Nosocomial outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with aromatherapy

doi:10.1016/j.ajic.2016.11.002

American Journal of Infection Control

Volume 45, Issue 4, 1 April 2017, Pages 453-455

https://doi.org/10.1016/j.ajic.2016.11.002 Get rights and content

Highlights

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An increase of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) took place in a surgical intensive care unit.
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Molecular typing confirmed a nosocomial outbreak was present.
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Transmission of XDR-PA had likely occurred via patient care oil for aromatherapy.
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Significance of exogenous sources for XDR-PA and importance of strict infection control are emphasized.

An increase of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) in various clinical specimens among intensive care unit patients (n = 7) initiated an outbreak investigation consisting of patient data analyses, control of adherence to infection control guidelines, microbiologic surveys, and molecular-based studies. XDR-PA was detected in a jointly used aroma-oil nursing bottle for aromatherapy. We implemented the restriction of oil sharing among patients. Hence, the outbreak was controlled successfully.

Section snippets

Methods

The University Hospital of Innsbruck, a 1,600-bed, tertiary care hospital, covers a broad range of surgical and medical specialties. The surgical intensive care unit (SICU) consists of 4 rooms each containing 3 beds. Patients are routinely screened on admission (oropharyngeal, rectal, and nasal), and standard hygienic precautions are carried out routinely. Colonization was defined as evidence of XDR-PA in unsterile body sites, without any signs or symptoms of infection (eg, samples from nose or

Results

After an increase of XDR-PA isolates from multiple sites of 7 among 33 patients admitted to the SICU (21.2%) during a month-long period, an outbreak investigation was initiated (Table 1). Direct observation of hygiene practices revealed the following problem: patient wash water was directly discharged into the basins inside the patients' rooms instead of a dedicated sink for disposal, allowing a splash back. Major contamination precautions, such as a splash guard between the basin and the

Discussion

We describe an outbreak of XDR-PA in a surgical ICU affecting 7 patients lasting for at least 24 days. The likely cause of the outbreak was an exogenous source. Exogenous sources of nosocomial XDR-PA outbreaks have been previously reported.2, 4, 7

All XDR-PA patients had an exposure to a single bottle of patient care oil, which was shared among them. The incriminated patient care oil was contaminated with the identical XDR-PA strain as found in all 7 samples of cases. The incriminated patient

References (10)

M. Thuong et al.
Epidemiology of Pseudomonas aeruginosa and risk factors for carriage acquisition in intensive care unit
J Hosp Infect
(2003)
K.G. Kerr et al.
Pseudomonas aeruginosa: a formidable and ever-present adversary
J Hosp Infect
(2009)
A.M. Rogues et al.
Contribution of tap water to patient colonization with Pseudomonas aeruginosa in a medical intensive care unit
J Hosp Infect
(2007)
A.P. Magiorakos et al.
Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance
Clin Microbiol Infect
(2012)
P. Maroye et al.
Investigation of an outbreak of Ralstonia pickettii in a paediatric hospital by RAPD
J Hosp Infect
(2000)

There are more references available in the full text version of this article.

Cited by (5)

Cross-sectional point prevalence survey to study the environmental contamination of nosocomial pathogens in intensive care units under real-life conditions
2018, Journal of Hospital Infection
Citation Excerpt :
Only 40–50% of surfaces that should be cleaned are wiped by housekeepers, and frequent turnover of personnel may contribute to the problem [14,15]. The authors had trained and evaluated the performance of cleaning staff just months before this study during an outbreak of an extremely-drug-resistant Pseudomonas aeruginosa [16]; as such, this specific point was not re-examined in detail in the present study. Another reason for the study findings could be the use of detergents harbouring gaps in effectiveness towards hospital pathogens, or the use of sublethal concentrations of biocides [17], subsequently resulting in bacterial adaptation [18].
In intensive care units (ICUs), inanimate surfaces and equipment may be contaminated by nosocomial pathogens, including multi-drug-resistant micro-organisms.
To assess the degree of environmental contamination close to and distant from patients, and contamination of healthcare workers' (HCWs) hands with nosocomial pathogens under real-life conditions and to investigate potential transmission events.
Over the course of three weeks, agar contact samples were taken close to and distant from patient areas and from HCWs' hands in eight ICUs of a tertiary care hospital in Innsbruck, Austria. Each ICU was visited once without announcement. Species identification and antimicrobial susceptibility testing were performed according to standard methods, and corresponding strains from patient, environment and hand samples were genotyped using pulsed-field gel electrophoresis.
Among 523 samples, HCWs' hands were most frequently contaminated with potentially pathogenic bacteria (15.2%), followed by areas close to patients (10.9%) and areas distant from patients (9.1%). Gram-positive bacteria were identified most often (67.8%), with Enterococcus spp. being the most prevalent species (70% vancomycin sensitive and 30% vancomycin resistant) followed by Staphylococcus aureus, of which 64% were classified as meticillin-resistant Staphylococcus aureus. Molecular typing documented identical strains among patient, environment and hand isolates.
This study found widespread contamination of the ICU environment with clinically relevant pathogens, including multi-drug-resistant micro-organisms, despite cleaning and disinfection. The bioburden might not be restricted to areas close to patients. The role of extended environmental disinfection of areas distant from patients in order to improve infection prevention needs further discussion.
Is aromatherapy a critical care intervention?
2020, AACN Advanced Critical Care
Citation Excerpt :
It is important to minimize the potential for infection when using aromatherapy. In 2016, an outbreak of drug-resistant Pseudomonas aeruginosa in an Australian surgical intensive care unit was linked to a bottle of essential oil that had been shared between 7 patients.25 As hospitals have moved to single-patient-use products, there have been no further reports of infection.
Pseudomonas aeruginosa: Infections, Animal Modeling, and Therapeutics
2023, Cells
Understanding the challenges of non-food industrial product contamination
2020, FEMS Microbiology Letters
Treatment efficacy of MEDI3902 in pseudomonas aeruginosa bloodstream infection and acute pneumonia rabbit models
2019, Antimicrobial Agents and Chemotherapy

: Conflicts of interest: None to report.

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Brief ReportNosocomial outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with aromatherapy

Highlights

Section snippets

Methods

Results

Discussion

J Hosp Infect

J Hosp Infect

J Hosp Infect

Clin Microbiol Infect

J Hosp Infect

Brief Report
Nosocomial outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with aromatherapy