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Sanitary system reconstruction reduces risk of P. aeruginosa infection
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Remodeling of hospital sanitation and water installations to control environmental contamination effectively minimized the risk of multidrug-resistant Pseudomonas aeruginosa infections in allogeneic hematopoietic stem cell transplant patients, according to recent data.
“The sanitary and water supply system is a common reservoir for P. aeruginosa biofilm formation [and] as a consequence, hospital construction design needs to consider these sources of transmission of [multidrug-resistant P. aeruginosa (MDRPa)] from the environment,” Annelene Kossow, MD, from the Institute of Hygiene at the University of Muenster in Germany, and colleagues wrote. “We hypothesized that environmental reservoirs pose a severe risk to patients undergoing [hematopoietic stem cell transplantation] for acquiring MDRPa and develop invasive disease.”
During a reconstruction at the University of Muenster Hospital’s transplantation unit, researchers implemented a variety of hygiene measures to reduce environmental contamination by, and subsequent spreading of, MDRPa. These modifications included a newly designed shower drain, disinfecting siphons underneath the sinks and rimless toilets. The investigators tracked the number of hematopoietic stem cell transplantation (HSCT) patients colonized and/or infected by MDRPa and the outcomes of infected patients from 2012 to 2014. They monitored the environmental occurrence of MDRPa for the duration of the study. To evaluate genotype relationships between isolates, they also performed whole genome sequencing (WGS) of nosocomial MDRPa strains.
By 2014, the number of patients colonized and infected by MDRPa decreased from 18 and 13 patients to 3 and 0 patients, whereas mortality by MDRPa decreased from 3.6% to 0%. Environmental detection of MDRPa decreased from 18.9% in 2012/2013 to 6.1% in 2014 in toilets and from 8.1% to 3% in shower outlets. WGS of nosocomial MDRPa strains revealed a significant association between environmental and patient-derived isolates.
“Taken together, our study demonstrated that structural changes combined with a bundle of infection prevention measures can lead to a decrease in environmental occurrence and a reduction of MDRPa infections in HSCT patients,” Kossow and colleagues wrote. “this strategy with its special focus on hospital construction measures may serve as a model for other institutions facing the daunting challenge of multidrug-resistant bacteria in high-risk patients.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.
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