Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T20:28:27.014Z Has data issue: false hasContentIssue false
  • English
  • Français

Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014—2017

Published online by Cambridge University Press:  03 April 2019

Kiran M. Perkins ,
Sujan C. Reddy ,
Ryan Fagan ,
Matthew J. Arduino  and
Joseph F. Perz
Kiran M. Perkins*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sujan C. Reddy
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Ryan Fagan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew J. Arduino
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Joseph F. Perz
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Kiran M Perkins, MD, 1600 Clifton Rd, MS H16-3, Atlanta, GA 20329. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).

Design:

Retrospective observational study.

Methods:

We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.

Results:

Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.

Conclusions:

Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 6 , June 2019 , pp. 621 - 626
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kanamori, H, Weber, DJ, Rutala, WA. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis 2016;62:1423–1435.CrossRefGoogle ScholarPubMed
Williams, MM, Armbruster, CR, Arduino, MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. Biofouling 2013;29:147–162.CrossRefGoogle ScholarPubMed
From plumbing to patients: water management programs for healthcare facilities. Centers for Disease Control and Prevention website. www.cdc.gov/hai/prevent/water-management.html. Published 2017. Accessed November 2018.Google Scholar
Falkinham, JO 3rd, Hillborn, ED, Arduino, MJ, Pruden, A, Edwards, MA. Epidemiology and ecology of opportunistic premise plumbing pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa . Environ Health Perspect 2015;123:749–758.CrossRefGoogle ScholarPubMed
Tofteland, S, Naseer, U, Lislevand, JH, Sundsfjord, A, Samuelsen, O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One 2013;8(3):e59015.CrossRefGoogle Scholar
Kizny Gordon, AE, Mathers, AJ, Cheong, EYL, et al. The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections—a systematic review of the literature. Clin Infect Dis 2017;64:1435–1444.CrossRefGoogle ScholarPubMed
Carlin, PC. Wastewater drains: epidemiology and interventions in 23 carbapenem-resistant organism outbreaks. Infect Control Hosp Epidemiol 2018. doi: 10.1017/ice.2018.18.CrossRefGoogle Scholar
Soda, EA, Barskey, AE, Shah, PP, et al. Vital signs: healthcare-associated Legionnaires’ disease surveillance data from 20 states and a large metropolitan area—United States, 2015. Morb Mortal Wkly Rep 2017;66:584–589.CrossRefGoogle Scholar
Benedict, KM, Reses, H, Vigar, M, et al. Surveillance for waterborne disease outbreaks associated with drinking water—United States, 2013–2014. Morb Mortal Wkly Rep 2017; 66:1216–1221.CrossRefGoogle ScholarPubMed
Peralta, G, Tobin-D’Angelo, M, et al. Notes from the field: Mycobacterium abscessus infections among patients of a pediatric dentistry practice—Georgia, 2015. Morb Mortal Wkly Rep 2016;13:355–356.CrossRefGoogle Scholar
Hatzenbuehler, LA, Tobin-D’Angelo, M, Drenzek, C, et al. Pediatric dental clinic-associated outbreak of Mycobacterium abscessus infection. J Pediatr Infect Dis Soc 2017;6:e116–e122.CrossRefGoogle ScholarPubMed
Edens, C, Liebich, L, Halpin, AL, et al. Mycobacterium chelonae eye infections associated with humidifier use in an outpatient LASIK clinic—Ohio, 2015. Morb Mortal Wkly Rep 2015; 64:1177.CrossRefGoogle Scholar
Marra, AR, Diekema, DJ, Edmond, MB. Mycobacterium chimaera infections associated with contaminated heater-cooler devices for cardiac surgery: outbreak management. Clin Infect Dis 2017;65:669–674.CrossRefGoogle ScholarPubMed
Perkins, KM, Lawsin, A, Hasan, NA, et al. Notes from the field: Mycobacterium chimaera contamination of heater-cooler devices used in cardiac surgery—United States. Morb Mortal Wkly Rep 2016;65:1117–1118.CrossRefGoogle ScholarPubMed
