA-48-like was found in an IncL plasmid, whereas mer operon was (i) in an IncR plasmid associated with blaCTX-M-15 in 3 Tc-Kp-OXA-48-like, (ii) in an IncC plasmid associated with blaCMY-2 in 1 Tc-Kp-OXA-48-like, (iii) and in an IncFIB plasmid associated with blaCTX-M-15 in 1 Tc-Kp-OXA-48-like. This is, to our knowledge, the first study to describe in K. pneumoniae producing plasmid-encoded carbapenemase, the potential impact of Hg in the co-transfer of mer operons and carbapenemase genes located in the same or different plasmids. KEY POINTS: • Environmental reservoirs are playing an important role in the selection of carbapenemase genes. • Conjugation assays, selecting with Hg, obtained 10 transconjugants with carbapenemase genes. • mer operons were located in the same or different plasmids than carbapenemase genes.
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Affiliation(s)
- Patricia Perez-Palacios
- Unidad de Gestión Clínica de Enfermedades Infecciosas Y Microbiología Clínica, Hospital Universitario Virgen Macarena, Seville, Spain. .,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain. .,Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain.
| | - Mercedes Delgado-Valverde
- Unidad de Gestión Clínica de Enfermedades Infecciosas Y Microbiología Clínica, Hospital Universitario Virgen Macarena, Seville, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain
| | - Ana Gual-de-Torrella
- Unidad de Gestión Clínica de Enfermedades Infecciosas Y Microbiología Clínica, Hospital Universitario Virgen Macarena, Seville, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain
| | - Jesús Oteo-Iglesias
- Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain.,Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Álvaro Pascual
- Unidad de Gestión Clínica de Enfermedades Infecciosas Y Microbiología Clínica, Hospital Universitario Virgen Macarena, Seville, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain.,Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
| | - Felipe Fernández-Cuenca
- Unidad de Gestión Clínica de Enfermedades Infecciosas Y Microbiología Clínica, Hospital Universitario Virgen Macarena, Seville, Spain.,Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Seville, Spain
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26
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Perez-Palacios P, Gual-de-Torrella A, Delgado-Valverde M, Oteo-Iglesias J, Hidalgo-Díaz C, Pascual Á, Fernández-Cuenca F. Transfer of plasmids harbouring bla OXA-48-like carbapenemase genes in biofilm-growing Klebsiella pneumoniae: Effect of biocide exposure. Microbiol Res 2021; 254:126894. [PMID: 34717138 DOI: 10.1016/j.micres.2021.126894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/17/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
The spread of OXA-48-encoding plasmids from Klebsiella pneumoniae (OXA-48-Kpn), especially successful high-risk (HR) clones, is a growing concern. Biofilm formation can contribute to the dissemination of OXA-48-Kpn. It is not known whether biocides can affect the transfer of OXA-48-Kpn in biofilm. The aim of this study was to evaluate the effect of biocides on the conjugation frequency (CF) of OXA-48-Kpn in both biofilm and planktonic cultures. For that, seven OXA-48-Kpn isolates (4 belonging to HR clones and 3 to non-HR clones) were selected as donors. Each isolate was mixed (1:1) with Escherichia coli J53 (recipient) and grown on polystyrene microplates without biocides (control) and with 0.25x MIC of triclosan (TRI), chlorhexidine digluconate (CHX), povidone-iodine (POV), sodium hypochlorite (SOD) or ethanol (ETH). The CF was calculated as the number of transconjugants/number of E. coli J53. The results showed that for isolates growing in the absence of biocide, the mean fold change in the CF in biofilm with respect to that determined in planktonic cells (CF-BF/CF-PK) was 0.2 in non-HR isolates and ranged from 2.0 to 14.7 in HR isolates. In HR isolates grown in the presence of biocide, especially CHX, TRI, and ETH, the fold changes in CF-BF/CF-PK decreased, whereas in non-HR isolates the fold changes were similar or increased slightly with CHX, ETH, SOD and POV. In conclusion, the fold changes in the CF-BF/CF-PK are higher in HR isolates comparing to non-HR isolates in abscence of biocides. The fold changes in CF-BF/CF-PK of the HR isolates in the presence of biocides varied with the type of biocides, whereas in non-HR isolates, biocides have no significant effect, or produce only a slight increase in the fold change of CF-BF/CF-PK.
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Affiliation(s)
- Patricia Perez-Palacios
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Ana Gual-de-Torrella
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mercedes Delgado-Valverde
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Jesús Oteo-Iglesias
- Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Carmen Hidalgo-Díaz
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Álvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Felipe Fernández-Cuenca
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, RD16/CIII/0004/0002), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain.
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27
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Olmsted RN. Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic. Infect Dis Clin North Am 2021; 35:697-716. [PMID: 34362539 PMCID: PMC8331249 DOI: 10.1016/j.idc.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
The built environment has been integral to response to the global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In particular, engineering controls to mitigate risk of exposure to SARS-CoV-2 and other newly emergent respiratory pathogens in the future will be important. Anticipating emergence from this pandemic, or at least adaptation given increasing administration of effective vaccines, and the safety of patients, personnel, and others in health care facilities remain the core goals. This article summarizes known risks and highlights prevention strategies for daily care as well as response to emergent infectious diseases and this parapandemic phase.
