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- Title
Clusters of Klebsiella pneumoniae carbapenemase with potential links to hand hygiene sink drains in an intensive care unit.
- Authors
Badawy, Dina; Tahhan, Samar; Rebick, Gabriel; Mac Donald, Clayton; Nugent, Jackie; Sarabi, Qosay; D'Oliveira, Roy; Small, Lorne
- Abstract
Background: Between January and September 2022, 10 patients who were admitted to the Intensive Care Unit (ICU) for a period of more than 72 hours were found to have carbapenemase-producing Enterobacteriaceae (CPE) in their screening/clinical specimens. No epidemiological association was found among them, and none had received healthcare outside Canada in the preceding 12 months. The study investigated whether sink drains could be a source of CPE transmission. Methods: A retrospective study was conducted on all patients admitted to the ICU during the surveillance period who tested positive for CPE, alongside a pilot study involving environmental screening cultures collected from hand hygiene (HH) and washroom sink drains in ICU rooms after the patients had been discharged. Information was gathered on CPE risk factors, such as recent travel history or hospitalization outside of Canada, endoscopic retrograde cholangiopancreatography procedures, or hemodialysis within the last 12 months. Results: During the surveillance period, 15 non-duplicate CPE isolates were obtained from 14 patients in the ICU. Out of the 14, 10 patients were identified after ICU stays of greater than 72 hours. Klebsiella pneumoniae carbapenemase (KPC) was the most identified carbapenemase, found in five (50%) of isolates, followed by three (30%) New Delhi metallo-β-lactamase, and two (20%) Oxacillinase-48 like carbapenemase. In addition, a total of 33 sink drains underwent testing: 24 were HH sinks, while nine were inpatient washrooms. Among the 24 HH sink drains, nine (37.5%) tested positive for CPE, eight of these sink drains (88.9%) had KPC genes, two (22%) had NDM genes, and one (11%) had VIM genes. Among the HH sink drains contaminated by CPE, three (33.3%) out of these nine shared the same species/gene combination (KPC-Citrobacter freundii) as the CPE-positive patient recently discharged from the room. Conclusion: These findings suggest a potential link between KPC-producing Citrobacter freundii detected in the HH sink drain and a CPE-positive patient. However, the direction of transmission remains unclear. Further research is necessary to analyze the molecular genotyping and validate any potential relatedness among them, in addition, collaborative efforts from the infection prevention and control, microbiology, environmental, and facilities teams are essential to eliminate CPE from HH sink drains.
- Subjects
SANITATION equipment; INTENSIVE care units; PILOT projects; LENGTH of stay in hospitals; PUBLIC health surveillance; SODIUM hypochlorite; MEDICAL equipment contamination; CARBAPENEM-resistant bacteria; ENTEROBACTERIACEAE diseases; RETROSPECTIVE studies; CULTURES (Biology); RISK assessment; INFECTION control; GENES; HAND washing; COLLECTION &; preservation of biological specimens; CARBAPENEMS; ELECTRONIC health records; MEDICAL waste disposal; DISCHARGE planning
- Publication
Canadian Journal of Infection Control / Revue Canadienne de Prévention des Infections, 2023, p115
- ISSN
1183-5702
- Publication type
Article
- DOI
10.36584/suffix