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A pseudo-outbreak of Pseudomonas on a special care baby unit
S Heard1, S Lawrence, B Holmes
1Department of Medical Microbiology, St. Bartholomew's Hospital, London.
Insights
A multi-antibiotic-resistant Pseudomonas outbreak in a Special Care Baby Unit was traced to a contaminated in-house transport medium. This highlights the importance of proper storage and handling of medical supplies to prevent infant infections.
Area of Science:
- Medical Microbiology
- Infectious Disease Epidemiology
- Healthcare Infection Control
Background:
- An outbreak of multi-antibiotic-resistant Pseudomonas was identified in a Special Care Baby Unit (SCBU).
- Initial investigations focused on patient-to-patient transmission, but screening failed to identify the source.
- A significant number of infants (13 additional cases) were found to be colonized.
Purpose of the Study:
- To investigate the source of a multi-antibiotic-resistant Pseudomonas outbreak in an SCBU.
- To identify the specific Pseudomonas species involved and the route of transmission.
- To discuss the implications of the outbreak and its investigation.
Main Methods:
- Isolation and biochemical characterization of Pseudomonas species from affected infants.
- Screening of infants using commercial and in-house transport media.
- Environmental investigation, including examination of stored media and suspected contamination sources.
Main Results:
- The outbreak involved Pseudomonas pickettii and at least one other Pseudomonas species.
- The source of contamination was traced to an in-house transport medium stored improperly under a sink.
- Water splashing from the sink was identified as the likely ultimate source of contamination.
Conclusions:
- Improper storage and handling of medical supplies, specifically transport media, can lead to significant healthcare-associated infections.
- Environmental contamination, even from seemingly minor sources like splashed sink water, poses a risk in clinical settings.
- Effective infection control requires vigilant monitoring of supplies and adherence to proper storage protocols to prevent outbreaks.
Abstract:
Following isolation of a multi-antibiotic-resistant pseudomonad from a newborn infant on admission to the Special Care Baby Unit and further isolation of apparently the same organism from two additional infants, a full investigation was instigated in an attempt to discover the source of the organism. This revealed a further 13 infants apparently colonized with the same organism. Repeated screening of the infants with a commercial sterile swab/transport medium failed to isolate the organism. Examination of bottles of the in-house transport medium, which had been stored under a sink, produced further isolates of the same organism. Water splashed from the sink was suspected as the ultimate source of contamination. Biochemical characterization showed that P. pickettii and at least one other Pseudomonas species were involved. The epidemiological, clinical and economic implications of the 'outbreak' are discussed together with the ultimate financial implications for investigation of such incidents.