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Affiliation(s)
- Russell N Olmsted
- Integrated Clinical Services (ICS), Trinity Health, Mailstop W3B, 20555 Victor Parkway, Livonia, MI 48152, USA.
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28
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Inkster T, Peters C, Wafer T, Holloway D, Makin T. Investigation and control of an outbreak due to a contaminated hospital water system, identified following a rare case of Cupriavidus pauculus bacteraemia. J Hosp Infect 2021; 111:53-64. [PMID: 33926650 DOI: 10.1016/j.jhin.2021.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cupriavidus pauculus is rare cause of clinical infection. We describe an outbreak of C. pauculus and other Gram-negative bacteraemias in a paediatric haemato-oncology unit secondary to a contaminated water supply and drainage system. AIM To describe the investigation and control measures implemented for a waterborne infection outbreak in a new build hospital. METHODS Extensive water testing from various points within the water system was undertaken. Taps, showerheads and components including flow straighteners underwent microbiological analysis. Drains were also swabbed. Surveillance for Gram-negative infections was established on the unit. FINDINGS Water testing revealed widespread contamination of the water and drainage system. Outlets were also heavily contaminated, including flow straighteners. Drains were found to have underlying structural abnormalities. Water testing enabled us to detect high-risk components within the water system such as the expansion vessels and outlets and the results assisted with hypotheses generation. Review of commissioning data and risk assessments revealed extensive risks present within the water system prior to and after hospital opening. CONCLUSION Careful design, adequate control measures and maintenance are essential for hospital water systems in order to prevent infections due to waterborne organisms. We discuss what can be learned from this incident with a view to future prevention.
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Affiliation(s)
- T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK.
| | - C Peters
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - T Wafer
- The Water Solutions Group, Haggs Road, Harrogate, UK
| | - D Holloway
- Water Quality Services, Intertek, Stoke on Trent, UK
| | - T Makin
- Makin and Makin Consultancy, Tarporley, UK
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Hamilton KA, Kuppravalli A, Heida A, Joshi S, Haas CN, Verhougstraete M, Gerrity D. Legionnaires' disease in dental offices: Quantifying aerosol risks to dental workers and patients. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:378-393. [PMID: 34161202 DOI: 10.1080/15459624.2021.1939878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legionella pneumophila is an opportunistic bacterial respiratory pathogen that is one of the leading causes of drinking water outbreaks in the United States. Dental offices pose a potential risk for inhalation or aspiration of L. pneumophila due to the high surface area to volume ratio of dental unit water lines-a feature that is conducive to biofilm growth. This is coupled with the use of high-pressure water devices (e.g., ultrasonic scalers) that produce fine aerosols within the breathing zone. Prior research confirms that L. pneumophila occurs in dental unit water lines, but the associated human health risks have not been assessed. We aimed to: (1) synthesize the evidence for transmission and management of Legionnaires' disease in dental offices; (2) create a quantitative modeling framework for predicting associated L. pneumophila infection risk; and (3) highlight influential parameters and research gaps requiring further study. We reviewed outbreaks, management guidance, and exposure studies and used these data to parameterize a quantitative microbial risk assessment (QMRA) model for L. pneumophila in dental applications. Probabilities of infection for dental hygienists and patients were assessed on a per-exposure and annual basis. We also assessed the impact of varying ventilation rates and the use of personal protective equipment (PPE). Following an instrument purge (i.e., flush) and with a ventilation rate of 1.2 air changes per hour, the median per-exposure probability of infection for dental hygienists and patients exceeded a 1-in-10,000 infection risk benchmark. Per-exposure risks for workers during a purge and annual risks for workers wearing N95 masks did not exceed the benchmark. Increasing air change rates in the treatment room from 1.2 to 10 would achieve an ∼85% risk reduction, while utilization of N95 respirators would reduce risks by ∼95%. The concentration of L. pneumophila in dental unit water lines was a dominant parameter in the model and driver of risk. Future risk assessment efforts and refinement of microbiological control protocols would benefit from expanded occurrence datasets for L. pneumophila in dental applications.
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Affiliation(s)
- Kerry A Hamilton
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Aditya Kuppravalli
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
- BASIS Scottsdale High School, Scottsdale, Arizona
| | - Ashley Heida
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Sayalee Joshi
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Charles N Haas
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, Pennsylvania
| | - Marc Verhougstraete
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
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Abstract
Although many aspects of infection prevention and control (IPC) mirror institutional efforts, optimization of IPC practices in the neonatal intensive care unit requires careful consideration of its unique population and environment, addressed here for key IPC domains. In addition, innovative mitigation efforts to address challenges specific to limited resource settings are discussed.
