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Royer G, Virieux-Petit M, Aujoulat F, Hersent C, Baranovsky S, Hammer-Dedet F, Masnou A, Marchandin H, Corne P, Jumas-Bilak E, Romano-Bertrand S. Residual risk of Pseudomonas aeruginosa waterborne contamination in an intensive care unit despite the presence of filters at all water points-of-use. J Hosp Infect 2024; 149:155-164. [PMID: 38705477 DOI: 10.1016/j.jhin.2024.04.012] [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: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess the residual risk of waterborne contamination by Pseudomonas aeruginosa from a water network colonized by a single genotype [sequence type (ST) 299] despite the presence of antimicrobial filters in a medical intensive care unit (ICU). METHODS During the first 19-month period since the ICU opened, contamination of the water network was assessed monthly by collecting water upstream of the filters. Downstream water was also sampled to assess the efficiency of the filters. P. aeruginosa isolates from patients were collected and compared with the waterborne ST299 P. aeruginosa by multiplex-rep polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. Cross-transmission events by other genotypes of P. aeruginosa were also assessed. RESULTS Overall, 1.3% of 449 samples of filtered water were positive for P. aeruginosa in inoculum, varying between 1 and 104 colony-forming units/100 mL according to the tap. All P. aeruginosa hydric isolates belonged to ST299 and displayed fewer than two single nucleotide polymorphisms (SNPs). Among 278 clinical isolates from 122 patients, 10 isolates in five patients showed identical profiles to the hydric ST299 clone on both multiplex-rep PCR and PFGE, and differed by an average of fewer than five SNPs, confirming the water network reservoir as the source of contamination by P. aeruginosa for 4.09% of patients. Cross-transmission events by other genotypes of P. aeruginosa were responsible for the contamination of 1.75% of patients. DISCUSSION/CONCLUSION Antimicrobial filters are not sufficient to protect patients from waterborne pathogens when the water network is highly contaminated. A microbiological survey of filtered water may be needed in units hosting patients at risk of P. aeruginosa infections, even when all water points-of-use are fitted with filters.
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Affiliation(s)
- G Royer
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France; Département de prévention, diagnostic et traitement des infections, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - M Virieux-Petit
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France; Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - F Aujoulat
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - C Hersent
- Service de Prévention des Infections et de la Résistance, CHU Montpellier, France
| | - S Baranovsky
- Service de Prévention des Infections et de la Résistance, CHU Montpellier, France
| | - F Hammer-Dedet
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - A Masnou
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - H Marchandin
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France; Service de Microbiologie et Hygiène hospitalière, CHU Nîmes, Nîmes, France
| | - P Corne
- Département de Médecine Intensive et Réanimation, CHU Montpellier, Montpellier, France
| | - E Jumas-Bilak
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France
| | - S Romano-Bertrand
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France.
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2
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Fucini GB, Hackmann C, Gastmeier P. Sink interventions in the ICU to reduce risk of infection or colonization with Gram-negative pathogens: a systematic review of the literature. J Hosp Infect 2024; 143:82-90. [PMID: 38529781 DOI: 10.1016/j.jhin.2023.10.011] [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: 08/28/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major problem in intensive care units (ICUs). The hospital water environment is a potential reservoir for Gram-negative bacteria (GNB), and it has been shown that contaminated sinks contribute to the spread of GNB in outbreak and non-outbreak settings. This study aimed to investigate which sink interventions may reduce GNB infection and colonization rates in the ICU. METHODS A database search (MEDLINE via PubMed, EMBASE via Ovid and ClinicalTrials.gov) was undertaken without restrictions on language or date of publication. Studies of any design were included if they described an intervention on the water fixtures in patient rooms, and presented data about HAI or colonization rates in non-outbreak settings. Acquisition (infection and/or colonization) rates of GNB and Pseudomonas aeruginosa were analysed as outcomes. RESULTS In total, 4404 records were identified. Eleven articles were included in the final analysis. No randomized controlled trials were included in the analysis, and all studies were reported to have moderate to serious risk of bias. Removing sinks and applying filters on taps had a significant impact on GNB acquisition, but there was high heterogeneity among reported outcomes and sample size among the studies. CONCLUSION Few studies have investigated the association of sinks in patient rooms with healthcare-associated acquisition of GNB in non-outbreak settings. Heterogeneity in study design made it impossible to generalize the results. Prospective trials are needed to further investigate whether removing sinks from patient rooms can reduce the endemic rate of HAIs in the ICU.
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Affiliation(s)
- G-B Fucini
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - C Hackmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - P Gastmeier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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3
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Fucini GB, Geffers C, Schwab F, Behnke M, Sunder W, Moellmann J, Gastmeier P. Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs. J Hosp Infect 2023; 139:99-105. [PMID: 37308060 DOI: 10.1016/j.jhin.2023.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear. AIM To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI). METHODS This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA). FINDINGS In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P. aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45). CONCLUSIONS Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.
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Affiliation(s)
- G-B Fucini
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - C Geffers
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - M Behnke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - W Sunder
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - J Moellmann
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - P Gastmeier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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Challenges in the Hospital Water System and Innovations to Prevent Healthcare-Associated Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2023. [DOI: 10.1007/s40506-023-00261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Yetiş Ö, Ali S, Karia K, Wilson P. Failure of a hollow-fibre shower filter device to prevent exposure of patients to Pseudomonas aeruginosa. J Hosp Infect 2022; 130:1-6. [PMID: 36049574 DOI: 10.1016/j.jhin.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa in hospital waters is a risk for invasive infection. Point-of-use filters (POU) are used to reduce patient exposure to the organism; hollow-fibre filters are becoming more popular. However retrograde colonisation of the filter mechanism may contaminate the effluent. AIMS To assess the efficacy of POU filter head (polysulfone; hollow-fibre matrix) shower filters in preventing P. aeruginosa exposure to high-risk patient groups. METHODS Pre-flush (opening the outlet and collecting the first 100 mL of water) samples were analysed to measure P. aeruginosa contamination from 25 shower outlets (∼21% of the total showers on the 6 wards), with and without a hollow-fibre filter. P. aeruginosa was measured in a subset of outlets harbouring P. aeruginosa (sampling period August 19th 2019 to January 10th 2020). FINDINGS All twenty-five shower waters were heavily colonized (>300CFU/mL) with P. aeruginosa at the showerhead. P. aeruginosa was found in 32% (8/25) of post-filter shower water effluent with a (geometric mean =4x106(n=4) (6.8x10ˆ4 - 2x10ˆ8). Filters were sampled at (15 - 150) days of usage (median =15) with 26% (6/23) of filter units becoming colonized before the expiry date. CONCLUSION POU filter showerhead units may not be effective in preventing exposure of vulnerable patients to P. aeruginosa in hospital waters due to retrograde contamination (external contamination of the shower head passed back to the filter cartridge itself) or failure of the hollow-fibre filter-matrix. Reliance should not be placed on the use of hollow fibre filters to protect patients from exposure to P. aeruginosa without repeated microbiological monitoring while they are used.
