Program Schedule

1369
Legionella(L) Risk Associated with Ice Machines (IM) in Hospitalized Patients at University of Pittsburgh Medical Center Presbyterian (UPMC-P)

Session: Poster Abstract Session: Cleaning and Disinfection in Healthcare Settings
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Legionlla Poster Final.pdf (773.4 kB)
  • Background: L is common in many environments (soil , water (W), etc.) but only multiplies at 20C-50C. Therefore, L preventative measures such as Copper (C)/Silver (S) ionization are directed at warm W systems and have been in place at UPMC-P since 1984. Ion levels are monitored monthly with prescribed protocols for low levels and/or + faucets. In 10/13 a transplant patient developed respiratory failure thought to have recurrent hospital acquired pneumonia (HAP). Despite therapy the patient died. A bronchoalveolar lavage grew L. pneumophilia (P) not sero 1. The objective of this study was to investigate a L HAP.

    Methods: All hot W sources in patient's care area (7 faucets and 4 showers all negative) were cultured. Adequate C/S levels were confirmed and L surveillance increased. The patient had been ordered NPO with ice and had a witnessed aspiration. The IM cultured + for LP NOT serogroup 1 and a fluorescent L species. Over the next month 2 immunocompetent cases were identified. They were no identified commonalities except NPO with ice orders and witnessed aspiration. W sources and ice from patients' care areas were culture negative. Ice from 16 IMs (4 of which had W reservoir (R)) and 10 additional WRs were cultured All IMs were sanitized using CDC defined methods and in-line 0.2 W Filters were placed to prevent entry of L. Overall 47 clinical care IMs and 15 WRs were cultured for L.

    Results:

    1/6 IM was replaced, sanitized, filtered, and weekly cultured negative X 4. 5/6 + IMs were sanitized/filtered. 1/5 was repetitively + and required disassembly to identify issues unique to that IM. Issues identified that facilitated growth/resistance to disinfection.

             Thermal element (generator) adjacent to the WR generated temps as high as 94.80 F.

             Maintenance process was directed at descaling, not disinfecting

             Some IM components remained + due to lack of contact with the disinfectant

    Conclusion:

             L amplification can occur in IM WR at increased temperatures due to proximity of the generator.

             IMs should be routinely chlorinated and descaled.

             Small pore filters may prevent introduction of L into IM.

             Routine sanitizing, filtering, and culturing of patient care IMs is likely necessary to prevent L colonization/infections in susceptible hospitalized patients.

    Carlene Muto, MD, MS, FSHEA1, Ashley Querry, BS2, Edward Dudek, MPPM3, Alison Galdys, MD1, Laurie Rack, DNP, RN, NEA-BC4, Leon Young, BS MT5, Joseph Crouse6 and Anthony Pasculle, ScD7, (1)Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, (2)Infection Prevention and Control, University of Pittsburgh Medical Center, Pittsburgh, PA, (3)Maintance, University of Pittsburgh Medical Center, Pittsburgh, PA, (4)Patient Support Services, University of Pittsburgh Medical Center - Presbyterian University Hospital, Pittsburgh, PA, (5)Infection Prevention & Control, University of Pittsburgh Medical Center - Presbyterian University Hospital, Pittsburgh, PA, (6)Engineering and Maintenance, University of Pittsburgh Medical Center, Pittsburgh, VT, (7)Microbiology, University of Pittsburgh Medical Center, Pittsburgh, PA

    Disclosures:

    C. Muto, None

    A. Querry, None

    E. Dudek, None

    A. Galdys, None

    L. Rack, None

    L. Young, None

    J. Crouse, None

    A. Pasculle, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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