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Aranega-Bou P, Cornbill C, Verlander NQ, Moore G. A splash-reducing clinical handwash basin reduces droplet-mediated dispersal from a sink contaminated with Gram-negative bacteria in a laboratory model system. J Hosp Infect 2021; 114:171-174. [PMID: 33895165 DOI: 10.1016/j.jhin.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Infection prevention strategies need to be identified and evaluated to reduce the risk associated with contaminated hospital sinks. This study used settle plates to compare the dispersal of Gram-negative bacteria from a conventional, rear-draining clinical handwash basin (CHWB) and a 'splash-reducing' CHWB with and/or without impaired drainage. Two scenarios were assessed: dispersal from a contaminated basin and dispersal from a contaminated drain. The associated tap was operated for 1 min and, for all contamination scenarios, the 'splash-reducing' CHWB had significantly lower odds of spreading contamination than the conventional CHWB.
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Affiliation(s)
- P Aranega-Bou
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK.
| | - C Cornbill
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
| | - N Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service, Public Health England, Colindale, UK
| | - G Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
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Standard versus combined chemical, mechanical, and heat decontamination of hospital drains harboring carbapenemase-producing organisms (CPOs): A randomized controlled trial. Infect Control Hosp Epidemiol 2021; 42:1275-1278. [PMID: 33551004 DOI: 10.1017/ice.2020.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We sought to determine whether combined chemical, mechanical, and heat cleaning was superior to standard cleaning for the decontamination of 32 sink and shower drains harboring carbapenemase-producing organisms (CPOs). Of 16 intervention drains, 10 (63%) were decontaminated until day 7 versus 1 (5%) of 16 comparator drains (P = .002). Intensive cleaning may be useful if administered repeatedly in drain-associated CPO outbreaks.
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Volling C, Ahangari N, Bartoszko JJ, Coleman BL, Garcia-Jeldes F, Jamal AJ, Johnstone J, Kandel C, Kohler P, Maltezou HC, Maze Dit Mieusement L, McKenzie N, Mertz D, Monod A, Saeed S, Shea B, Stuart RL, Thomas S, Uleryk E, McGeer A. Are Sink Drainage Systems a Reservoir for Hospital-Acquired Gammaproteobacteria Colonization and Infection? A Systematic Review. Open Forum Infect Dis 2020; 8:ofaa590. [PMID: 33553469 PMCID: PMC7856333 DOI: 10.1093/ofid/ofaa590] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 01/23/2023] Open
Abstract
Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Monod
- Sinai Health System, Toronto, Ontario, Canada
| | | | | | | | - Sera Thomas
- Sinai Health System, Toronto, Ontario, Canada
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Risk Factors Associated with Carbapenemase-Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment. Appl Environ Microbiol 2020; 86:AEM.01715-20. [PMID: 32917755 PMCID: PMC7688209 DOI: 10.1128/aem.01715-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment. Hospital wastewater is an increasingly recognized reservoir for resistant Gram-negative organisms. Factors involved in establishment and persistence of Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) in hospital wastewater plumbing are unclear. This study was conducted at a hospital with endemic KPCOs linked to wastewater reservoirs and robust patient perirectal screening for silent KPCO carriage. Over 5 months, both rooms occupied and rooms not occupied by KPCO-positive patients were sampled at three wastewater sites within each room (sink drain, sink P-trap, and toilet or hopper). Risk factors for KPCO positivity were assessed using logistic regression. Whole-genome sequencing (WGS) identified environmental seeding by KPCO-positive patients. A total of 219/475 (46%) room sampling events were KPCO positive in at least one wastewater site. KPCO-positive patient exposure was associated with increased risk of environmental positivity for the room and toilet/hopper. Previous positivity and intensive care unit room type were consistently associated with increased risk. Tube feeds were associated with increased risk for the drain, while exposure to patients with Clostridioides difficile was associated with decreased risk. Urinary catheter exposure was associated with increased risk of P-trap positivity. P-trap heaters reduced risk of P-trap and sink drain positivity. WGS identified genomically linked environmental seeding in 6 of 99 room occupations by 40 KPCO-positive patients. In conclusion, KPCO-positive patients seed the environment in at least 6% of opportunities; once positive for KPCOs, wastewater sites are at greater risk of being positive subsequently. Increased nutrient exposure, e.g., due to tube food disposal down sinks, may increase risk; frequent flushing may be protective. IMPORTANCEKlebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment.
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Carbapenemase-producing Enterobacterales in hospital drains in Southern Ontario, Canada. J Hosp Infect 2020; 106:820-827. [PMID: 32916210 DOI: 10.1016/j.jhin.2020.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital drains may be an important reservoir for carbapenemase-producing Enterobacterales (CPE). AIM To determine prevalence of CPE in hospital drains exposed to inpatients with CPE, relatedness of drain and patient CPE, and risk factors for drain contamination. METHODS Sink and shower drains in patient rooms and communal shower rooms exposed to 310 inpatients with CPE colonization/infection were cultured at 10 hospitals. Using short- and long-read whole-genome sequencing, inpatient and corresponding drain CPE were compared. Risk factors for drain contamination were assessed using multi-level modelling. FINDINGS Of 1209 exposed patient room and communal shower room drains, 53 (4%) yielded 62 CPE isolates in seven (70%) hospitals. Of 49 CPE isolates in patient room drains, four (8%) were linked to prior room occupants. Linked drain/room occupant pairs included Citrobacter freundii ST18 isolates separated by eight single nucleotide variants (SNVs), related blaKPC-containing IncN3-type plasmids (different species), related blaKPC-3-containing IncN-type plasmids (different species), and related blaOXA-48-containing IncL/M-type plasmids (different species). In one hospital, drain isolates from eight rooms on two units were Enterobacter hormaechei separated by 0-6 SNVs. Shower drains were more likely to be CPE-contaminated than hand hygiene (odds ratio: 3.45; 95% confidence interval: 1.66-7.16) or patient-use (13.0; 4.29-39.1) sink drains. Hand hygiene sink drains were more likely to be CPE-contaminated than patient-use sink drains (3.75; 1.17-12.0). CONCLUSION Drain contamination was uncommon but widely dispersed. Drain CPE unrelated to patient exposure suggests contamination by undetected colonized patients or retrograde (drain-to-drain) contamination. Drain types had different contamination risks.
