Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Institute for Intensive Care Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
J Hosp Infect. 2023 Sep;139:161-167. doi: 10.1016/j.jhin.2023.06.013. Epub 2023 Jun 19.
Pseudomonas aeruginosa and other Gram-negative bacteria have the ability to persist in moist environments in healthcare settings, but their spread from these areas can result in outbreaks of healthcare-associated infections.
This study reports the investigation and containment of a multi-drug-resistant P. aeruginosa outbreak in three intensive care units of a Swiss university hospital. In total, 255 patients and 276 environmental samples were screened for the multi-drug-resistant P. aeruginosa outbreak strain. The environmental sampling and molecular characterization of patient and environmental strains, and control strategies implemented, including waterless patient care, are described.
Between March and November 2019, the outbreak affected 29 patients. Environmental sampling detected the outbreak strain in nine samples of sink siphons of three different intensive care units with a common water sewage system, and on one gastroscope. Three weeks after replacement of the sink siphons, the outbreak strain re-grew in siphon-derived samples and newly affected patients were identified. The outbreak ceased after removal of all sinks in the proximity of patients and in medication preparation areas, and minimization of tap water use. Multi-locus sequence typing indicated clonality (sequence type 316) in 28/29 patient isolates and all 10 environmental samples.
Sink removal combined with the introduction of waterless patient care terminated the multi-drug-resistant P. aeruginosa outbreak. Sinks in intensive care units may pose a risk for point source outbreaks with P. aeruginosa and other bacteria persisting in moist environments.
铜绿假单胞菌和其他革兰氏阴性菌能够在医疗保健环境中的潮湿环境中持续存在，但它们从这些区域的传播可能导致医疗保健相关感染的爆发。
本研究报告了对瑞士一所大学医院的三个重症监护病房中发生的多重耐药铜绿假单胞菌爆发的调查和控制。共对 255 名患者和 276 个环境样本进行了筛查，以确定多重耐药铜绿假单胞菌爆发菌株。描述了患者和环境菌株的环境采样和分子特征以及实施的控制策略，包括无水患者护理。
2019 年 3 月至 11 月期间，爆发影响了 29 名患者。环境采样在三个不同重症监护病房的共用污水系统的九个水槽虹吸管样本和一个胃镜中检测到了爆发菌株。更换水槽虹吸管三周后，在虹吸管衍生样本中重新生长出了爆发菌株，并发现了新的受影响患者。在移除患者附近和药物制备区域的所有水槽以及最大限度减少自来水使用后，爆发停止。多位点序列分型表明，29 名患者分离株中的 28 株和所有 10 个环境样本均具有克隆性（序列型 316）。
水槽的移除加上无水患者护理的引入，终止了多重耐药铜绿假单胞菌的爆发。重症监护病房的水槽可能会对铜绿假单胞菌和其他细菌在潮湿环境中持续存在的点源爆发构成风险。
