Investigation and control of an outbreak due to a contaminated hospital water system, identified following a rare case of Cupriavidus pauculus bacteraemia

Inkster, Teresa; Peters, Christine; Wafer, Tim; Holloway, Donald A.; Makin, T.

doi:10.1016/j.jhin.2021.02.001

Cited by 23 publications

(6 citation statements)

References 28 publications

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“…These resistance genes can reside in various genera of hardy environmental organisms and sinks may provide a platform for horizontal gene transfer [ 49 ]. C. pauculus has previously been linked with clinical WPS: in one case a C. pauculus bacteraemia was linked to a contaminated hospital water system [ 50 ] while in another case a ‘pseudo-outbreak’ at an outpatient clinic was linked to rinsing culture swabs in tap water [ 51 ], however isolation of C. pauculus from a hospital sink trap has not previously been reported.…”

Section: Introductionmentioning

confidence: 99%

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

Butler

Kelly

Muddiman

et al. 2022

Journal of Medical Microbiology

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Introduction. Cupriavidus pauculus is historically found in soil and water but has more recently been reported to cause human infection and death. Hospital sink traps can serve as a niche for bacterial persistence and a platform for horizontal gene transfer, with evidence of dissemination of pathogens in hospital plumbing systems driving nosocomial infection. Gap Statement. This paper presents the first C. pauculus strain isolated from a hospital sink trap. There are only six genome assemblies available on NCBI for C. pauculus ; two of these are PacBio/Illumina hybrids. This paper presents the first ONT/Illumina hybrid assembly, with five contigs. The other assemblies available consist of 37, 38, 111 and 227 contigs. This paper also presents data on biofilm formation and lethal dose in Galleria mellonella; there is little published information describing these aspects of virulence. Aim. The aims were to identify the isolate found in a hospital sink trap, characterize its genome, and assess whether it could pose a risk to human health. Methodology. The genome was sequenced, and a hybrid assembly of short and long reads produced. Antimicrobial susceptibility was determined by the broth microdilution method. Virulence was assessed by measuring in vitro biofilm formation compared to Pseudomonas aeruginosa and in vivo lethality in Galleria mellonella larvae. Results. The isolate was confirmed to be a strain of C. pauculus , with a 6.8 Mb genome consisting of 6468 coding sequences and an overall G+C content of 63.9 mol%. The genome was found to contain 12 antibiotic resistance genes, 8 virulence factor genes and 33 metal resistance genes. The isolate can be categorized as resistant to meropenem, amoxicillin, amikacin, gentamicin and colistin, but susceptible to cefotaxime, cefepime, imipenem and ciprofloxacin. Clear biofilm formation was seen in all conditions over 72 h and exceeded that of P. aeruginosa when measured at 37 °C in R2A broth. Lethality in G. mellonella larvae over 48 h was relatively low. Conclusion. The appearance of a multidrug-resistant strain of C. pauculus in a known pathogen reservoir within a clinical setting should be considered concerning. Further work should be completed to compare biofilm formation and in vivo virulence between clinical and environmental strains, to determine how easily environmental strains may establish human infection. Infection control teams and clinicians should be aware of the emerging nature of this pathogen and further work is needed to minimize the impact of contaminated hospital plumbing systems on patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

Butler

Kelly

Muddiman

et al. 2022

Journal of Medical Microbiology

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“…Splashing will disperse water droplets containing microorganisms at least 2 m from the outlet or surface of the sink/drain and patients and medical equipment are frequently located within this 2 m splash zone (Inkster et al, 2021).…”

Section: What Are the Routes Of Transmission?mentioning

confidence: 99%

Aspects and problems associated with the water services to be considered in intensive care units

Walker¹,

Inkster

Weinbren

2023

Journal of Infection Prevention

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Background Water is a product taken for granted and assumed to be a safe commodity in intensive care units (ICU). Biofilm readily becomes established in complex water services presenting a risk to vulnerable patients. Harboured within biofilms are opportunistic pathogens which can be transmitted via hand contact, splashing, aerosol and indirect contact through medical equipment. Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims This research based commentary set out to identify current problems with water and wastewater systems in ICU settings. Methods Databases and open source information was used to obtain data on current water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe current challenges. Findings the authors found a number of problems with water systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion Hand hygiene stations are frequently misused or close enough to patients such that splashing poses a transmission risk. The wastewater system (drain) also presents a risk, from where Gram-negative antibiotic resistant organisms may be dispersed resulting in untreatable patient infections. The water and wastewater system provide a superhighway for the movement of pathogenic microorganisms and these risks need to be addressed if we are to safeguard vulnerable users in ICU.

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“…In the United Kingdom, Inkster and colleagues [54] reported an 8-month epidemiology investigation to resolve the source of mature biofilm developing in the BWDS within the first three years of building occupancy at Queen Elizabeth Royal Hospital for Children. In 2018, the investigation identified 23 confirmed pediatric disease cases in the hematologyoncology unit.…”

Section: Construction Activities Without Commissioningmentioning

confidence: 99%

Building Water Quality Commissioning in Healthcare Settings: Reducing Legionella and Water Contaminants Utilizing a Construction Scheduling Method

Scanlon,

Gordon,

Reynolds

2023

Buildings

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Construction activities in healthcare settings potentially expose building occupants to life-threatening waterborne pathogens, including Legionella. The lack of a building water quality commissioning (BWQC) process has been identified as a substantial construction risk factor associated with disease cases and deaths. A BWQC schedule method was developed as a technical note to address gaps between the construction, commissioning, and operation phases of work to establish water quality and safety for a building water distribution system. The BWQC schedule method enables healthcare organizations to meet commissioning criteria set forth in guidelines and regulatory requirements for implementing a water management program (WMP) prior to initiating patient care operations. The authors used Office Timeline® Pro+Edition V7.02, Office Timeline LLC, Bellevue WA 98004, USA to depict a Gantt chart as a BWQC schedule listing key project tasks and milestones of construction and water management activities. Design and construction professionals, in conjunction with healthcare organizations, should examine the BWQC construction schedule method and customize it for project-specific implementation. Additionally, building owners should consider incorporating the method into an organization’s construction policies for a standardized approach to BWQC practices.

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Investigation and control of an outbreak due to a contaminated hospital water system, identified following a rare case of Cupriavidus pauculus bacteraemia

Cited by 23 publications

References 28 publications

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

Hospital sink traps as a potential source of the emerging multidrug-resistant pathogen Cupriavidus pauculus: characterization and draft genome sequence of strain MF1

Aspects and problems associated with the water services to be considered in intensive care units

Building Water Quality Commissioning in Healthcare Settings: Reducing Legionella and Water Contaminants Utilizing a Construction Scheduling Method

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