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36
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Heireman L, Hamerlinck H, Vandendriessche S, Boelens J, Coorevits L, De Brabandere E, De Waegemaeker P, Verhofstede S, Claus K, Chlebowicz-Flissikowska MA, Rossen JWA, Verhasselt B, Leroux-Roels I. Toilet drain water as a potential source of hospital room-to-room transmission of carbapenemase-producing Klebsiella pneumoniae. J Hosp Infect 2020; 106:232-239. [PMID: 32707194 DOI: 10.1016/j.jhin.2020.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) have rapidly emerged in Europe, being responsible for nosocomial outbreaks. AIM Following an outbreak in the burn unit of Ghent University Hospital, we investigated whether CPE can spread between toilets through drain water and therefrom be transmitted to patients. METHODS In 2017, the burn centre of our hospital experienced an outbreak of OXA-48-producing Klebsiella pneumoniae that affected five patients staying in three different rooms. Environmental samples were collected from the sink, shower, shower stretcher, hand rail of the bed, nursing carts, toilets, and drain water to explore a common source. Whole-genome sequencing and phylogenetic analysis was performed on K. pneumoniae outbreak isolates and two random K. pneumoniae isolates. FINDINGS OXA-48-producing K. pneumoniae was detected in toilet water in four out of six rooms and drain water between two rooms. The strain persisted in two out of six rooms after two months of daily disinfection with bleach. All outbreak isolates belonged to sequence type (ST) 15 and showed isogenicity (<15 allele differences). This suggests that the strain may have spread between rooms by drain water. Unexpectedly, one random isolate obtained from a patient who became colonized while residing at the geriatric ward clustered with the outbreak isolates, suggesting the outbreak to be larger than expected. Daily application of bleach tended to be superior to acetic acid to disinfect toilet water; however, disinfection did not completely prevent the presence of carbapenemase-producing K. pneumoniae in toilet water. CONCLUSION Toilet drain water may be a potential source of hospital room-to-room transmission of carbapenemase-producing K. pneumoniae.
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Affiliation(s)
- L Heireman
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - H Hamerlinck
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S Vandendriessche
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - J Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium; Infection Control Team, Ghent University Hospital, Ghent, Belgium
| | - L Coorevits
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - E De Brabandere
- Infection Control Team, Ghent University Hospital, Ghent, Belgium
| | - P De Waegemaeker
- Infection Control Team, Ghent University Hospital, Ghent, Belgium
| | - S Verhofstede
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K Claus
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - M A Chlebowicz-Flissikowska
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W A Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - B Verhasselt
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - I Leroux-Roels
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium; Infection Control Team, Ghent University Hospital, Ghent, Belgium.
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37
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Proctor CR, Rhoads WJ, Keane T, Salehi M, Hamilton K, Pieper KJ, Cwiertny DM, Prévost M, Whelton AJ. Considerations for large building water quality after extended stagnation. AWWA WATER SCIENCE 2020; 2:e1186. [PMID: 32838226 DOI: 10.31219/osf.io/qvj3b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 05/25/2023]
Abstract
The unprecedented number of building closures related to the coronavirus disease (COVID-19) pandemic is concerning because water stagnation will occur in many buildings that do not have water management plans in place. Stagnant water can have chemical and microbiological contaminants that pose potential health risks to occupants. Health officials, building owners, utilities, and other entities are rapidly developing guidance to address this issue, but the scope, applicability, and details included in the guidance vary widely. To provide a primer of large building water system preventative and remedial strategies, peer-reviewed, government, industry, and nonprofit literature relevant to water stagnation and decontamination practices for plumbing was synthesized. Preventative practices to help avoid the need for recommissioning (e.g., routine flushing) and specific actions, challenges, and limitations associated with recommissioning were identified and characterized. Considerations for worker and occupant safety were also indicated. The intended audience of this work includes organizations developing guidance.
