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Infect Control Hosp Epidemiol 2009;30:000–000
© 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2009/3001-00XX$15.00
DOI: 10.1086/592700
Original Article
Outbreak of Multidrug-Resistant Pseudomonas aeruginosa Colonization and Infection Secondary to Imperfect Intensive Care Unit Room Design
由于ICU房间设计不合理而导致的多重耐药的铜绿假单胞菌定植感染暴发
Susy Hota, MD; Zahir Hirji, MHSc; Karen Stockton, MHSc; Camille Lemieux, MD, LLB; Helen Dedier, MLT; Gideon Wolfaardt, PhD; Michael A. Gardam, MD, MSc
From the Department of Infection Prevention and Control, University Health Network (S.H., Z.H., K.S., C.L., H.D., M.A.G.), and the Department of Medicine, University of Toronto (S.H., M.A.G.), and the Department of Chemistry and Biology, Ryerson University (G.W.), Toronto, Ontario, Canada.
Background. Pseudomonas aeruginosa has been increasingly recognized for its ability to cause significant hospital-associated outbreaks, particularly since the emergence of multidrug-resistant strains. Biofilm formation allows the pathogen to persist in environmental reservoirs. Thus, multiple hospital room design elements, including sink placement and design, can impact nosocomial transmission of P. aeruginosa and other pathogens.
Methods. From December 2004 through March 2006, 36 patients exposed to the intensive care unit or transplant units of a tertiary care hospital were infected with a multidrug-resistant strain of P. aeruginosa. All phenotypically similar isolates were examined for genetic relatedness by means of pulsed-field gel electrophoresis. Clinical characteristics of the affected patients were collected, and a detailed epidemiological and environmental investigation of potential sources was carried out.
Results. Seventeen of the infected patients died within 3 months; for 12 (71%) of these patients, infection with the outbreak organism contributed to or directly caused death. The source of the outbreak was traced to hand hygiene sink drains, where biofilms containing viable organisms were found. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least 1 meter from the sink. Various attempts were made to disinfect the drains, but it was only when the sinks were renovated to prevent splashing onto surrounding areas that the outbreak was terminated.
Conclusion. This report highlights the importance of biofilms and of sink and patient room design in the propagation of an outbreak and suggests some strategies to reduce the risks associated with hospital sinks.
Received April 10, 2008; accepted August 6, 2008; electronically published December 1, 2008.
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发表于 2008-12-4 13:01