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Chico-Sánchez P, Gras-Valentí P, Algado-Sellés N, Jiménez-Sepúlveda N, Rodríguez-Díaz JC, Merino-deLucas E, Galiana-Ivars M, Fuster-Pérez M, Cartagena-Llopis L, Balboa-Esteve S, Cánovas-Jávega S, Esclapez-Martínez A, Monerris-Palmer M, Cerezo-Milán P, Sánchez-Payá J, Ronda-Pérez E. Effectiveness of the systematic use of antimicrobial filters in the water taps of critical care units for the prevention of healthcare-associated infections with Pseudomonas aeruginosa. Am J Infect Control 2022; 50:435-439. [PMID: 35369937 DOI: 10.1016/j.ajic.2021.10.029] [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: 08/05/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is the third leading aetiological agent in healthcare-associated infections (HAIs) and the one most frequently found in patients with pneumonia associated with mechanical ventilation. In intensive care units (ICU), its appearance is associated with higher mortality, an increase in the days spent on ventilation, and hospital stay length and costs. Thus, evaluating strategies for preventing these infections is essential for their control. Therefore, our objective was to evaluate the effectiveness of the systematic use of antimicrobial filters in preventing PA infections in critical care units. METHODS This was an open experimental crossover study. A total of 2,156 patients admitted for more than 24 hours in critical care units were included, 1,129 of them in units with filters, and 1,027 in units without filters. The study groups were followed-up for 24 months and HAIs were checked for the presence of PA. Chi-squared test were used to compare the rate of HAIs between groups and we calculated 95% confidence intervals adjusted by Poisson regression for the rate ratio (RR) of the association magnitude. RESULTS Both groups were homogeneous in terms of intrinsic and extrinsic patient factors. The incidence of PA infections in the units with filters was 5.5 cases/1,000 hospitalized days and 5.4/1,000 hospitalized days for the units without water filters (RR = 1.09 [0.67-1.79]). CONCLUSIONS Routine placing antimicrobial filters in the water taps in critical care units was not an effective means of preventing the emergence of HAIs caused by PA.
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Virieux-Petit M, Hammer-Dedet F, Aujoulat F, Jumas-Bilak E, Romano-Bertrand S. From Copper Tolerance to Resistance in Pseudomonas aeruginosa towards Patho-Adaptation and Hospital Success. Genes (Basel) 2022; 13:genes13020301. [PMID: 35205346 PMCID: PMC8872213 DOI: 10.3390/genes13020301] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
The hospital environment constitutes a reservoir of opportunistic pathogens responsible for healthcare-associated infections (HCAI) such as Pseudomonas aeruginosa (Pa). Pa persistence within technological niches, the increasing emergence of epidemic high-risk clones in HCAI, the epidemiological link between plumbing strains and clinical strains, make it a major nosocomial pathogen. Therefore, understanding the mechanisms of Pa adaptation to hospital water systems would be useful in preventing HCAI. This review deciphers how copper resistance contributes to Pa adaptation and persistence in a hospital environment, especially within copper water systems, and ultimately to its success as a causative agent of HCAI. Numerous factors are involved in copper homeostasis in Pa, among which active efflux conferring copper tolerance, and copper-binding proteins regulating the copper compartmentalization between periplasm and cytoplasm. The functional harmony of copper homeostasis is regulated by several transcriptional regulators. The genomic island GI-7 appeared as especially responsible for the copper resistance in Pa. Mechanisms of copper and antibiotic cross-resistance and co-resistance are also identified, with potential co-regulation processes between them. Finally, copper resistance of Pa confers selective advantages in colonizing and persisting in hospital environments but also appears as an asset at the host/pathogen interface that helps in HCAI occurrence.
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Affiliation(s)
- Maxine Virieux-Petit
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Florence Hammer-Dedet
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Fabien Aujoulat
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Estelle Jumas-Bilak
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
- Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, 34093 Montpellier, France
| | - Sara Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
- Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, 34093 Montpellier, France
- UMR 5151 HSM, Equipe Pathogènes Hydriques Santé et Environnements, U.F.R. des Sciences Pharmaceutiques et Biologiques, Université Montpellier, 15, Avenue Charles Flahault, BP 14491, CEDEX 5, 34093 Montpellier, France
- Correspondence: ; Tel.: +33-4-11-75-94-30
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Sasahara T, Ogawa M, Fujimura I, Ae R, Kosami K, Morisawa Y. Efficacy and Effectiveness of Showerheads Attached with Point-of-use (POU) Filter Capsules in Preventing Waterborne Diseases in a Japanese Hospital. Biocontrol Sci 2020; 25:223-230. [PMID: 33281180 DOI: 10.4265/bio.25.223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Tap water contamination is a growing concern in healthcare facilities, and despite chlorination, tap water in these facilities contains several pathogenic microorganisms causing healthcare-associated waterborne infections or nosocomial outbreaks. Shower units are particularly prone to contamination as they are conducive for bacterial growth and can even produce bioaerosols containing pathogenic bacteria. Shower units coupled with point-of-use (POU) water filters are a simple and safe option; however, their efficacy has been under-reported. Therefore, we determined the efficacy of showerheads attached with a POU filter capsule in preventing infections in our hospital. We investigated the presence of pathogenic bacteria in water sampled from three shower units. After replacing the original shower units with new ones incorporated with a sterile-grade water filter capsule (0.2 µm; QPoint™), the water samples were analyzed for up to 2 months. The POU filters removed several pathogenic bacteria (Mycobacterium, Pseudomonas, Stenotrophomonas, Aeromonas, and Klebsiella spp.). Filter effectiveness depends on regional water quality and we believe that effective tap water treatment combined with the use of POU filters (introduced at a reasonable cost in healthcare facilities) can considerably minimize waterborne diseases in hospitals and improve patient care.
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Affiliation(s)
- Teppei Sasahara
- Department of Infection and Immunity, School of Medicine, Jichi Medical University.,Health Service Center, Jichi Medical University.,Division of Public Health, Center for Community Medicine, Jichi Medical University
| | | | | | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University
| | - Yuji Morisawa
- Department of Infection and Immunity, School of Medicine, Jichi Medical University
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Doulgeraki AI, Bikouli V, Argyri AA, Chorianopoulos N, Mitre E, Charvourou G, Sourri P, Tassou CC, Oikonomou A. Exploring the Bacterial Communities of the Kaiafas Thermal Spring Anigrides Nymphes in Greece Prior to Rehabilitation Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9133. [PMID: 33297492 PMCID: PMC7730472 DOI: 10.3390/ijerph17239133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
Anigrides Nymphes of Lake Kaiafas is a thermal spring that is well known for its therapeutical properties, as the hot water (32-34 °C) is rich in sulfur compounds and minerals. Nowadays, efforts are made from the Hellenic Republic to modernize the existing facilities and infrastructure networks of the area. To study the complex ecosystem of the thermal spring, we collected water from four sampling points (Lake, and Caves 1, 2, and 3). Filtration method was used for microbial enumeration. In parallel, total bacterial DNA was extracted and subjected to next-generation sequencing (NGS). A total of 166 different bacterial families were detected. Differences in families, genera, and species abundances were detected between the different sampling points. Specifically, Comamonadaceae was the most common family detected in Lake and Cave 3. Similarly, in Caves 1 and 2, Rhodobacteraceae was detected at a higher percentage compared to the rest of the families. Moreover, the detection of sequences assigned to waterborne or opportunistic pathogens, i.e., Enterobacteriaceae, Legionellaceae, Coxiellaceae, and Clostridiaceae, as well as Enterococcus and Vibrio, is of great importance. Although the presence of pathogens was not examined by quantitative PCR, the detection of their sequences strengthens the need of the planned rehabilitation actions of this natural environment in order to allow human swimming.
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Affiliation(s)
- Agapi I. Doulgeraki
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Vasiliki Bikouli
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Anthoula A. Argyri
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Nikos Chorianopoulos
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Elisavet Mitre
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Georgia Charvourou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Patra Sourri
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Chrysoula C. Tassou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization-DIMITRA, Sof. Venizelou 1, 14123 Lycovrissi, Greece; (V.B.); (A.A.A.); (N.C.); (E.M.); (G.C.); (P.S.); (C.C.T.)
| | - Alexandra Oikonomou
- Ephorate of Palaeoanthropology and Speleology, Hellenic Republic Ministry of Culture and Sports, Ardittou 34b, 11636 Athens, Greece;
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Verhougstraete M, Reynolds KA, Pearce-Walker J, Gerba C. Cost-benefit analysis of point-of-use devices for health risks reduction from pathogens in drinking water. JOURNAL OF WATER AND HEALTH 2020; 18:968-982. [PMID: 33328368 DOI: 10.2166/wh.2020.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Microbial contamination of drinking water post-municipal treatment is difficult to predict as a risk factor for human health. One method to reduce morbidity or mortality from unpredictable exposures is through point-of-use (POU) treatment devices. The goal of this project was to assess the cost-benefit of POU water treatment at the tap in terms of protection from microbes in drinking water. This project estimated: (1) incidence of acute illness (AI), sequela, and mortality associated with waterborne pathogens; (2) illness reduction rates from using POU devices; and (3) healthcare cost reductions associated with POU devices. Infection rates and costs associated with 10 of the most common waterborne pathogens were identified and used to calculate national annual costs. We estimated 9M AI, 0.6M sequela, and 1,400 mortality cases that occur annually in the USA from these pathogens. The greatest cost-benefit was seen when considering the totality of disease burden reduction (AI, sequela, and mortality) including all pathogens at a national level and applying a 35% infection reduction, resulting in a total cost per averted disease case of $1,815. This study suggests that it is cost-beneficial to prevent water-related illness using POU devices.