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Affiliation(s)
- Caitlin R Proctor
- Division of Environmental and Ecological Engineering, Lyles School of Civil Engineering, Weldon School of Biomedical Engineering, School of Materials Engineering Purdue University West Lafayette Indiana
| | - William J Rhoads
- Department of Civil and Environmental Engineering Virginia Tech Blacksburg Virginia
| | - Tim Keane
- Legionella Risk Management, Inc. Chalfont Pennsylvania
| | - Maryam Salehi
- Department of Civil Engineering University of Memphis Memphis Tennessee
| | - Kerry Hamilton
- School of Sustainable Engineering and the Built Environment Arizona State University Tempe Arizona
| | - Kelsey J Pieper
- Department of Civil and Environmental Engineering Northeastern University Boston Massachusetts
| | - David M Cwiertny
- Department of Civil and Environmental Engineering, Seamans Center for the Engineering Arts and Sciences University of Iowa Iowa City Iowa
- Center for Health Effects of Environmental Contamination University of Iowa Iowa City Iowa
- Public Policy Center University of Iowa Iowa City Iowa
| | - Michele Prévost
- Civil, Geological and Mining Engineering Polytechnique Montreal Montréal Québec Canada
| | - Andrew J Whelton
- Lyles School of Civil Engineering, Division of Environmental and Ecological Engineering Purdue University West Lafayette Indiana
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38
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Proctor CR, Rhoads WJ, Keane T, Salehi M, Hamilton K, Pieper KJ, Cwiertny DM, Prévost M, Whelton AJ. Considerations for Large Building Water Quality after Extended Stagnation. ACTA ACUST UNITED AC 2020; 2:e1186. [PMID: 32838226 PMCID: PMC7323006 DOI: 10.1002/aws2.1186] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023]
Abstract
The unprecedented number of building closures related to the coronavirus disease (COVID‐19) pandemic is concerning because water stagnation will occur in many buildings that do not have water management plans in place. Stagnant water can have chemical and microbiological contaminants that pose potential health risks to occupants. Health officials, building owners, utilities, and other entities are rapidly developing guidance to address this issue, but the scope, applicability, and details included in the guidance vary widely. To provide a primer of large building water system preventative and remedial strategies, peer‐reviewed, government, industry, and nonprofit literature relevant to water stagnation and decontamination practices for plumbing was synthesized. Preventative practices to help avoid the need for recommissioning (e.g., routine flushing) and specific actions, challenges, and limitations associated with recommissioning were identified and characterized. Considerations for worker and occupant safety were also indicated. The intended audience of this work includes organizations developing guidance.
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Affiliation(s)
- Caitlin R Proctor
- Division of Environmental and Ecological Engineering, Lyles School of Civil Engineering, Weldon School of Biomedical Engineering, School of Materials Engineering Purdue University West Lafayette IN
| | - William J Rhoads
- Department of Civil and Environmental Engineering Virginia Tech Blacksburg VA
| | - Tim Keane
- Consulting Engineer, Legionella Risk Management, Inc PA
| | - Maryam Salehi
- Department of Civil Engineering University of Memphis Memphis TN
| | - Kerry Hamilton
- School of Sustainable Engineering and the Built Environment Arizona State University Tempe AZ
| | - Kelsey J Pieper
- Department of Civil and Environmental Engineering Northeastern University Boston MA
| | - David M Cwiertny
- Department of Civil & Environmental Engineering, 4105 Seamans Center for the Engineering Arts and Sciences University of Iowa Iowa City IA.,Center for Health Effects of Environmental Contamination, 251 North Capitol Street, Chemistry Building - Room W195 University of Iowa Iowa City IA.,Public Policy Center, 310 South Grand Ave, 209 South Quadrangle University of Iowa Iowa City IA
| | - Michele Prévost
- Professor and Principal Chairholder, NSERC Industrial Chair on Drinking Water, Civil, Geological and Mining Engineering, Polytechnique Montreal CP Québec Canada
| | - Andrew J Whelton
- Purdue University, Lyles School of Civil Engineering, Division of Environmental and Ecological Engineering West Lafayette IN
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Kotay SM, Parikh HI, Barry K, Gweon HS, Guilford W, Carroll J, Mathers AJ. Nutrients influence the dynamics of Klebsiella pneumoniae carbapenemase producing enterobacterales in transplanted hospital sinks. WATER RESEARCH 2020; 176:115707. [PMID: 32224328 DOI: 10.1016/j.watres.2020.115707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Antimicrobial resistance has been recognized as a threat to human health. The role of hospital sinks acting as a reservoir for some of the most concerning antibiotic resistant organisms, carbapenemase producing Enterobacterales (CPE) is evident but not well understood. Strategies to prevent establishment, interventions to eliminate these reservoirs and factors which drive persistence of CPE are not well established. We use a uniquely designed sink lab to transplant CPE colonized hospital sink plumbing with an aim to understand CPE dynamics in a controlled setting, notably exploiting both molecular and culture techniques. After ex situ installation the CPE population in the sink plumbing drop from previously detectable to undetectable levels. The addition of nutrients is followed by a quick rebound in CPE detection in the sinks after as many as 37 days. We did not however detect a significant shift in microbial community structure or the overall resistance gene carriage in longitudinal samples from a subset of these transplanted sinks using whole shotgun metagenomic sequencing. Comparing nutrient types in a benchtop culture study model, protein rich nutrients appear to be the most supportive for CPE growth and biofilm formation ability. The role of nutrients exposure is determining factor for maintaining a high bioburden of CPE in the sink drains and P-traps. Therefore, limiting nutrient disposal into sinks has reasonable potential with regard to decreasing the CPE wastewater burden, especially in hospitals seeking to control an environmental reservoir.
