246. Pseudomonas Putida (PsP) Cluster Associated with a Contaminated Bronchoscope(B) in a Medical ICU (MICU) at the University of Pittsburgh Medical Center (UPMC)
Session: Poster Abstract Session: HAI: Environment and Device Cleaning
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • ABSTR. ID Week 2016 MICU PsP Poster FINAL.PDF (379.2 kB)
  • Background: PsP is an environmental isolate infrequently identified as a pathogen in hospital settings. UPMC is a complex 757 bed tertiary care center with a case-mix index of 2.16. Since 2008 there have only been 8 hospital acquired PsP MICU patients. 

    In Oct 2015, two MICU patients in adjacent rooms were identified with PsP hospital associated pneumonia (HAP).  A multidisciplinary team reviewed any commonalities such as shared staff, and bronchoscopy procedures at bedside.  All scopes are reprocessed with HLD and leak tested prior to use.

     

    Methods:  9 Bs are used in the MICU, usage records were reviewed and all 9 were cultured.   If a positive scope is identified, the scope lumen is evaluated for defects via boroscopy. PsP isolates underwent molecular typing using Pulsed Field Gel Electrophoresis (PFGE). The genome sequence of these PsP isolates were compared to 14 isolates in Genbank.

    Results:

    No deficiencies in B reprocessing were identified and no scope failed leak testing.  Both PsP + MICU patients had undergone B with the same scope (V27) and this scope grew PsP. All other 8 Bs were culture negative.  V27 was removed from service and no additional cases were identified. Boroscopy of V27 identified a kink in the biopsy channel likely associated with the HLD failure.  V27 underwent replacement of the biopsy channel and culture negative prior to reuse.

    The MICU PsP isolates and scope V27 isolate were >90% similar by PFGE. A PsP isolate from another patient in a different area from 1 month prior to the cluster was positive.  This PsP isolate was genetically related to MICU cluster with a 86.5% similarity. This clone was not closely related to other Genbank PsP sequences. This cluster likely represents a new clone.

    Conclusion: 

    B, like ERCP and EUS scopes, become contaminated during use and may fail HLD despite defect free reprocessing

    Culturing implicated scopes can help identify exposure

    Luminal defects can increase risk of scope contamination.

    Boroscopy was crucial in identifying the luminal defect but are not a routine component of scope maintenance.

    Use of disposable scopes would eliminate risk and should be explored.

    Ongoing investigation is underway to evaluate the new PsP clone.

     

    Ashley Querry, BS, CIC1, Amy Metzger, BS, MT (ASCP), CIC, CHI1, Alison Galdys, MD2, Anthony Pasculle, ScD3, Edgar Delgado, RRT, FAARC4, Michael Donahoe, MD5 and Carlene Muto, MD, MS, FSHEA2, (1)Infection Prevention and Control, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, (2)Infection Prevention & Hospital Epidemiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA, (3)Microbiology, University of Pittsburgh Medical Center, Pittsburgh, PA, (4)University of Pittsburgh Medical Center, Pittsburgh, PA, (5)Pulmonary, University of Pittsbhurgh Medical Center, Pittsburgh, PA

    Disclosures:

    A. Querry, None

    A. Metzger, None

    A. Galdys, None

    A. Pasculle, None

    E. Delgado, None

    M. Donahoe, None

    C. Muto, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.