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Affiliation(s)
- Marc Verhougstraete
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA E-mail:
| | - Kelly A Reynolds
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA E-mail:
| | - Jennifer Pearce-Walker
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA E-mail:
| | - Charles Gerba
- College of Agriculture and Life Sciences, University of Arizona, Tucson, USA
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11
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Slekovec C, Robert J, Berthelot P, van der Mee-Marquet N, Rogues AM, Derouin V, Cholley P, Bertrand X, Gbaguidi-Haore H. Do contact precautions reduce the incidence of ICU-acquired Pseudomonas aeruginosa infections? The DPCPYO cluster-randomized crossover trial. Clin Infect Dis 2020; 73:e2781-e2788. [PMID: 33137174 DOI: 10.1093/cid/ciaa1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Issue of contact precautions as contributory factors for reducing P. aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on the incidence of ICU-acquired Pa infections. METHODS In this multicenter cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0-1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1-0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome), as competing events. Models were adjusted for within-ICU correlation, patient- and ICU-level covariates. The Simpson diversity index (SDI) and the transmission index (TI) of Pa isolates were derived from pulsed-field gel electrophoresis typing. RESULTS Within recruited ICUs, the cumulative incidence and the incidence rate of ICU-acquired Pa infections were 3.38% (55/1625) vs 3.44% (57/1658) and 3.31 vs 3.52 per 1 000 patient-days at risk during CP and IP, respectively. Multivariable models indicated that the intervention did not significantly change the cumulative incidence (subdistribution hazard ratio 0.91, 95% confidence interval [CI] 0.49-1.67, p=0.76) and the rate (cause-specific hazard ratio 1.36, 95%CI 0.71-2.63, p=0.36) of the primary outcome. SDI and TI did not significantly differ between CP and IP. CONCLUSIONS The addition of contact precautions to standard precautions for Pa-positive patients with a surveillance screening program does not significantly reduce ICU-acquired Pa infections in non-outbreak situations.
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Affiliation(s)
- Céline Slekovec
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Jérôme Robert
- Centre d'Immunologie et des Maladies Infectieuses-Paris, Cimi-Paris, INSERM, Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Sorbonne Université, Paris, France
| | - Philippe Berthelot
- Hygiène Hospitalière et Maladies Infectieuses, Centre Hospitalier Universitaire, Saint-Etienne, France
| | | | - Anne-Marie Rogues
- Hygiène Hospitalière, Centre Hospitalier Universitaire, INSERM U657, Université de Bordeaux, Bordeaux, France
| | - Véronique Derouin
- Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Paris Sud-Clamart, Le Kremlin-Bicêtre, France
| | - Pascal Cholley
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Xavier Bertrand
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Houssein Gbaguidi-Haore
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
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Parkinson J, Baron JL, Hall B, Bos H, Racine P, Wagener MM, Stout JE. Point-of-use filters for prevention of health care-acquired Legionnaires' disease: Field evaluation of a new filter product and literature review. Am J Infect Control 2020; 48:132-138. [PMID: 31668765 DOI: 10.1016/j.ajic.2019.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services requires that health care facilities assess their building water systems and minimize the risk of growth and spread of Legionella and other waterborne pathogens. Increasingly, point-of-use (POU) filters are being used to prevent exposure to these pathogens. This study provides efficacy and performance specifications (membrane size, pore size, and use restrictions), which will aid in selecting POU filters. METHODS New faucet and shower filters rated for 62 days of use were evaluated at an acute care facility in Southwestern Ontario, Canada. Five faucets and 5 showers served as controls or were equipped with filters. Hot water samples were collected weekly for 12 weeks and cultured for Legionella, heterotrophic plate count, and Pseudomonas. Literature searches for articles on POU filters used in health care settings were performed using PubMed and Google Scholar. Filter specifications from 5 manufacturers were also compared. RESULTS The 62-day POU filters installed on both faucets and showers eliminated Legionella and reduced heterotrophic plate count concentrations for 12 weeks. No Pseudomonas was recovered during this study. Twenty peer-reviewed studies are summarized, and 21 features of 53 POU filters have been compiled. CONCLUSIONS The information provides infection preventionists and facility engineers with information to verify claims from manufacturers and compare differences among POU products, including validated efficacy, filter design, and operational specifications.
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Weinbren M, Scott D, Bower W, Milanova D. Observation study of water outlet design from a cross-infection/user perspective: time for a radical re-think? J Hosp Infect 2019; 103:e68-e72. [DOI: 10.1016/j.jhin.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Is the Potable Water System an Advantageous Preinfection Niche for Bacteria Colonizing the Cystic Fibrosis Lung? mBio 2019; 10:mBio.00883-19. [PMID: 31164466 PMCID: PMC6550525 DOI: 10.1128/mbio.00883-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
People with cystic fibrosis are susceptible to lung infections from a variety of bacteria, a number of which also reside in the potable water system, including Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia complex, and nontuberculosis Mycobacteria. Here, I propose chemical and physical aspects of the potable water system along with bacterial lifestyle strategies in this system that may enhance successful colonization of cystic fibrosis lungs by these bacteria, including iron and copper levels, lipids, and low growth rates within low-oxygen biofilms. People with cystic fibrosis are susceptible to lung infections from a variety of bacteria, a number of which also reside in the potable water system, including Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia complex, and nontuberculosis Mycobacteria. Here, I propose chemical and physical aspects of the potable water system along with bacterial lifestyle strategies in this system that may enhance successful colonization of cystic fibrosis lungs by these bacteria, including iron and copper levels, lipids, and low growth rates within low-oxygen biofilms.
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Iyo T, Asakura K, Nakano M, Omae K. Microorganism levels in spray from warm-water bidet toilet seats: factors affecting total viable and heterotrophic plate counts, and examination of the fluctuations and origins of Pseudomonas aeruginosa. JOURNAL OF WATER AND HEALTH 2018; 16:346-358. [PMID: 29952324 DOI: 10.2166/wh.2017.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objectives of this study were to conduct an appropriate microbial evaluation of warm-water bidet toilet seats. Health-related advantages and disadvantages have been associated with using warm-water bidet toilet seats, which are classified according to the tank type, including tanks equipped with reservoir water heaters and on-demand tankless systems equipped with an instantaneous water heater. However, related bacterial research is sparse. Here, we performed a long-term survey of the behavior of microorganisms (i.e., the total viable count (TVC), heterotrophic plate counts (HPCs), and Pseudomonas aeruginosa count) in a university campus. We also examined the differences between the tank and on-demand types, and the origins of P. aeruginosa. A low TVC (≤1/mL) in the spray waters from both on-demand and tank-type warm-water bidet toilet seats showed low bacterial contamination, although there was an increase in HPC, i.e., growth of biofilms, inside in the warm-water bidet toilet seats. When P. aeruginosa was detected in spray water over an extended duration, the P. aeruginosa origin was considered as either from feces or tap water. Collectively our findings demonstrate that hygienic safety of warm-water bidet toilet seats is being maintained overall.
