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Electronic ventilator temperature sensors as a potential source of respiratory tract colonization with
A M Rogues1, J Maugein, A Allery
1Service d'Hygiène Hospitalière, Hôpital du Haut Lévêque, Groupe Hospitalier Sud, CHU de Bordeaux, France.
Abstract:
Stenotrophomonas maltophilia (S. maltophilia) is an important cause of nosocomial infection among ventilated and immunocompromised patients, and among patients receiving broad-spectrum antimicrobials. We report a cluster of patients in a surgical intensive care unit who were colonized or infected with S. maltophilia. An epidemiological investigation was initiated after surveillance data revealed that eight patients were culture-positive from sputum for S. maltophilia in the preceding month. Review of respiratory care procedures revealed that when mechanical ventilators were serviced between patients, the electronic temperature probes used with servo-controlled humidifiers were wiped with inadequate disinfection. We collected cultures of case-patient room surfaces, sinks and ventilator equipment. S. maltophilia was recovered from room surfaces, ventilator expiratory circuits and a temperature sensor which had been kept in ambient air after disinfection. Patients and environmental isolates were examined by RAPD-PCR. Three clinical isolates and one environmental isolate had the same profile, which suggests cross-contamination or common source exposure. The outbreak was controlled by adequate disinfection of the temperature sensors. No single epidemic strain was identified but several observations support the conclusion that the temperature probes contributed to the outbreak.
Insights
A cluster of Stenotrophomonas maltophilia (S. maltophilia) infections in a surgical ICU was linked to contaminated ventilator temperature probes. Improved disinfection of these probes successfully controlled the outbreak.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Critical Care Medicine
Background:
- Stenotrophomonas maltophilia (S. maltophilia) is a significant cause of nosocomial infections, particularly in vulnerable patient populations.
- Nosocomial infections pose a substantial threat to patients in intensive care units, especially those requiring mechanical ventilation.
- Previous outbreaks have highlighted the importance of environmental hygiene in preventing the spread of multidrug-resistant organisms.
Purpose of the Study:
- To investigate an outbreak of S. maltophilia colonization and infection in a surgical intensive care unit.
- To identify the source and transmission route of S. maltophilia during the outbreak.
- To implement and evaluate control measures to contain the spread of S. maltophilia.
Main Methods:
- Epidemiological investigation including surveillance data review and analysis of patient cultures.
- Environmental sampling of patient rooms, sinks, and mechanical ventilator equipment, including temperature probes.
- Molecular typing (RAPD-PCR) of clinical and environmental S. maltophilia isolates to assess relatedness.
Main Results:
- Eight patients in the surgical ICU were found to be culture-positive for S. maltophilia from sputum.
- S. maltophilia was recovered from room surfaces, ventilator expiratory circuits, and a disinfected temperature sensor.
- Molecular analysis indicated potential cross-contamination or common source exposure, with similar profiles between some clinical and environmental isolates.
Conclusions:
- Inadequate disinfection of electronic temperature probes used with humidifiers on mechanical ventilators likely contributed to the S. maltophilia outbreak.
- Implementing adequate disinfection protocols for temperature sensors was effective in controlling the spread of S. maltophilia.
- While no single epidemic strain was identified, the findings underscore the role of environmental contamination in S. maltophilia transmission.
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Step 2:
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Step 3:
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Step 4:
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