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Affiliation(s)
- Shireen Meher Kotay
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
| | - Hardik I Parikh
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Katie Barry
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Hyun Soon Gweon
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - William Guilford
- Department of Biomedical Engineering, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Joanne Carroll
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Amy J Mathers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA; Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
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Anforderungen der Hygiene an abwasserführende Systeme in medizinischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:484-501. [DOI: 10.1007/s00103-020-03118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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41
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Cooper J, Himaras Y, Wong T, Bryce E. Evaluation of a new sink design incorporating ozonated water. J Hosp Infect 2019; 104:497-502. [PMID: 31812680 DOI: 10.1016/j.jhin.2019.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Novel sink and U-trap designs have been developed to reduce contamination by users and diminish biofilm. Real-world experience with new sink designs and adjunctive measures such as ozone has been limited. AIMS To assess a new sink design for splashback and to evaluate the ozonated water feature for reduction of microbial bioburden. METHODS A portable sink unit was created that permitted the application of white absorbent paper to plexiglass shields beside and behind the sink. Participants, wearing painter coveralls and masks, spread 30 mL of tempera paint over their hands and washed for 20 s with neutral soap. Each participant repeated this five times sequentially, and cumulative results were recorded. Escherichia coli was exposed to ozonated water from the sink unit and to regular tap water and evaluated for microbial survival. FINDINGS Compared with a conventional sink, the SmartFLO3 sink had less environmental contamination within the sink, surrounding area and splashback on to the participant. Despite modifications to enhance ozone generation, readings of reactive oxygen species did not exceed 0.3 ppm, and no significant bactericidal effect was demonstrated. CONCLUSIONS The SmartFLO3 sink reduces splashback and has the potential to reduce pathogen transmission from sinks. At the low levels of ozone generated in this study, no clear bacterial killing effect was observed compared with tap water alone.
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Affiliation(s)
- J Cooper
- Department of Employee Safety, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
| | - Y Himaras
- Division of Infectious Diseases, Vancouver Coastal Health and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Wong
- Division of Medical Microbiology and Infection Prevention, Vancouver Coastal Health and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - E Bryce
- Division of Medical Microbiology and Infection Prevention, Vancouver Coastal Health and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Effectiveness of foam disinfectants in reducing sink-drain gram-negative bacterial colonization. Infect Control Hosp Epidemiol 2019; 41:280-285. [PMID: 31801646 DOI: 10.1017/ice.2019.325] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sink drainage systems are not amenable to standard methods of cleaning and disinfection. Disinfectants applied as a foam might enhance efficacy of drain decontamination due to greater persistence and increased penetration into sites harboring microorganisms. OBJECTIVE To examine the efficacy and persistence of foam-based products in reducing sink drain colonization with gram-negative bacilli. METHODS During a 5-month period, different methods for sink drain disinfection in patient rooms were evaluated in a hospital and its affiliated long-term care facility. We compared the efficacy of a single treatment with 4 different foam products in reducing the burden of gram-negative bacilli in the sink drain to a depth of 2.4 cm (1 inch) below the strainer. For the most effective product, the effectiveness of foam versus liquid-pouring applications, and the effectiveness of repeated foam treatments were evaluated. RESULTS A foam product containing 3.13% hydrogen peroxide and 0.05% peracetic acid was significantly more effective than the other 3 foam products. In comparison to pouring the hydrogen peroxide and peracetic acid disinfectant, the foam application resulted in significantly reduced recovery of gram-negative bacilli on days 1, 2, and 3 after treatment with a return to baseline by day 7. With repeated treatments every 3 days, a progressive decrease in the bacterial load recovered from sink drains was achieved. CONCLUSIONS An easy-to-use foaming application of a hydrogen peroxide- and peracetic acid-based disinfectant suppressed sink-drain colonization for at least 3 days. Intermittent application of the foaming disinfectant could potentially reduce the risk for dissemination of pathogens from sink drains.