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Affiliation(s)
- Toru Iyo
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan E-mail:
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16, Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan
| | - Makiko Nakano
- Departments of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Sinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuyuki Omae
- Departments of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Sinjuku-ku, Tokyo 160-8582, Japan
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Transcriptional Responses of Pseudomonas aeruginosa to Potable Water and Freshwater. Appl Environ Microbiol 2018; 84:AEM.02350-17. [PMID: 29305509 DOI: 10.1128/aem.02350-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/01/2018] [Indexed: 02/03/2023] Open
Abstract
Many Pseudomonas aeruginosa infections are derived from residential, recreational, or surface water sources; thus, these environments represent an important preinfection niche. To better understand P. aeruginosa biology in these environments, we quantified transcriptional changes by microarray after exposure to diluted LB, diluted R2B, potable tap water, and freshwater from a eutrophic pond. Quantitative reverse transcription-PCR (qRT-PCR) confirmed the conservation of these responses in other water sources, and competition experiments were used to test the importance of three implicated metabolic pathways. The global transcriptional responses in potable water and freshwater showed strong induction of genes involved in metabolism of the head groups and acyl tails of phospholipids, as well as nucleotide metabolism, with commensurate decreased transcript expression of genes encoding their synthetic pathways. These data suggest that phospholipids and nucleotides are part of the nutritional milieu of these two environments. A unique response in municipal-delivered potable water was to the metals in the piping system, particularly copper. To identify potential nutrient sources used by P. aeruginosa in these environments, we used competition assays between the wild-type and deletion mutant strains in three pathways induced under these conditions. For phospholipid head-group metabolism, ethanolamine utilization (eutB) was important for competition in potable water, while choline oxidation (betBA) was important for competition in freshwater. Nucleotide utilization, particularly pyrimidine metabolism (dht), showed a trend toward importance in freshwater but was not statistically significant. These findings provide new insights into the P. aeruginosa response to potable water and freshwater and led to the identification of potentially important nutrient sources in these environments.IMPORTANCE Much of our knowledge about Pseudomonas aeruginosa comes from the infection niche, and much less is known about its lifestyle in the environment. P. aeruginosa is an adaptable bacterium capable of growing in many environments but is particularly common in potable water systems and freshwater. We used the transcriptional responses of P. aeruginosa to these environments to identify important nutrient sources specific to either of these two environments. Additionally, these environments could provide experimental situations to understand gene function for the large number of transcripts with unknown functions induced under these conditions.
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Kossow A, Kampmeier S, Willems S, Berdel WE, Groll AH, Burkhardt B, Rossig C, Groth C, Idelevich EA, Kipp F, Mellmann A, Stelljes M. Control of Multidrug-Resistant Pseudomonas aeruginosa in Allogeneic Hematopoietic Stem Cell Transplant Recipients by a Novel Bundle Including Remodeling of Sanitary and Water Supply Systems. Clin Infect Dis 2018; 65:935-942. [PMID: 28520856 DOI: 10.1093/cid/cix465] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/15/2017] [Indexed: 12/20/2022] Open
Abstract
Background Infections by multidrug-resistant Pseudomonas aeruginosa (MDRPa) are an important cause of morbidity and mortality in patients after allogeneic hematopoietic stem cell transplantation (HSCT). Humid environments can serve as a reservoir and source of infection by this pathogen. To minimize the risk of infection from these reservoirs, we performed extensive remodeling of sanitation and water installations as the focus of our hygiene bundle. Methods During the reconstruction of our transplantation unit (April 2011-April 2014) we implemented several technical modifications to reduce environmental contamination by and subsequent spreading of MDRPa, including a newly designed shower drain, disinfecting siphons underneath the sinks, and rimless toilets. During a 3-year study period (2012-2014), we tracked the number of patients affected by MDRPa (colonized and/or infected) and the outcome of infected patients, and monitored the environmental occurrence of this pathogen. We further performed whole-genome sequencing of nosocomial MDRPa strains to evaluate genotypic relationships between isolates. Results Whereas 31 (9.2%; 18 colonized, 13 infected) patients were affected in 2012 and 2013, the number decreased to 3 in 2014 (17%; 3 colonized, 0 infected). Lethality by MDRPa similarly decreased from 3.6% to 0%. Environmental detection of MDRPa decreased in toilets from 18.9% in 2012-2013 to 6.1% in the following year and from 8.1% to 3.0%, respectively, in shower outlets. Whole-genome sequencing showed close relationships between environmental and patient-derived isolates. Conclusions Hospital construction measures aimed at controlling environmental contamination by and spread of MDRPa are effective at minimizing the risk of highly lethal MDRPa infections.
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Affiliation(s)
| | | | | | | | - Andreas H Groll
- University Children's Hospital Muenster, Department of Pediatric Hematology and Oncology
| | - Birgit Burkhardt
- University Children's Hospital Muenster, Department of Pediatric Hematology and Oncology
| | - Claudia Rossig
- University Children's Hospital Muenster, Department of Pediatric Hematology and Oncology
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Baranovsky S, Jumas-Bilak E, Lotthé A, Marchandin H, Parer S, Hicheri Y, Romano-Bertrand S. Tracking the spread routes of opportunistic premise plumbing pathogens in a haematology unit with water points-of-use protected by antimicrobial filters. J Hosp Infect 2017; 98:53-59. [PMID: 28760634 DOI: 10.1016/j.jhin.2017.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Water networks in hospitals are frequently contaminated by opportunistic premise plumbing pathogens (OPPPs) leading to installation of antimicrobial filters on water points-of-use (POU) in order to limit patients' exposure. AIM To assess the spread of OPPPs through secondary water routes (outside the plumbing system) in an adult haematology unit in which 52 out of 73 water POU were high risk for patients and protected by antimicrobial filters. METHODS An observational audit identified six secondary water routes for which bacteria tracking and typing were performed in 315 surface samplings. Bacterial isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and compared to the infra-species level by multiplex repetitive element sequence-based polymerase chain reaction and/or by restriction fragment length polymorphism in pulse-field gel electrophoresis. FINDINGS Pseudomonas aeruginosa and Stenotrophomonas maltophilia, as well as non-pathogenic OPPP indicators, were detected in water collected upstream of antimicrobial filters. P. aeruginosa was the sole OPPP retrieved from tested surfaces (5.1%). The same clone of P. aeruginosa spread from water source to dry surfaces in the same room and cross-contaminated two sinks in different rooms. Three clones of non-pathogenic OPPP indicators spread more widely in different rooms. CONCLUSION A strategy based on filtration of most (but not all) water POU in a haematology unit could be sufficient to limit the spread of OPPPs to the environment, provided a functional mapping of 'high-risk' POU has been undertaken. The residual spread of OPPPs and OPPP indicators linked to non-filtered water POU argues for careful monitoring of non-filtered water use.
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Affiliation(s)
- S Baranovsky
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - E Jumas-Bilak
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - A Lotthé
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - H Marchandin
- UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France; Laboratoire de Bactériologie CHU Nîmes, Nîmes, France
| | - S Parer
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - Y Hicheri
- Département d'Hématologie Clinique, CHU Montpellier, Montpellier, France
| | - S Romano-Bertrand
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France.
