Advertisement

Pseudomonas aeruginosa in hospital water systems: biofilms, guidelines, and practicalities

Published:December 29, 2014DOI:https://doi.org/10.1016/j.jhin.2014.11.019

      Summary

      Pseudomonas aeruginosa is one of many micro-organisms that can act as an opportunistic pathogen and colonize and infect vulnerable patients. Hospital water is a recognized source P. aeruginosa. Several outbreaks, including the incidents involving babies in Northern Ireland in 2011/12, have been attributed to contaminated water systems. As a direct result of the deaths of four neonates in Northern Ireland, guidance documents ‒ addendums to Health Technical Memorandum 01-04 (Department of Health, England) ‒ were produced to advise National Health Service managers on how to deal with the presence of P. aeruginosa in augmented care units. The guidance was based on current expert opinion and limited scientific evidence. Public Health England has established a reproducible and controllable water distribution test rig in a laboratory setting to further understand the contamination of water systems by P. aeruginosa and to identify vulnerable sites for microbial colonization. It is anticipated that these studies will add to the evidence base and enable the guidance documents to be updated in due course.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ayliffe G.A.
        • Babb J.R.
        • Collins B.J.
        • Lowbury E.J.
        • Newsom S.W.
        Pseudomonas aeruginosa in hospital sinks.
        Lancet. 1974; 2: 578-581
        • Anonymous
        Health Technical Memorandum 04-01 Addendum: Pseudomonas aeruginosa – advice for augmented care units.
        Department of Health, London2013
        • Jefferies J.M.C.
        • Cooper T.
        • Yam T.
        • Clarke S.C.
        Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources.
        J Med Microbiol. 2012; 61: 1052-1061
        • Adjide C.C.
        • De Meyer A.
        • Weyer M.
        • et al.
        Stenotrophomonas maltophilia and Pseudomonas aeruginosa water-associated microbiologic risk assessment in Amiens’ University Hospital Centre.
        Pathologie-biologie. 2010; 58 (e1‒5)
        • Crivaro V.
        • Di Popolo A.
        • Caprio A.
        • et al.
        Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures.
        BMC Infect Dis. 2009; 9: 70
        • Merrer J.
        • Girou E.
        • Ducellier D.
        • et al.
        Should electronic faucets be used in intensive care and hematology units?.
        Intensive Care Med. 2005; 31: 1715-1718
        • Vilar-Compte D.
        • Jacquemin B.
        • Diaz-Gonzalez A.
        • Velasquez C.
        • Volkow P.
        Pseudomonas aeruginosa outbreak, in the area of surgical wound ambulatory care, in postmastectomy patients.
        Salud Publica Mex. 2003; 45: 371-378
        • Trautmann M.
        • Halder S.
        • Lepper P.M.
        • Exner M.
        Reservoirs of Pseudomonas aeruginosa in the intensive care unit. The role of tap water as a source of infection.
        Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2009; 52: 339-344
        • Trautmann M.
        • Bauer C.
        • Schumann C.
        • et al.
        Common RAPD pattern of Pseudomonas aeruginosa from patients and tap water in a medical intensive care unit.
        Int J Hyg Environ Health. 2006; 209: 325-331
        • Trautmann M.
        • Lepper P.M.
        • Haller M.
        Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism.
        Am J Infect Control. 2005; 33: S41-S49
        • Blanc D.S.
        • Petignat C.
        • Janin B.
        • Bille J.
        • Francioli P.
        Frequency and molecular diversity of Pseudomonas aeruginosa upon admission and during hospitalization: a prospective epidemiologic study.
        Clin Microbiol Infect. 1998; 4: 242-247
        • Walker J.T.
        • Jhutty A.
        • Parks S.
        • et al.
        Investigation of healthcare-acquired infections associated with Pseudomonas aeruginosa biofilms in taps in neonatal units in Northern Ireland.
        J Hosp Infect. 2014; 86: 16-23
        • Moore G.E.
        • Walker J.T.
        Presence and control of Legionella pneumophila and Pseudomonas aeruginosa biofilms in hospital water systems.
        in: Percival S. Williams D. Randle J. Cooper T. Biofilms in infection prevention and control. Elsevier, Amsterdam2014
        • Walker J.
        • Hoffman P.
        A pragmatic approach to Pseudomonas.
        Health Estate. 2012; 66: 23-27
        • Kelsey M.
        Pseudomonas in augmented care: should we worry?.
        J Antimicrob Chemother. 2013; 68: 2697-2700
        • Leprat R.
        • Denizot V.
        • Bertrand X.
        • Talon D.
        Non-touch fittings in hospitals: a possible source of Pseudomonas aeruginosa and Legionella spp.
        J Hosp Infect. 2003; 53: 77
        • Moritz M.M.
        • Flemming H.C.
        • Wingender J.
        Integration of Pseudomonas aeruginosa and Legionella pneumophila in drinking water biofilms grown on domestic plumbing materials.
        Int J Hyg Environ Health. 2010; 213: 190-197
        • Waines P.L.
        • Moate R.
        • Moody A.J.
        • Allen M.
        • Bradley G.
        The effect of material choice on biofilm formation in a model warm water distribution system.
        Biofouling. 2011; 27: 1161-1174
        • Anonymous
        Health Building Note 00-10 Part C: Sanitary.
        Department of Health, London2013
        • Mayes C.
        • McCracken G.
        • Rooney P.
        Minimising risk from Pseudomonas aeruginosa using tap design.
        Archs Dis Childh Fetal Neonatal Ed. 2014; 90: A40
        • Hota S.
        • Hirji Z.
        • Stockton K.
        • et al.
        Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design.
        Infect Control Hosp Epidemiol. 2009; 30: 25-33
        • HFS, HPS and Pseudomonas aeruginosa and Water (Scotland) Group
        Guidance for neonatal units (NNUs) (levels 1, 2 & 3), adult and paediatric intensive care units (ICUs) in Scotland to minimise the risk of Pseudomonas aeruginosa infection from water.
        Health Protection Scotland, Glasgow2014
        • Loveday H.P.
        • Wilson J.A.
        • Kerr K.
        • Pitchers R.
        • Walker J.T.
        • Browne J.
        Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review.
        J Hosp Infect. 2014; 86: 7-15