Schreiber, PW, Sax, H. Mycobacterium chimaera infections associated with heater-cooler units in cardiac surgery. Curr Opin Infect Dis 2017;30:388–394.CrossRefGoogle ScholarPubMed
Brooks, RB, Mitchell, PK, Miller, JR, et al. Multistate outbreak of Burkholderia cepacia complex bloodstream infections after exposure to contaminated saline flush syringes—United States, 2016–2017. Clin Infect Dis 2018. doi: 10.1093/cid/ciy910.CrossRefGoogle ScholarPubMed
Glowicz, J, Crist, M, Gould, C, et al. A multistate investigation of healthcare-associated Burkholderia cepacia complex infections related to liquid docusate sodium contamination, January—October 2016. Am J Infect Control 2018;45:649–655.CrossRefGoogle Scholar
Decker, BK, Palmore, TN. The role of water in healthcare-associated infections. Curr Opin Infect Dis 2013;26:345–351.CrossRefGoogle ScholarPubMed
Crist, MB, Perz, JF. Modern healthcare versus nontuberculous mycobacteria: who will have the upper hand? Clin Infect Dis 2017;64:912–913.Google ScholarPubMed
Maki, DG, Crnich, CJ. History forgotten is history relived: nosocomial infection control is also essential in the outpatient setting. Arch Intern Med 2005;165:2565–2567.CrossRefGoogle ScholarPubMed
Jhung, MA, Sunenshine, RH, Noble-Wang, J, et al. A national outbreak of Ralstonia mannitolilytica associated with use of a contaminated oxygen-delivery device among pediatric patients. Pediatrics 2007;119:1061–1068.CrossRefGoogle ScholarPubMed
Block, C, Ergaz-Shaltiel, Z, Valinsky, L, et al. Déjà vu: Ralstonia mannitolilytica infection associated with a humidifying respiratory therapy device, Israel, June to July 2011. Euro Surveill 2013;18:20471.Google ScholarPubMed
Haller, S, Höller, C, Jacobshagen, A, et al. Contamination during production of heater-cooler units by Mycobacterium chimaera potential cause for invasive cardiovascular infections: results of an outbreak investigation in Germany, April 2015 to February 2016. Euro Surveill 2016;21:30215.CrossRefGoogle ScholarPubMed
Li, T, Abebe, LS, Cronk, R, Bartram, J. A systematic review of waterborne infections from nontuberculous mycobacteria in health care facility water systems. Int J Hygiene Environ Health 2017;220:611–620.CrossRefGoogle ScholarPubMed
Bancroft, J, Shih, D, Cassidy, PM, et al. Standardized case definition for extrapulmonary nontuberculous mycobacteria infections. Council of State and Territorial Epidemiologists website. www.cste.org/resource/resmgr/2018_position_statements/17-ID-07_RevisedApr2018.pdf. Published April 2018. Accessed March 11, 2019.Google Scholar
Winthrop, KL, Henkle, E, Walker, A, Cassidy, M, Hedberg, K, Schafer, S. On the reportability of nontuberculous mycobacterial disease to public health authorities. Ann Am Thorac Soc 2017; 14:314–7.CrossRefGoogle ScholarPubMed
Shih, DC, Cassidy, PM, Perkins, KM, Crist, MB, Cieslak, PR, Leman, RL. Extrapulmonary nontuberculous mycobacterial disease surveillance—Oregon, 2014–2016. Morb Mortal Wkly Rep 2018; 67:854–857.CrossRefGoogle ScholarPubMed
Hanlin, JH, Myers, ER. Healthcare plumbing systems are sources and vectors of infection for HAIs. Infection Control Today website. https://www.infectioncontroltoday.com/environmental-hygiene/healthcare-plumbing-systems-are-sources-and-vectors-infection-hais. Published March 1, 2018. Accessed March 11, 2019.Google Scholar
Center for Clinical Standards and Quality/Survey and Certification Group. Requirement to reduce Legionella risk in healthcare facility water systems to prevent cases and outbreaks of Legionnaires’ disease [Memorandum]. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-30.pdf. Published June 9, 2017. Accessed March 11, 2019.Google Scholar
Edwards, M, Rhoads, W, Pruden, A, Pearce, A, Falkinham, JO. Green water systems and opportunistic premise plumbing pathogens. Plumb Eng 2014;42:63–65.Google Scholar