Background: UPMC is a complex 757 bed tertiary care hospital in western Pennsylvania. In Jan 2016, an increase in CR KP isolates was observed in the open 8 bed SICU. Three new cases were identified in one month compared to the 2015 average of 0.5 new cases/month. Three additional cases were identified who had exposure to SICU in Jan but whose CR KP isolates were recovered on another unit. Preliminary review of the six cases found that, in addition to SICU exposure, all cases were exposed to the same OR gastroscope (G5). An investigation was launched to determine the exposure source as well as the relatedness of CR KP strains.
Methods: To identify additional cases, rectal swabs were collected on all current inpatients exposed to the SICU in Jan - 19 patients total. Aside from the 6 cases, no patients exposed to G5 were still inpatient at the time of investigation. G5 was removed from service and reprocessing records were reviewed. G5 underwent a microbiologic assessment utilizing 2 scope culturing techniques. Additionally, a boroscopy was performed to examine the scope lumen for defects. All available CR KP isolates underwent PFGE and whole genome sequencing (WGS) molecular typing using previously described methods (Marsh et al. PLoS ONE. 2015. 10(12).)
Results: No environmental source was identified. No deficiencies in scope reprocessing were observed. An additional CR KP patient was identified from the SICU screen who was not exposed to G5. All seven isolates were related by PFGE and WGS. Another CR KP isolate collected in Dec 2015 from a known CR KP patient was also related. This patient was exposed to G5 in Dec 2015. Both G5 cultures were negative, but boroscopy revealed several deep scratches and luminal debris. G5 underwent channel replacement and cultured negative prior to going back into service. No further cases were identified.
· Given boroscopy results, CR KP transmission likely occurred through a contaminated gastroscope with subsequent limited horizontal transmission in the SICU
· G5 possibly was contaminated in Dec 2015 after being used on a known CR KP patient
· Non-recovery of organisms from a suspected scope should not preclude a scope from suspicion
· Less complex scopes (as compared to ERCP scopes) may fail high level disinfection and cause infections
A. Pasculle, None
D. Morgan, None
C. Muto, None