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Pseudomonas aeruginosa Outbreak in a Neonatal Intensive Care Unit Attributed to Hospital Tap Water. Infect Control Hosp Epidemiol 2017; 38:801-808. [PMID: 28516821 DOI: 10.1017/ice.2017.87] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate an outbreak of Pseudomonas aeruginosa infections and colonization in a neonatal intensive care unit. DESIGN Infection control assessment, environmental evaluation, and case-control study. SETTING Newly built community-based hospital, 28-bed neonatal intensive care unit. PATIENTS Neonatal intensive care unit patients receiving care between June 1, 2013, and September 30, 2014. METHODS Case finding was performed through microbiology record review. Infection control observations, interviews, and environmental assessment were performed. A matched case-control study was conducted to identify risk factors for P. aeruginosa infection. Patient and environmental isolates were collected for pulsed-field gel electrophoresis to determine strain relatedness. RESULTS In total, 31 cases were identified. Case clusters were temporally associated with absence of point-of-use filters on faucets in patient rooms. After adjusting for gestational age, case patients were more likely to have been in a room without a point-of-use filter (odds ratio [OR], 37.55; 95% confidence interval [CI], 7.16-∞). Case patients had higher odds of exposure to peripherally inserted central catheters (OR, 7.20; 95% CI, 1.75-37.30) and invasive ventilation (OR, 5.79; 95% CI, 1.39-30.62). Of 42 environmental samples, 28 (67%) grew P. aeruginosa. Isolates from the 2 most recent case patients were indistinguishable by pulsed-field gel electrophoresis from water-related samples obtained from these case-patient rooms. CONCLUSIONS This outbreak was attributed to contaminated water. Interruption of the outbreak with point-of-use filters provided a short-term solution; however, eradication of P. aeruginosa in water and fixtures was necessary to protect patients. This outbreak highlights the importance of understanding the risks of stagnant water in healthcare facilities. Infect Control Hosp Epidemiol 2017;38:801-808.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cohen R, Babushkin F, Cohen S, Afraimov M, Shapiro M, Uda M, Khabra E, Adler A, Ben Ami R, Paikin S. A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit. Antimicrob Resist Infect Control 2017; 6:7. [PMID: 28096975 PMCID: PMC5225573 DOI: 10.1186/s13756-016-0167-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Pseudomonas aeruginosa (PA) surveillance may improve empiric antimicrobial therapy, since colonizing strains frequently cause infections. This colonization may be ‘endogenous’ or ‘exogenous’, and the source determines infection control measures. We prospectively investigated the sources of PA, the clinical impact of PA colonization upon admission and the dynamics of colonization at different body sites throughout the intensive care unit stay. Methods Intensive care patients were screened on admission and weekly from the pharynx, endotracheal aspirate, rectum and urine. Molecular typing was performed using Enterobacterial Repetitive Intergenic Consensus Polymerase Chain reaction (ERIC-PCR). Results Between November 2014 and January 2015, 34 patients were included. Thirteen (38%) were colonized on admission, and were at a higher risk for PA-related clinical infection (Hazard Ratio = 14.6, p = 0.0002). Strains were often patient-specific, site-specific and site-persistent. Sixteen out of 17 (94%) clinical isolates were identical to strains found concurrently or previously on screening cultures from the same patient, and none were unique. Ventilator associated pneumonia-related strains were identical to endotracheal aspirates and pharynx screening (87–75% of cases). No clinical case was found among patients with repeated negative screening. Conclusion PA origin in this non-outbreak setting was mainly ‘endogenous’ and PA-strains were generally patient- and site-specific, especially in the gastrointestinal tract. While prediction of ventilator associated pneumonia-related PA-strain by screening was fair, the negative predictive value of screening was very high.
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Affiliation(s)
- Regev Cohen
- Head of Infectious diseases unit, Sanz Medical Center, Laniado hospital, Neytanya, Israel ; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Frida Babushkin
- Infectious diseases unit, Sanz Medical Center, Laniado hospital, Netanya, Israel
| | - Shoshana Cohen
- Infectious diseases unit, Sanz Medical Center, Laniado hospital, Netanya, Israel
| | - Marina Afraimov
- Infectious diseases unit, Sanz Medical Center, Laniado hospital, Netanya, Israel
| | - Maurice Shapiro
- Medical and Surgical intensive care unit, Sanz Medical Center, Laniado hospital, Netanya, Israel
| | - Martina Uda
- Medical and Surgical intensive care unit, Sanz Medical Center, Laniado hospital, Netanya, Israel
| | - Efrat Khabra
- National Center of Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Amos Adler
- National Center of Infection Control, Ministry of Health, Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Ben Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Infectious diseases unit Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Svetlana Paikin
- Microbiology Laboratory, Sanz Medical Center, Laniado hospital, Netanya, Israel
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Totaro M, Valentini P, Casini B, Miccoli M, Costa AL, Baggiani A. Experimental comparison of point-of-use filters for drinking water ultrafiltration. J Hosp Infect 2016; 96:172-176. [PMID: 28073586 DOI: 10.1016/j.jhin.2016.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Waterborne pathogens such as Pseudomonas spp. and Legionella spp. may persist in hospital water networks despite chemical disinfection. Point-of-use filtration represents a physical control measure that can be applied in high-risk areas to contain the exposure to such pathogens. New technologies have enabled an extension of filters' lifetimes and have made available faucet hollow-fibre filters for water ultrafiltration. AIM To compare point-of-use filters applied to cold water within their period of validity. METHODS Faucet hollow-fibre filters (filter A), shower hollow-fibre filters (filter B) and faucet membrane filters (filter C) were contaminated in two different sets of tests with standard bacterial strains (Pseudomonas aeruginosa DSM 939 and Brevundimonas diminuta ATCC 19146) and installed at points-of-use. Every day, from each faucet, 100 L of water was flushed. Before and after flushing, 250 mL of water was collected and analysed for microbiology. FINDINGS There was a high capacity of microbial retention from filter C; filter B released only low Brevundimonas spp. counts; filter A showed poor retention of both micro-organisms. CONCLUSION Hollow-fibre filters did not show good micro-organism retention. All point-of-use filters require an appropriate maintenance of structural parameters to ensure their efficiency.
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Affiliation(s)
- M Totaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P Valentini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - B Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A L Costa
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Liu S, Gunawan C, Barraud N, Rice SA, Harry EJ, Amal R. Understanding, Monitoring, and Controlling Biofilm Growth in Drinking Water Distribution Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:8954-8976. [PMID: 27479445 DOI: 10.1021/acs.est.6b00835] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In drinking water distribution systems (DWDS), biofilms are the predominant mode of microbial growth, with the presence of extracellular polymeric substance (EPS) protecting the biomass from environmental and shear stresses. Biofilm formation poses a significant problem to the drinking water industry as a potential source of bacterial contamination, including pathogens, and, in many cases, also affecting the taste and odor of drinking water and promoting the corrosion of pipes. This article critically reviews important research findings on biofilm growth in DWDS, examining the factors affecting their formation and characteristics as well as the various technologies to characterize and monitor and, ultimately, to control their growth. Research indicates that temperature fluctuations potentially affect not only the initial bacteria-to-surface attachment but also the growth rates of biofilms. For the latter, the effect is unique for each type of biofilm-forming bacteria; ammonia-oxidizing bacteria, for example, grow more-developed biofilms at a typical summer temperature of 22 °C compared to 12 °C in fall, and the opposite occurs for the pathogenic Vibrio cholerae. Recent investigations have found the formation of thinner yet denser biofilms under high and turbulent flow regimes of drinking water, in comparison to the more porous and loosely attached biofilms at low flow rates. Furthermore, in addition to the rather well-known tendency of significant biofilm growth on corrosion-prone metal pipes, research efforts also found leaching of growth-promoting organic compounds from the increasingly popular use of polymer-based pipes. Knowledge of the unique microbial members of drinking water biofilms and, importantly, the influence of water characteristics and operational conditions on their growth can be applied to optimize various operational parameters to minimize biofilm accumulation. More-detailed characterizations of the biofilm population size and structure are now feasible with fluorescence microscopy (epifluorescence and CLSM imaging with DNA, RNA, EPS, and protein and lipid stains) and electron microscopy imaging (ESEM). Importantly, thorough identification of microbial fingerprints in drinking water biofilms is achievable with DNA sequencing techniques (the 16S rRNA gene-based identification), which have revealed a prevalence of previously undetected bacterial members. Technologies are now moving toward in situ monitoring of biomass growth in distribution networks, including the development of optical fibers capable of differentiating biomass from chemical deposits. Taken together, management of biofilm growth in water distribution systems requires an integrated approach, starting from the treatment of water prior to entering the networks to the potential implementation of "biofilm-limiting" operational conditions and, finally, ending with the careful selection of available technologies for biofilm monitoring and control. For the latter, conventional practices, including chlorine-chloramine disinfection, flushing of DWDS, nutrient removal, and emerging technologies are discussed with their associated challenges.
