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Waterborne Pseudomonas aeruginosa transmission in a hematology unit?

Published:November 28, 2017DOI:https://doi.org/10.1016/j.ajic.2017.10.013

      Background

      Pseudomonas aeruginosa is an important nosocomial pathogen that commonly colonizes hospital water supplies, including in taps and sinks. We report the transmission of P. aeruginosa from water to patients in a clinical hematology setting.

      Methods

      P. aeruginosa from water samples were compared to clinical isolates from hematology ward patients, via molecular typing (pulsed field gel electrophoresis).

      Results

      P. aeruginosa cultured from blood cultures from 3 patients was indistinguishable from water strains, by molecular typing. Based on infection control inspections, the transmission event was surmised to be due to cleaning of equipment, specifically an infusion therapy procedure tray used to transport intravenous drugs to patients, with water from an outlet colonized by P. aeruginosa.

      Conclusion

      We show the importance of holistic factors, such as disposal of patient waste water, cleaning of tap outlets, and cleaning of medical equipment, in the transmission of P. aeruginosa, and demonstrate that the role of waterborne transmission of this organism in a hematology setting cannot be overlooked. We suggest that appropriate management of water, including both holistic and engineering interventions, is needed to stop transmission of P. aeruginosa from water to patients.

      Key Words

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      References

        • Quick J.
        • Cumley N.
        • Wearn C.M.
        • Niebel M.
        • Constantinidou C.
        • Thomas C.M.
        • et al.
        Seeking the size of Pseudomonas aeruginosa infections in a recently opened hospital: an observational study using whole genome sequencing.
        BMJ Open. 2014; : 4e006278
        • Garvey M.I.
        • Bradley C.W.
        • Tracey J.
        • Oppenheim B.
        Continued transmission of Pseudomonas aeruginosa from a hand wash basin tap in a critical care unit.
        J Hosp Infect. 2016; 94: 8-12
        • Walker J.T.
        • Jhutty A.
        • Parks S.
        • Willis C.
        • Copley V.
        • Turton J.F.
        • et al.
        Investigation of healthcare associated infections associated with Pseudomonas aeruginosa biofilm in taps in neonatal units in Northern Ireland.
        J Hosp Infect. 2014; 86: 16-23
        • Wise J.
        Three babies die in Pseudomonas outbreak at Belfast neonatal unit.
        BMJ. 2012; 344: e592
        • Department of Health
        Water Systems, Health Technical Memorandum 04-01: Addendum.
        (Pseudomonas aeruginosa—advice for augmented care units; Available from:) (Accessed September 25, 2017)
        • Department of Health
        Health Technical Memorandum 04-01: Safe water in healthcare premises.
        (Part C: Pseudomonas aeruginosa—advice for augmented care units; Available from:) (Accessed September 25, 2017)
        • McCarthy K.L.
        • Paterson D.L.
        Long-term mortality following Pseudomonas aeruginosa bloodstream infection.
        J Hosp Infect. 2017; 95: 292-299
        • Richet H.
        • Escande M.C.
        • Marie J.P.
        • Zittoun R.
        • Lagrange P.H.
        Epidemic Pseudomonas aeruginosa serotype O16 bacteraemia in haematology-oncology patient.
        J Clin Micro. 1989; 27: 1992-1996
        • Kaufmann M.E.
        Pulsed-field gel electrophoresis.
        in: Woodford N. Johnson A.P. Methods in molecular medicine 15: molecular bacteriology: protocols and clinical applications. Humana Press, New York (NY)1998: 33-50
        • Public Health England
        UK standards for microbiology investigation—B37 investigation of blood cultures (for organisms other than Mycobacterium species).
        (Available from:) (Accessed September 25, 2017)
        • Garvey M.I.
        • Bradley C.W.
        • Jumaa P.
        Environmental decontamination following occupancy of a burns patient with multiple carbapenemase-producing organisms.
        J Hosp Infect. 2016; 93: 136-140
        • Loveday H.P.
        • Wilson J.A.
        • Kerr K.
        • Pitchers R.
        • Walker J.T.
        • Browne J.
        Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review.
        J Hosp Infect. 2014; 86: 7-15
        • Walker J.
        • Moore G.
        Pseudomonas aeruginosa in hospital water systems: biofilms, guidelines, and practicalities.
        J Hosp Infect. 2015; 89: 324-327
        • Walker J.
        • Moore G.
        Safe water in healthcare premises.
        J Hosp Infect. 2016; 94: 1
        • Garvey M.I.
        • Bradley C.W.
        • Wilkinson M.A.C.
        • Bradley C.R.
        • Holden E.
        Engineering waterborne Pseudomonas aeruginosa out of a critical care unit.
        Int J Hyg Environ Health. 2017; 220: 1014-1019
        • Garvey M.I.
        • Bradley C.W.
        • Jumaa P.
        The risks of contamination from tap end filters.
        J Hosp Infect. 2016; 94: 282-283
        • Garvey M.I.
        • Bradley C.W.
        • Holden K.L.
        • Hewins K.L.
        • Ngui S.L.
        • Tedder R.
        • et al.
        Use of genome sequencing to identify hepatitis C virus transmission in a renal healthcare setting.
        J Hosp Infect. 2017; 96: 157-162