Acetic acid decontamination of sink drains to prevent spread of multi-drug resistant Pseudomonas aeruginosa on a hematology ward
Rosa van Mansfeld, MD PhD [email protected] ECCMID 2017, Vienna Transparency Declaration
• No conflicts of interest Introduction
• 3 patients with multi-drug resistant (MDR) P. aeruginosa
• Identical AFLP type as found before in 2013/2014
• retrospective case finding until 2012 11 patients with identical P. aeruginosa
• Only epidemiological link: hematology department
3 Nosocomial transmission?
Environmental screening MDR P. aeruginosa strain in sink and shower drains
4 Nosocomial outbreaks of P. aeruginosa
• Associated with sinks, drains, faucets, soap dispensers etc….
• Possible solutions: – Replace drains, drain trap, taps, etc… – Chemical (e.g. hypochlorite) cleaning – Remove sinks, only bottled water use (on ICU) – Cover drains with “mushrooms” – Self-cleaning drain traps More attention to proper infection control and cleaning! 5 Aim Investigate whether 25% acetic acid (1) can be used to decontaminate sink and shower drains from MDR P.aeruginosa in our hospital.
1. Aspelund A.J. et al, Journal of Hospital Infection, 2016 94, 13-20.
2. Image: wikipedia 6 Methods
• 39 sink and shower drains 25% acetic acid solution 3/week
• Don’t use for 30 min
• A selection of drains sampled weekly for culture
• Cultured overnight on selective media mass-spectrometry
• P. aeruginosa strains from the drains were typed with AFLP
7 P. aeruginosa in patient room drains
Datum
16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 17 17 17 17 17 17 17 17
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11 11 11 11 11
12 09 09 09 09 10 10 10 10 12 12 12 01 01 01 01 01 02 02 02
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2
7 5 7 5
10 16 23 30
14 14 21 28 12 19 27 21 28 12 16 23 30 13 20 27
Locatie type douche wastafel douche wastafel toilet wastafel kamer douche wastafel wastafel toilet wastafel kamer douche wastafel douche wastafel kamer wastafel sluis wastafel douche douche douche wastafel douche wastafel kamer douche wastafel douche wastafel kamer wastafel kamer wastafel toilet wastafel douche douche douche wastafel douche douche wastafel douche douche wastafel douche Doucheputje wastafel douche wastafel douche wastafel wastafel kamer wastafel douche douche wastafel toilet 8 Outbreak strain =
• 3 rooms positive occupied by colonized patient • 2 rooms shower drains with no link to recent patient • Disinfection effective, however 2 drains intermittent
30 doucheShower drainj Neg Neg Neg* AT12106Neg Neg Neg Neg Neg Neg Neg NT Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg AT12106Neg 24 wastafelSink douchedrainj Neg Neg Neg AT12106Pos Neg Neg Pos Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg 24 doucheShower drainj Neg Neg Neg Pos Pos Pos Neg Neg Neg Neg Neg Neg Neg Neg AT12106Neg Neg Neg Neg Neg AT12106Neg Neg Neg Neg Neg Neg 42 wastafelSink douchedrainj AT12106AT12106Neg AT12106Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg 50 wastafelSink douchedrainj AT16176AT16176AT12106 Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg ng ng ng ng ng ng ng 52 DoucheputjeShower drainj Neg Neg AT12106 Pos Pos Pos Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg Neg sept oct nov dec jan feb 9 Conclusion • Treatment of sink and shower drains 3/week with acetic acid did not completely eradicate MDR P. aeruginosa
• Once a week treatment seems to keep the load of PA low
• No new spread to patients has been documented so far
• Longer follow-up necessary: effect on nosocomial spread of MDR P. aeruginosa appropriate frequency of the treatment.
10 Infection prevention and control!!!!
11 Discussion
• Other seeding source?
• Costs: ICU with 40 sinks/drains and 38 CVVH drains €15.000/year (without cultures)
• Detection level (culturing sewer, other pathogens present)
• Clinical relevance reduction of load?
12 Acknowledgement
• Tessa Hoeben • Annie Kaiser • Moniek Heusinkveld • Eva de Jongh • Joffrey van Prehn • Christina Vandenbroucke-Grauls
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