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Nosocomial Pseudomonas aeruginosa urinary tract infections
Abstract:
Two separate outbreaks of Pseudomonas aeruginosa urinary tract infections (UTIs) were associated with cystoscopy or transurethral prostate resection. The first outbreak was identified after routine bacteremia surveillance demonstrated four cases of P aeruginosa septicemia in a three-month period. A six-month retrospective review of the microbiology records identified 14 cases of P aeruginosa UTI associated with urologic surgery instrumentation. The outbreak terminated after the implementation of two major control measures: (1) replacement of hexachlorophene solution with an iodophor solution for preparing patients and cleaning instruments before disinfection, and (2) weekly gas sterilization of cystoscopy instruments. The second outbreak, consisting of 11 cases of P aeruginosa UTI after transurethral resection of the prostate gland, occurred in a 187-bed community hospital. All available patient isolates were serotype 011, and culture of a rubber adaptor attached to the resectoscope also yielded growth of that serotype. The outbreak promptly terminated when the rubber adaptor was sterilized between cases.
Insights
Two Pseudomonas aeruginosa outbreaks linked to urologic procedures highlight the importance of infection control. Implementing enhanced sterilization protocols for surgical instruments effectively terminated these urinary tract infection (UTI) outbreaks.
Area of Science:
- Infectious Diseases
- Urology
- Hospital Epidemiology
Background:
- Nosocomial urinary tract infections (UTIs) pose a significant challenge in healthcare settings.
- Pseudomonas aeruginosa is a common opportunistic pathogen implicated in hospital-acquired infections.
- Urologic instrumentation procedures, such as cystoscopy and transurethral prostate resection, are associated with an increased risk of UTIs.
Purpose of the Study:
- To investigate and characterize two distinct outbreaks of Pseudomonas aeruginosa UTIs.
- To identify the sources and transmission routes of P. aeruginosa during urologic procedures.
- To evaluate the effectiveness of infection control interventions in terminating these outbreaks.
Main Methods:
- Retrospective review of microbiology records and patient data.
- Bacteremia surveillance to detect initial cases.
- Microbial culture and serotyping of patient isolates and equipment.
- Implementation and assessment of infection control measures, including changes in antiseptic solutions and sterilization techniques.
Main Results:
- The first outbreak involved 14 cases of P. aeruginosa UTI associated with urologic surgery instrumentation, identified through surveillance and retrospective review.
- Implementation of iodophor solution for patient preparation/instrument cleaning and weekly gas sterilization of cystoscopy instruments terminated the first outbreak.
- The second outbreak involved 11 cases of P. aeruginosa UTI following transurethral resection of the prostate, linked to a contaminated rubber adaptor on the resectoscope (serotype 011).
- Sterilization of the contaminated rubber adaptor promptly terminated the second outbreak.
Conclusions:
- Rigorous adherence to infection control protocols, including appropriate disinfection and sterilization of urologic instruments, is critical for preventing P. aeruginosa outbreaks.
- Specific interventions, such as switching antiseptic solutions and implementing routine sterilization of equipment components, can effectively control and prevent recurrent UTIs associated with urologic procedures.
- Environmental and equipment contamination represents a significant risk factor for nosocomial P. aeruginosa UTIs in urologic surgery.