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Outbreak of severe Pseudomonas aeruginosa respiratory infections due to contaminated nebulizers
N A Cobben1, M Drent, M Jonkers
1Department of Pulmonology, University Hospital, Maastricht, the Netherlands.
Abstract:
During the six months from January-June 1994, 10 cases of severe and 11 of less severe pulmonary infection caused by Pseudomonas aeruginosa were diagnosed in patients with chronic obstructive airways disease. Possible sources were evaluated. P. aeruginosa was isolated from four of the 22 nebulizers tested. The relationship of isolates from the patients and nebulizers was confirmed by sero- and phage-typing, and by arbitrarily-primed polymerase chain reaction (AP-PCR). Three types were identified and the distribution of types in patients with severe infection was as follows (one patient had a multiple infection). Type I was isolated from two nebulizers and from sputa, and/or blood and/or bronchial protected specimen brush samples or bronchial lavage fluid from four patients. Type II came from the sputa of three patients and a third nebulizer; and type III from sputa and/or blood of four further patients and another nebulizer. The data provided evidence for the relation between P. aeruginosa as a cause of infection and the contamination of the nebulizers. When nebulizer mouthpieces were changed every 24 h and sterilized between patients, no more contamination occurred, and the outbreak ceased.
Insights
Contaminated nebulizers caused Pseudomonas aeruginosa infections in patients with chronic obstructive airways disease. Sterilizing equipment and changing nebulizer mouthpieces halted the outbreak, demonstrating a link between device contamination and patient infection.
Area of Science:
- Medical Microbiology
- Pulmonology
- Infectious Disease
Background:
- Pseudomonas aeruginosa is an opportunistic pathogen.
- Patients with chronic obstructive airways disease (COWD) are susceptible to respiratory infections.
- Nebulizer devices can become contaminated with microorganisms.
Purpose of the Study:
- To investigate the source of Pseudomonas aeruginosa pulmonary infections in patients with chronic obstructive airways disease.
- To determine the role of nebulizer contamination in these infections.
- To implement control measures and assess their effectiveness.
Main Methods:
- Epidemiological investigation of pulmonary infections.
- Isolation and identification of Pseudomonas aeruginosa from patient samples (sputa, blood, bronchial lavage) and nebulizers.
- Molecular typing of isolates using sero-typing, phage-typing, and arbitrarily-primed polymerase chain reaction (AP-PCR).
Main Results:
- Twenty-one cases of Pseudomonas aeruginosa pulmonary infection (10 severe, 11 less severe) were diagnosed in COWD patients.
- P. aeruginosa was isolated from 4 out of 22 tested nebulizers.
- Molecular typing confirmed the link between nebulizer contamination and patient infections, identifying three distinct types.
- Implementation of strict nebulizer hygiene protocols (24-hour mouthpiece changes, sterilization) led to the cessation of the outbreak.
Conclusions:
- Contaminated nebulizers were identified as a significant source of Pseudomonas aeruginosa pulmonary infections in COWD patients.
- Effective infection control measures, including proper nebulizer maintenance and sterilization, are crucial for preventing outbreaks.
- This study highlights the importance of device hygiene in healthcare settings to mitigate the risk of hospital-acquired infections.