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Faucet aerators: A source of patient colonization with Stenotrophomonas maltophilia
D J Weber1, W A Rutala, C N Blanchet
1Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill 27599-7030, USA.
Background:
Multiple nosocomial outbreaks have been linked to contaminated water sources within the hospital. We report in this article a cluster of patients in a surgical intensive care unit who were colonized or infected with Stenotrophomonas maltophilia.
Methods:
This study was conducted at an acute care academic hospital. Patients colonized or infected with S maltophilia were identified by prospective surveillance. Environmental isolates were obtained by culturing multiple water sources by using standard techniques. Patient and environmental isolates were examined by pulsed-field gel electrophoresis.
Results:
Patients were colonized with 2 isolates of S maltophilia, which were found by pulsed-field gel electrophoresis to be identical to strains isolated from the faucet aerators present in sinks in the patients' rooms. Multiple different strains, as defined by pulsed-field gel electrophoresis, were isolated from patients during this outbreak.
Conclusions:
We believe that low level contamination of our potable water led to contamination of the faucet aerators with subsequent bacterial amplification on the aerator, which led to contamination of water after aeration. Cultures should be performed on faucet aerators when water sources are suspected as the reservoir for a nosocomial outbreak. If additional clusters of infected or colonized patients are linked to contaminated aerators, consideration should be given to routine disinfection or removal of the aerators.
Insights
Faucet aerators in surgical ICUs can harbor Stenotrophomonas maltophilia, leading to patient colonization and infection. Routine testing and disinfection of aerators are recommended to prevent hospital-acquired outbreaks.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Nosocomial outbreaks are frequently linked to contaminated hospital water sources.
- A cluster of Stenotrophomonas maltophilia (S. maltophilia) colonization/infection occurred in a surgical intensive care unit.
Purpose of the Study:
- To investigate the source of S. maltophilia in a surgical intensive care unit outbreak.
- To identify the role of water sources in patient colonization and infection.
Main Methods:
- Prospective surveillance identified patients with S. maltophilia.
- Environmental water sources, including faucet aerators, were cultured.
- Pulsed-field gel electrophoresis (PFGE) was used to compare patient and environmental isolates.
Main Results:
- S. maltophilia isolates from patients matched strains from faucet aerators.
- PFGE revealed multiple S. maltophilia strains during the outbreak.
- Faucet aerators served as a reservoir for S. maltophilia.
Conclusions:
- Low-level potable water contamination likely led to faucet aerator contamination and bacterial amplification.
- Faucet aerator cultures are crucial when water is a suspected outbreak reservoir.
- Routine aerator disinfection or removal may be necessary to prevent future outbreaks.