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Jones LD, Mana TS, Cadnum JL, Jencson AL, Alhmidi H, Silva SY, Wilson BM, Donskey CJ. Instillation of disinfectant behind a temporary obstruction created by an inflated urinary catheter balloon improves sink drain disinfection. Am J Infect Control 2019; 47:1522-1524. [PMID: 31402067 DOI: 10.1016/j.ajic.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
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Tetsuka N, Hirabayashi A, Matsumoto A, Oka K, Hara Y, Morioka H, Iguchi M, Tomita Y, Suzuki M, Shibayama K, Yagi T. Molecular epidemiological analysis and risk factors for acquisition of carbapenemase-producing Enterobacter cloacae complex in a Japanese university hospital. Antimicrob Resist Infect Control 2019; 8:126. [PMID: 31367347 PMCID: PMC6657070 DOI: 10.1186/s13756-019-0578-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background To clarify the molecular epidemiology of carbapenem-resistant Enterobacter cloacae complex (CREC) and the risk factors for acquisition of carbapenemase-producing E. cloacae complex (CPEC). Methods Using clinical CREC isolates detected in a Japanese university hospital over 4 years, carbapenemase production was screened with phenotypic methods. Carbapenemase genes were analysed by PCR and sequencing. Molecular epidemiological analyses were conducted with repetitive extragenic palindromic (REP)-PCR and multilocus sequence typing (MLST). CRECs were identified to the subspecies level by hsp60 sequencing. Whole-genome sequencing of plasmids was conducted. A case-control study was performed to identify risk factors for acquisition of CPEC among patients with CREC. Results Thirty-nine CRECs including 20 CPECs carrying bla IMP-1 were identified. Patients with CPEC had longer hospital stay before detection (26.5 days vs. 12 days, p = 0.008), a urinary catheter (odds ratio [OR], 5.36; 95% confidence interval [CI], 1.14-30.9; p = 0.023), or intubation (OR, 7.53; 95% CI, 1.47-53.8; p = 0.008) compared to patients without CPEC. Four genetically closely related CPEC clusters were observed, which showed that three of four CPEC clusters corresponded to E. asburiae (ST 53), E. hormaechei subsp. steigerwaltii (ST 113 and ST 1047) and E. cloacae subsp. cloacae (ST 513) by MLST and hsp60 sequencing. Seven representative plasmids shared structures with class I integron containing bla IMP-1 and IncHI2A replicon type. Conclusions A longer hospital stay, presence of a urinary catheter, and intubation are risk factors for CPEC acquisition. In addition to horizontal transmission of genetically indistinguishable CPECs, IncHI2A plasmid carrying bla IMP-1 appeared to be transferred among genetically different ECs.
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Affiliation(s)
- Nobuyuki Tetsuka
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan.,2Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
| | - Aki Hirabayashi
- 3Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akane Matsumoto
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan
| | - Keisuke Oka
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan.,2Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
| | - Yuki Hara
- 2Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan.,4Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi Japan
| | - Hiroshi Morioka
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan
| | - Mitsutaka Iguchi
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan
| | - Yuka Tomita
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan
| | - Masato Suzuki
- 3Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keigo Shibayama
- 5Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuya Yagi
- 1Department of Infectious Diseases, Nagoya University Hospital, 65 Tsurumai, Nagoya, Aichi 466-0065 Japan.,2Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
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45
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Cole K, Talmadge JE. Mitigation of microbial contamination from waste water and aerosolization by sink design. J Hosp Infect 2019; 103:193-199. [PMID: 31145930 DOI: 10.1016/j.jhin.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/22/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a significant cause of increased medical costs, morbidity, mortality, and have been partly associated with sinks, their waste water outlets and associated pipework. AIM To determine whether an engineered sink could limit microbial aerosol contaminants in the air and sink basin. METHODS Multiple comparisons were undertaken between an experimental sink, designed to limit aerosolization and p-trap contamination to a control hospital sink, both connected to a common drain system. The experimental sink was equipped with ultraviolet light (UV), an aerosol containment hood, ozonated water generator and a flush system to limit bacterial growth/aerosolization and limit microbial growth in the p-trap. Nutrient material was added daily to simulate typical material discarded into a hospital sink. Surface collection swabs, settle plates and p-trap contamination levels were assessed for bacteria and fungi. FINDINGS The experimental sink had significantly decreased levels of bacterial and fungal p-trap contamination (99.9% for Tryptic Soy (TSA) and Sabouraud agar (SAB) plates) relative to the initial levels. Aerosol-induced contaminant from the p-traps was significantly lower for the experimental vs the control sink for TSA (76%) and SAB (86%) agar settle plates. CONCLUSIONS Limiting microbial contamination is critical for the control of nosocomial infections of in-room sinks, which provide a major source of contamination. Our experimental sink studies document that regular ozonated water rinsing of the sink surface, decontamination of p-trap water, and UV decontamination of surfaces limits microbial aerosolization and surface contamination, with potential to decrease patient exposure and reduce hospital acquired infections.