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Affiliation(s)
| | - Cindy Gunawan
- ithree institute, University of Technology Sydney , Sydney, NSW 2007, Australia
| | - Nicolas Barraud
- Department of Microbiology, Genetics of Biofilms Unit, Institut Pasteur , Paris 75015, France
| | - Scott A Rice
- The Singapore Centre for Environmental Life Sciences Engineering and School of Biological Sciences, Nanyang Technological University , 639798, Singapore
| | - Elizabeth J Harry
- ithree institute, University of Technology Sydney , Sydney, NSW 2007, Australia
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Florentin A, Lizon J, Asensio E, Forin J, Rivier A. Water and surface microbiologic quality of point-of-use water filters: A comparative study. Am J Infect Control 2016; 44:1061-2. [PMID: 27086907 DOI: 10.1016/j.ajic.2016.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
Waterborne pathogens, such Legionella pneumophila and Pseudomonas aeruginosa, are major contributors to hospital-associated infection. Point-of-use water filtration has demonstrated benefits to prevent infection implicating waterborne pathogens. Despite the quality of the filters, misuse may expose patients to these pathogens.
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Iyo T, Asakura K, Nakano M, Yamada M, Omae K. Bidet toilet seats with warm-water tanks: residual chlorine, microbial community, and structural analyses. JOURNAL OF WATER AND HEALTH 2016; 14:68-80. [PMID: 26837831 DOI: 10.2166/wh.2015.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite the reported health-related advantages of the use of warm water in bidets, there are health-related disadvantages associated with the use of these toilet seats, and the bacterial research is sparse. We conducted a survey on the hygienic conditions of 127 warm-water bidet toilet seats in restrooms on a university campus. The spray water from the toilet seats had less residual chlorine than their tap water sources. However, the total viable microbial count was below the water-quality standard for tap water. In addition, the heat of the toilet seats' warm-water tanks caused heterotrophic bacteria in the source tap water to proliferate inside the nozzle pipes and the warm-water tanks. Escherichia coli was detected on the spray nozzles of about 5% of the toilet seats, indicating that the self-cleaning mechanism of the spray nozzles was largely functioning properly. However, Pseudomonas aeruginosa was detected on about 2% of the toilet seats. P. aeruginosa was found to remain for long durations in biofilms that formed inside warm-water tanks. Infection-prevention measures aimed at P. aeruginosa should receive full consideration when managing warm-water bidet toilet seats in hospitals in order to prevent opportunistic infections in intensive care units, hematology wards, and other hospital locations.
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Affiliation(s)
- Toru Iyo
- Department of Health Sciences, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan E-mail:
| | - Keiko Asakura
- Department of Social and Preventive Epidemiology, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo 113-0033, Japan
| | - Makiko Nakano
- Departments of Preventive Medicine and Public Health, Kieo University School of Medicine, 35 Shinanomachi, Sinjuku-ku, Tokyo 160-8582, Japan
| | - Mutsuko Yamada
- Departments of Preventive Medicine and Public Health, Kieo University School of Medicine, 35 Shinanomachi, Sinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuyuki Omae
- Departments of Preventive Medicine and Public Health, Kieo University School of Medicine, 35 Shinanomachi, Sinjuku-ku, Tokyo 160-8582, Japan
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Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party. J Hosp Infect 2015; 92 Suppl 1:S1-44. [PMID: 26598314 DOI: 10.1016/j.jhin.2015.08.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 12/25/2022]
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Cassir N, Thomas G, Hraiech S, Brunet J, Fournier PE, La Scola B, Papazian L. Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria. Am J Infect Control 2015; 43:640-3. [PMID: 25798778 DOI: 10.1016/j.ajic.2015.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/01/2015] [Accepted: 02/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a major cause of morbidity and mortality in intensive care unit (ICU) patients. Our objective was to evaluate the impact of daily bathing with chlorhexidine gluconate (CHG) on the incidence rates of HAIs, with a focus on their causative bacteria, in a French ICU. METHODS From March 2012-May 2013, we enrolled 325 patients with at least 1 episode of suspected sepsis in the ICU, during two 6-month periods. The intervention group was subjected daily to skin cleansing with 2% CHG-impregnated cloths, whereas the control group was bathed daily with soap and water. HAI included bloodstream infections, ventilator-associated pneumonia, and urinary tract infections. Incidence rates corresponded to the number of infections per 1,000 patient days. RESULTS Incidence of HAI was significantly decreased in the intervention group (29 vs 56; P = .01). After adjustment for baseline patient characteristics, the increased risk of HAI in the water and soap group was significant (odds ratio = 1.993; 95% confidence interval [CI], 1.132-3.508; P = .017). The incidence rate of clinical cultures positive for gram-negative bacteria, including Enterobacteriaceae and nonfermenting bacilli, decreased in the intervention group (risk ratio = 0.588; 95% CI, 0.346-0.978; P = .04). CONCLUSIONS CHG daily cleansing reduced the incidence rate of HAI caused by gram-negative bacteria, highlighting the role of the transient gram-negative bacteria skin colonization in the pathogenesis of HAI.
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Gerba CP. Use of an ultraviolet light at point-of-dispense faucet to eliminate Pseudomonas aeruginosa. Am J Infect Control 2015; 43:528-9. [PMID: 25721063 DOI: 10.1016/j.ajic.2015.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 11/29/2022]
Abstract
Tap water is believed to be a significant source of Pseudomonas aeruginosa in health care environments. This study evaluated an ultraviolet (UV) light point-of-dispense water treatment system for control of P aeruginosa. No P aeruginosa was detected in 30 different water dispensers in which the UV light device had been operating for 1-34 months. In comparison, P aeruginosa was found in other taps that did not feature this UV light system.
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Affiliation(s)
- Charles P Gerba
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, AZ.
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Baron JL, Peters T, Shafer R, MacMurray B, Stout JE. Field evaluation of a new point-of-use faucet filter for preventing exposure to Legionella and other waterborne pathogens in health care facilities. Am J Infect Control 2014; 42:1193-6. [PMID: 25234046 DOI: 10.1016/j.ajic.2014.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/31/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opportunistic waterborne pathogens (eg, Legionella, Pseudomonas) may persist in water distribution systems despite municipal chlorination and secondary disinfection and can cause health care-acquired infections. Point-of-use (POU) filtration can limit exposure to pathogens; however, their short maximum lifetime and membrane clogging have limited their use. METHODS A new faucet filter rated at 62 days was evaluated at a cancer center in Northwestern Pennsylvania. Five sinks were equipped with filters, and 5 sinks served as controls. Hot water was collected weekly for 17 weeks and cultured for Legionella, Pseudomonas, and total bacteria. RESULTS Legionella was removed from all filtered samples for 12 weeks. One colony was recovered from 1 site at 13 weeks; however, subsequent tests were negative through 17 weeks of testing. Total bacteria were excluded for the first 2 weeks, followed by an average of 1.86 log reduction in total bacteria compared with controls. No Pseudomonas was recovered from filtered or control faucets. CONCLUSION This next generation faucet filter eliminated Legionella beyond the 62 day manufacturers' recommended maximum duration of use. These new POU filters will require fewer change-outs than standard filters and could be a cost-effective method for preventing exposure to Legionella and other opportunistic waterborne pathogens in hospitals with high-risk patients.
