1University of Minnesota Health and University of Minnesota Health Masonic Children's Hospital,Minneapolis,Minnesota.
2Biostatistical Design and Analysis Center (BDAC),Clinical and Translational Science Institute (CTSI),University of Minnesota,Minneapolis,Minnesota.
Infect Control Hosp Epidemiol. 2017 Jul;38(7):792-800. doi: 10.1017/ice.2017.73. Epub 2017 May 23.
BACKGROUND In 2011, pediatric hematopoietic stem cell transplant (HSCT) patients were moved from an older hospital to a new children's hospital. To minimize bacterial growth in the new hospital's water during construction, the plumbing system was flushed and disinfected before occupancy. However, 6 months after occupancy, an increased incidence of rapidly growing mycobacteria (RGM) was detected in clinical cultures. Over 10 months, 15 pediatric HSCT patients were infected, while no pediatric HSCT patients had been infected in the preceding 12 months. OBJECTIVE To determine the cause of the outbreak and to interrupt patient acquisition of RGM. METHODS Water samples were collected from water entering the hospital and from drinking water and ice machines (DWIMs) from the old and new hospitals. Total heterotrophic plate counts (HPCs, CFU/mL) of water were undertaken, and select isolates were identified as RGM. RESULTS The cause of the outbreak was increased bacterial levels in the water (including RGM) in the DWIMs in the new (2011) hospital. Tests revealed higher HPCs in drinking water and ice from the DWIMs in the new hospital than in the DWIMs in the old hospital. Ultimately, HPCs were reduced by several different interventions. CONCLUSION In response to an RGM outbreak, HSCT patients were banned from ingesting DWIM ice and water and bottled water was provided. Since this interverntion 4 years ago, no additional RGM isolates have been identified in HSCT patient cultures. Our measures to reduce HPCs to goal levels in drinking water from DWIMs were successful, but the HPCs for ice have not consistently reached the goal of <500 CFU/mL. Infect Control Hosp Epidemiol 2017;38:792-800.
2011 年，儿科造血干细胞移植（HSCT）患者从旧医院转移到新儿童医院。为了最大限度地减少新医院建筑期间水中的细菌生长，在入住前对管道系统进行了冲洗和消毒。然而，入住后 6 个月，临床培养物中发现快速生长分枝杆菌（RGM）的发病率增加。在 10 个月的时间里，15 名儿科 HSCT 患者感染，而在之前的 12 个月中没有儿科 HSCT 患者感染。目的：确定暴发的原因并中断患者获得 RGM。方法：从进入医院的水以及新旧医院的饮用水和制冰机（DWIM）中采集水样。进行水的总异养平板计数（HPC，CFU/mL），并选择分离株鉴定为 RGM。结果：暴发的原因是新（2011 年）医院 DWIM 水中的细菌水平（包括 RGM）增加。测试显示，新医院 DWIM 的饮用水和冰中的 HPC 高于旧医院 DWIM。最终，通过几种不同的干预措施降低了 HPC。结论：针对 RGM 暴发，HSCT 患者被禁止摄入 DWIM 冰和水，并提供瓶装水。自 4 年前进行这种干预以来，HSCT 患者培养物中未再发现其他 RGM 分离株。我们将 DWIM 饮用水中的 HPC 降低到目标水平的措施是成功的，但冰的 HPC 并未始终达到<500 CFU/mL 的目标。感染控制与医院流行病学 2017；38：792-800。