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Affiliation(s)
- K Cole
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - J E Talmadge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
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46
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Sib E, Voigt AM, Wilbring G, Schreiber C, Faerber HA, Skutlarek D, Parcina M, Mahn R, Wolf D, Brossart P, Geiser F, Engelhart S, Exner M, Bierbaum G, Schmithausen RM. Antibiotic resistant bacteria and resistance genes in biofilms in clinical wastewater networks. Int J Hyg Environ Health 2019; 222:655-662. [PMID: 30905579 DOI: 10.1016/j.ijheh.2019.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/25/2019] [Accepted: 03/13/2019] [Indexed: 01/09/2023]
Abstract
Increasing isolation rates of resistant bacteria in the last years require identification of potential infection reservoirs in healthcare facilities. Especially the clinical wastewater network represents a potential source of antibiotic resistant bacteria. In this work, the siphons of the sanitary installations from 18 hospital rooms of two German hospitals were examined for antibiotic resistant bacteria and antibiotic residues including siphons of showers and washbasins and toilets in sanitary units of psychosomatic, haemato-oncological, and rehabilitation wards. In addition, in seven rooms of the haemato-oncological ward, the effect of 24 h of stagnation on the antibiotic concentrations and MDR (multi-drug-resistant) bacteria in biofilms was evaluated. Whereas no antibiotic residues were found in the psychosomatic ward, potential selective concentrations of piperacillin, meropenem and ciprofloxacin were detected at a rehabilitation ward and ciprofloxacin and trimethoprim were present at a haemato-oncology ward. Antibiotic resistant bacteria were isolated from the siphons of all wards, however in the psychosomatic ward, only one MDR strain with resistance to piperacillin, third generation cephalosporins and quinolones (3MRGN) was detected. In contrast, the other two wards yielded 11 carbapenemase producing MDR isolates and 15 3MRGN strains. The isolates from the haemato-oncological ward belonged mostly to two specific rare sequence types (ST) (P. aeruginosa ST823 and Enterobacter cloacae complex ST167). In conclusion, clinical wastewater systems represent a reservoir for multi-drug-resistant bacteria. Consequently, preventive and intervention measures should not start at the wastewater treatment in the treatment plant, but already in the immediate surroundings of the patient, in order to minimize the infection potential.
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Affiliation(s)
- E Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - C Schreiber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Parcina
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R Mahn
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - D Wolf
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany; University Clinic V, Department Hematology and Oncology, Medical University Innsbruck, Christoph-Probst-Platz Innrain 52, 6020, Innsbruck, Austria
| | - P Brossart
- Medical Clinic III, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - F Geiser
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - G Bierbaum
- Institute of Immunology, Medical Microbiology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
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Dispersal of gram-negative bacilli from contaminated sink drains to cover gowns and hands during hand washing. Infect Control Hosp Epidemiol 2019; 40:460-462. [PMID: 30767838 DOI: 10.1017/ice.2019.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We demonstrated that hand washing resulted in frequent dispersal of gram-negative bacilli from colonized sink drains in hospitals to cover gowns and hands. A plastic drain cover reduced but did not eliminate the risk for contamination. This mechanism of dispersal could result in contamination of healthcare personnel and patients.
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48
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Affiliation(s)
- Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
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49
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Droplet- Rather than Aerosol-Mediated Dispersion Is the Primary Mechanism of Bacterial Transmission from Contaminated Hand-Washing Sink Traps. Appl Environ Microbiol 2019; 85:AEM.01997-18. [PMID: 30367005 DOI: 10.1128/aem.01997-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/18/2018] [Indexed: 12/26/2022] Open
Abstract
An alarming rise in hospital outbreaks implicating hand-washing sinks has led to widespread acknowledgment that sinks are a major reservoir of antibiotic-resistant pathogens in patient care areas. An earlier study using green fluorescent protein (GFP)-expressing Escherichia coli (GFP-E. coli) as a model organism demonstrated dispersal from drain biofilms in contaminated sinks. The present study further characterizes the dispersal of microorganisms from contaminated sinks. Replicate hand-washing sinks were inoculated with GFP-E. coli, and dispersion was measured using qualitative (settle plates) and quantitative (air sampling) methods. Dispersal caused by faucet water was captured with settle plates and air sampling methods when bacteria were present on the drain. In contrast, no dispersal was captured without or in between faucet events, amending an earlier theory that bacteria aerosolize from the P-trap and disperse. Numbers of dispersed GFP-E. coli cells diminished substantially within 30 minutes after faucet usage, suggesting that the organisms were associated with larger droplet-sized particles that are not suspended in the air for long periods.IMPORTANCE Among the possible environmental reservoirs in a patient care environment, sink drains are increasingly recognized as a potential reservoir to hospitalized patients of multidrug-resistant health care-associated pathogens. With increasing antimicrobial resistance limiting therapeutic options for patients, a better understanding of how pathogens disseminate from sink drains is urgently needed. Once this knowledge gap has decreased, interventions can be engineered to decrease or eliminate transmission from hospital sink drains to patients. The current study further defines the mechanisms of transmission for bacteria that colonize sink drains.
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50
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Voigt AM, Faerber HA, Wilbring G, Skutlarek D, Felder C, Mahn R, Wolf D, Brossart P, Hornung T, Engelhart S, Exner M, Schmithausen RM. The occurrence of antimicrobial substances in toilet, sink and shower drainpipes of clinical units: A neglected source of antibiotic residues. Int J Hyg Environ Health 2019; 222:455-467. [PMID: 30622005 DOI: 10.1016/j.ijheh.2018.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/22/2018] [Accepted: 12/31/2018] [Indexed: 12/18/2022]
Abstract
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference. To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02 μg·L-1 to a maximum of 79 mg·L-1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.
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Affiliation(s)
- A M Voigt
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - H A Faerber
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - G Wilbring
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Skutlarek
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - C Felder
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R Mahn
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - D Wolf
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany; University Clinic V, Dpt. Hematology and Oncology, Medical University Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - P Brossart
- Medical Clinic, Department of Haematology and Oncology, Centre for Integrated Oncology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - T Hornung
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - S Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - M Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - R M Schmithausen
- Institute for Hygiene and Public Health, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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