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Affiliation(s)
- Julianne L Baron
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Special Pathogens Laboratory, Pittsburgh, PA
| | | | | | | | - Janet E Stout
- Special Pathogens Laboratory, Pittsburgh, PA; Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
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Venier AG, Leroyer C, Slekovec C, Talon D, Bertrand X, Parer S, Alfandari S, Guerin JM, Megarbane B, Lawrence C, Clair B, Lepape A, Perraud M, Cassier P, Trivier D, Boyer A, Dubois V, Asselineau J, Rogues AM, Thiébaut R. Risk factors for Pseudomonas aeruginosa acquisition in intensive care units: a prospective multicentre study. J Hosp Infect 2014; 88:103-8. [PMID: 25155240 DOI: 10.1016/j.jhin.2014.06.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
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Affiliation(s)
- A-G Venier
- CHU, CCLIN Sud-Ouest, Bordeaux, France; INSERM U657, Université de Bordeaux, Bordeaux, France.
| | - C Leroyer
- CHU, Hygiène hospitalière, Bordeaux, France
| | - C Slekovec
- CHU, Hygiène hospitalière, Besançon, France
| | - D Talon
- CHU, Hygiène hospitalière, Besançon, France
| | - X Bertrand
- CHU, Hygiène hospitalière, Besançon, France
| | - S Parer
- CHU, Hygiène hospitalière, Montpellier, France
| | - S Alfandari
- CH DRon, Réanimation et maladies infectieuses, Tourcoing, France
| | - J-M Guerin
- CHU Lariboisière, AP-HP, Hygiène hospitalière, Paris, France
| | - B Megarbane
- CHU Lariboisière, AP-HP, Réanimation médicale, Paris, France
| | - C Lawrence
- CHU Poincaré, AP-HP, Hygiène hospitalière, Garches, France
| | - B Clair
- CHU Poincaré, AP-HP, Réanimation médicale, Garches, France
| | - A Lepape
- CHU Lyon Sud, Réanimation médicale, Lyon, France
| | - M Perraud
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - P Cassier
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - D Trivier
- CH Lens, Hygiène hospitalière, Lens, France
| | - A Boyer
- CHU, Réanimation médicale, Bordeaux, France
| | - V Dubois
- CHU, Laboratoire de bactériologie, Bordeaux, France; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France
| | - J Asselineau
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France
| | - A-M Rogues
- INSERM U657, Université de Bordeaux, Bordeaux, France; CHU, Hygiène hospitalière, Bordeaux, France
| | - R Thiébaut
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France; INSERM, U897 Epidemiologie et Biostatistique, Bordeaux, France; Univ Bordeaux, ISPED, Bordeaux, France
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Zhou Z, Hu B, Qin L, Lin Y, Watanabe H, Zhou Q, Gao X. Removal of waterborne pathogens from liver transplant unit water taps in prevention of healthcare-associated infections: a proposal for a cost-effective, proactive infection control strategy. Clin Microbiol Infect 2014; 20:310-4. [DOI: 10.1111/1469-0691.12299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/12/2013] [Accepted: 06/14/2013] [Indexed: 11/27/2022]
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Loveday HP, Wilson JA, Kerr K, Pitchers R, Walker JT, Browne J. Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review. J Hosp Infect 2013; 86:7-15. [PMID: 24289866 DOI: 10.1016/j.jhin.2013.09.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings. AIM To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection. METHODS A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies. FINDINGS Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available. CONCLUSIONS Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, University of West London, London, UK
| | - J A Wilson
- Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK.
| | - K Kerr
- Department of Medical Microbiology, Harrogate and District NHS Foundation Trust, Hull York Medical School, York, UK
| | | | - J T Walker
- Biosafety Unit, Health Protection Agency, Porton Down, UK
| | - J Browne
- Richard Wells Research Centre, University of West London, London, UK
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Denham ME, Kasali A, Steinberg JP, Cowan DZ, Zimring C, Jacob JT. The Role of Water in the Transmission of Healthcare-Associated Infections: Opportunities for Intervention through the Environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2013. [DOI: 10.1177/193758671300701s08] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in water that cause healthcare-associated infections (HAIs). BACKGROUND: Water can serve as a reservoir or source for pathogens, which can lead to the transmission of healthcare-associated infections (HAIs). Water systems harboring pathogens, such as Legionella and Pseudomonas spp., can also foster the growth of persistent biofilms, presenting a great health risk. TOPICAL HEADINGS: Strategies for interrupting the chain of transmission through the built environment can be proactive or reactive, and include three primary approaches: safe plumbing practices (maintaining optimal water temperature and pressure; eliminating dead ends), decontamination of water sources (inactivating or killing pathogens to prevent contamination), and selecting appropriate design elements (fixtures and materials that minimize the potential for contamination). CONCLUSIONS: Current evidence clearly identifying the environment's role in the chain of infection is limited by the variance in surveillance strategies and in the methods used to assess impact of these strategies. In order to optimize the built environment to serve as a tool for mitigating infection risk from waterborne pathogens—from selecting appropriate water features to maintaining the water system—multidisciplinary collaboration and planning is essential.
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Balm MND, Salmon S, Jureen R, Teo C, Mahdi R, Seetoh T, Teo JTW, Lin RTP, Fisher DA. Bad design, bad practices, bad bugs: frustrations in controlling an outbreak of Elizabethkingia meningoseptica in intensive care units. J Hosp Infect 2013; 85:134-40. [PMID: 23958153 DOI: 10.1016/j.jhin.2013.05.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elizabethkingia meningoseptica is a nosocomial-adapted Gram-negative bacillus intrinsically resistant to antibiotics commonly used in the intensive care setting. An outbreak investigation commenced when five patients developed E. meningoseptica infection in two intensive care units (ICUs). METHODS Analysis of laboratory data, case reviews, ICU workflows and extensive environmental sampling were undertaken. Molecular typing was performed using repetitive element palindromic polymerase chain reaction. Follow-up studies after interventions included environmental monitoring and a survey of staff compliance with interventions. FINDINGS Laboratory data revealed increasing incidence of E. meningoseptica colonization or infection in ICU patients compared with preceding years. E. meningoseptica was cultured from 44% (35/79) of taps, but not from other sources. Hand hygiene sinks were used for disposal of patient secretions and rinsing re-usable patient care items. Sinks misused in this way were contaminated more often than sinks that were not misused (odds ratio 4.38, 95% confidence interval 1.68-11.39; P = 0.004). Molecular typing revealed that patient isolates had identical patterns to several isolates from hand hygiene taps. An urgent education programme was instituted to change these practices. Taps were cleaned systematically and aerators were changed. A temporary reduction in case numbers was achieved. Recolonization of taps was demonstrated on follow-up environmental screening, and cases recurred after two months. A survey revealed that 77.3% (163/213) of nursing staff still misused sinks due to time constraints or other problems adhering to the interventions. CONCLUSION Introduction of non-sanctioned practices due to suboptimal unit design may have unintentional consequences for ICU patients. Room design and staff workflows must be optimized for patient safety as lapses in procedure can inadvertently put patients at risk.
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Affiliation(s)
- M N D Balm
- Infection Control Team, National University Hospital, Singapore; Microbiology, Department of Laboratory Medicine, National University Hospital, Singapore
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Bhavanarushi S, Kanakaiah V, Bharath G, Gangagnirao A, Vatsala Rani J. Synthesis and antibacterial activity of 4,4′-(aryl or alkyl methylene)-bis(1H-pyrazol-5-ol) derivatives. Med Chem Res 2013. [DOI: 10.1007/s00044-013-0623-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Heudorf U, Hausemann A, Jager E. [Hygiene in intensive care units in Frankfurt am Main, Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1483-94. [PMID: 23114448 DOI: 10.1007/s00103-012-1545-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED : The German Commission on Hospital Hygiene and Infection Prevention has published several recommendations regarding hygiene in the intensive care unit. Compliance with these recommendations was surveyed. METHODS In 2005 and 2011, the intensive care units of all hospitals in Frankfurt am Main, Germany, were examined by members of the public health department, using a checklist based on the respective recommendations. RESULTS Recommendations on the architecture and function of intensive care wards were almost fully complied with, except for the stipulated amount of space and nursing personnel. Compliance with recommendations for prevention of ventilator-associated pneumonia and for prevention of catheter-related bloodstream infections was excellent, with only some minor exceptions. Regarding hand hygiene, in 2011 fewer faults were documented than in 2005. All hospitals took part in the German project of the world-wide campaign "clean care is safer care." In 2005, device-associated infections were surveyed in 92% intensive care units, and in 2011 in all of them. By 2011, screening of methicillin-resistant Staphylococcus aureus had been established in all intensive care units. CONCLUSION Most problems that were observed regarded a scarcity of space and of facilities for isolation of patients and of nursing personnel. Improvements were seen in hand hygiene and in screening for multidrug resistant organisms (MDRO).
