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Nosocomial Pseudomonas pickettii colonization associated with a contaminated respiratory therapy solution in a
Abstract:
Pseudomonas pickettii caused respiratory tract colonization in five infants in the special care nursery of a Chicago hospital. All organisms had the same antimicrobial susceptibilities. Endotracheal suctioning with saline from 5-ml unit-dose vials was identified by epidemiologic investigation as a risk factor for colonization. The vials of saline were contaminated with a strain of P. pickettii having the same antimicrobial susceptibility pattern as the isolates from patients. As part of an investigation of the manufacturing plant where the saline solution was produced, P. pickettii was recovered from deionized water used to make the product and from several sites in the processing line. Bypassing of a 180 degrees F (ca. 82 degrees C) water-holding tank appeared to be temporally related to product contamination. The ability of P. pickettii to survive and grow in this solution has been demonstrated in the laboratory. This outbreak demonstrates that, despite pertinent Food and Drug Administration regulations and company programs for identifying such contamination, intrinsically contaminated solutions can occasionally reach the bedside of the patient.
Insights
Contaminated saline vials led to Pseudomonas pickettii colonization in five infants. This outbreak highlights risks from intrinsically contaminated medical solutions reaching patients, despite regulations.
Area of Science:
- Medical Microbiology
- Infectious Disease Epidemiology
- Healthcare-Associated Infections
Background:
- Pseudomonas pickettii is an opportunistic pathogen.
- Healthcare-associated infections (HAIs) pose significant risks to vulnerable patient populations, particularly in neonatal intensive care units.
- Contamination of medical supplies can lead to outbreaks of infection.
Purpose of the Study:
- To investigate an outbreak of Pseudomonas pickettii respiratory tract colonization in infants.
- To identify the source and risk factors associated with the P. pickettii outbreak.
- To evaluate the effectiveness of existing contamination control measures.
Main Methods:
- Epidemiologic investigation including patient and environmental sampling.
- Microbiological analysis of clinical isolates and potential sources.
- Antimicrobial susceptibility testing of P. pickettii strains.
- Laboratory studies to assess P. pickettii survival in saline.
Main Results:
- Five infants in a special care nursery developed P. pickettii respiratory tract colonization.
- Endotracheal suctioning with 5-ml unit-dose saline vials was identified as a risk factor.
- P. pickettii contamination was traced to deionized water and processing lines at the saline manufacturing plant.
- Bypassing of a hot water tank at the manufacturing facility was temporally linked to contamination.
Conclusions:
- Intrinsically contaminated saline solutions can reach patients despite regulatory oversight.
- Manufacturing process failures can lead to microbial contamination of sterile medical products.
- Enhanced surveillance and quality control are crucial to prevent such outbreaks.