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Affiliation(s)
- U Heudorf
- Abteilung Medizinische Dienste und Hygiene, Amt für Gesundheit, Breite Gasse 28, Frankfurt am Main, Germany.
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Jefferies JMC, Cooper T, Yam T, Clarke SC. Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources. J Med Microbiol 2012; 61:1052-1061. [DOI: 10.1099/jmm.0.044818-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- J. M. C. Jefferies
- Health Protection Agency, Southampton, UK
- Molecular Microbiology Group, Academic Unit of Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T. Cooper
- Infection Prevention Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T. Yam
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Infection Prevention Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S. C. Clarke
- Molecular Microbiology Group, Academic Unit of Clinical & Experimental Sciences, University of Southampton Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Abstract
Stenotrophomonas maltophilia is an emerging multidrug-resistant global opportunistic pathogen. The increasing incidence of nosocomial and community-acquired S. maltophilia infections is of particular concern for immunocompromised individuals, as this bacterial pathogen is associated with a significant fatality/case ratio. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres, animals, foods, and water sources. Infections of S. maltophilia can occur in a range of organs and tissues; the organism is commonly found in respiratory tract infections. This review summarizes the current literature and presents S. maltophilia as an organism with various molecular mechanisms used for colonization and infection. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa. Recent evidence of cell-cell communication between these pathogens has implications for the development of novel pharmacological therapies. Animal models of S. maltophilia infection have provided useful information about the type of host immune response induced by this opportunistic pathogen. Current and emerging treatments for patients infected with S. maltophilia are discussed.
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Affiliation(s)
- Joanna S Brooke
- Department of Biological Sciences, DePaul University, Chicago, Illinois, USA.
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Lin YE, Stout JE, Yu VL. Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods. Infect Control Hosp Epidemiol 2011; 32:166-73. [PMID: 21460472 DOI: 10.1086/657934] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hospital-acquired Legionnaires' disease is directly linked to the presence of Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination). The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detect Legionella and monitoring of disinfectant concentrations are necessary to ensure long-term efficacy.
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Affiliation(s)
- Yusen E Lin
- National Kaohsiung Normal University, Kaohsiung, Taiwan
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Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia Due to Pseudomonas aeruginosa. Chest 2011; 139:909-919. [DOI: 10.1378/chest.10-0166] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Simon A, Tutdibi E, von Müller L, Gortner L. Beatmungsassoziierte Pneumonie bei Kindern. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-010-2303-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cuttelod M, Senn L, Terletskiy V, Nahimana I, Petignat C, Eggimann P, Bille J, Prod'hom G, Zanetti G, Blanc D. Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007). Clin Microbiol Infect 2011; 17:57-62. [DOI: 10.1111/j.1469-0691.2010.03164.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Point-of-use filtration method for the prevention of fungal contamination of hospital water. J Hosp Infect 2010; 76:56-9. [DOI: 10.1016/j.jhin.2010.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Accepted: 03/19/2010] [Indexed: 11/17/2022]
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Holmes C, Cervia JS, Ortolano GA, Canonica FP. Preventive efficacy and cost-effectiveness of point-of-use water filtration in a subacute care unit. Am J Infect Control 2010; 38:69-71. [PMID: 19709779 DOI: 10.1016/j.ajic.2009.04.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 04/27/2009] [Indexed: 10/20/2022]
Abstract
Infections with Pseudomonas aeruginosa and other waterborne pathogens (WBPs) are major contributors to serious morbidity and mortality in hospitals. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in the subacute care unit (SACU) of a 208-bed medical center. Our findings indicate that POU water filtration can significantly and cost-effectively reduce colonization of and infection with WBPs, including ventilator-associated pneumonia, in an SACU.
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Price LB, Liu CM, Johnson KE, Aziz M, Lau MK, Bowers J, Ravel J, Keim PS, Serwadda D, Wawer MJ, Gray RH. The effects of circumcision on the penis microbiome. PLoS One 2010; 5:e8422. [PMID: 20066050 PMCID: PMC2798966 DOI: 10.1371/journal.pone.0008422] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 11/09/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Circumcision is associated with significant reductions in HIV, HSV-2 and HPV infections among men and significant reductions in bacterial vaginosis among their female partners. METHODOLOGY/PRINCIPAL FINDINGS We assessed the penile (coronal sulci) microbiota in 12 HIV-negative Ugandan men before and after circumcision. Microbiota were characterized using sequence-tagged 16S rRNA gene pyrosequencing targeting the V3-V4 hypervariable regions. Taxonomic classification was performed using the RDP Naïve Bayesian Classifier. Among the 42 unique bacterial families identified, Pseudomonadaceae and Oxalobactericeae were the most abundant irrespective of circumcision status. Circumcision was associated with a significant change in the overall microbiota (PerMANOVA p = 0.007) and with a significant decrease in putative anaerobic bacterial families (Wilcoxon Signed-Rank test p = 0.014). Specifically, two families-Clostridiales Family XI (p = 0.006) and Prevotellaceae (p = 0.006)-were uniquely abundant before circumcision. Within these families we identified a number of anaerobic genera previously associated with bacterial vaginosis including: Anaerococcus spp., Finegoldia spp., Peptoniphilus spp., and Prevotella spp. CONCLUSIONS/SIGNIFICANCE The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases.
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Affiliation(s)
- Lance B Price
- Translational Genomics Research Institute (TGen), Flagstaff, Arizona, United States of America.
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Adjidé CC, De Meyer A, Weyer M, Obin O, Lamory F, Lesueur C, Trouillet L, Biendo M, Eb F, Ganry O. [Stenotrophomonas maltophilia and Pseudomonas aeruginosa water-associated microbiologic risk assessment in Amiens' University Hospital Centre]. ACTA ACUST UNITED AC 2009; 58:e1-5. [PMID: 19892487 DOI: 10.1016/j.patbio.2009.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/12/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.
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Affiliation(s)
- C C Adjidé
- Unité d'hygiène et épidémiologie hospitalière, service d'épidémiologie hygiène hospitalière et santé publique, CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Cervia JS, Ortolano GA, Canonica FP, McAlister MB. Role of biofilm in Pseudomonas aeruginosa colonization and infection. Infect Control Hosp Epidemiol 2009; 30:925-7. [PMID: 19653824 DOI: 10.1086/605643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cervia J, Farber B, Armellino D, Klocke J, Bayer RL, McAlister M, Stanchfield I, Canonica F, Ortolano G. Point-of-use water filtration reduces healthcare-associated infections in bone marrow transplant recipients. Transpl Infect Dis 2009; 12:238-41. [DOI: 10.1111/j.1399-3062.2009.00459.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barsanti MC, Woeltje KF. Infection Prevention in the Intensive Care Unit. Infect Dis Clin North Am 2009; 23:703-25. [DOI: 10.1016/j.idc.2009.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Trautmann M, Halder S, Lepper P, Exner M. Antwort der Autoren zu den Anmerkungen zum Beitrag: Reservoir von Pseuodomonas aeruginosa auf Intensivstationen aus dem Bundesgesundheitsblatt vom März 2009. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009. [DOI: 10.1007/s00103-009-0916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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