1251. Contaminated Sinks May be an Environmental Source for Serial Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE ) to ICU Patients
Session: Poster Abstract Session: Healthcare Epidemiology: Outbreaks
Friday, October 5, 2018
Room: S Poster Hall
  • IDWeek CRE outbreak 2018.pdf (482.9 kB)
  • Background: We performed an investigation after noting an increase in hospital-onset (HO) KPC-producing Enterobacteriaceae (KPC-E) infections in patients admitted to a tertiary referral hospital in North Carolina.

    Methods: We defined pre-outbreak (1/1/17-6/30/17), outbreak (7/1/17-10/31/17), and post-outbreak (11/1/17-3/31/18) phases. A clinical case was defined as any positive clinical culture for KPC-E. HO was defined as a positive clinical or surveillance culture collected on hospital day ≥ 3. Patients were mapped in space and time to inform targeted environmental sampling. Whole genome sequencing (WGS) was performed on selected KPC K. pneumoniae (Kp) environmental and patient isolates to determine relatedness.

    In October 2017, a CRE prevention bundle was implemented that included daily communication of CRE patient movement, increased audits/feedback of HCW compliance with hand hygiene, enhanced cleaning and disinfection in CRE rooms and high-risk units with bleach and UVC disinfection, and weekly rectal surveillance screens in 4 adult ICUs.

    Results: 0.67 clinical cases of KPC-E per month were observed during the pre-outbreak period compared to 3.75 clinical cases of KPC-E per month during the outbreak period. Kp was the most common species (Figure 1). Mapping of patients revealed probable direct and indirect transmission between patients in multiple hospital units (Figure 2). 3 patients who were non-sequentially admitted to the same ICU room over a 12-week span acquired KPC Kp (Figure 2). Environmental cultures from the in-room sink drain and P-trap grew KPC Kp that was related to the patient isolates by WGS; the sink was removed. Although no additional clinical cases of KPC-E occurred after full implementation of the bundle and sink removal, we continued to observe acquisition of KPC-E rectal colonization in all 4 ICUs (Figure 3).

    Conclusion: We describe a multi-species outbreak of KPC-E that was mitigated through evidence-based CRE control measures and removal of a colonized sink. However, ongoing low-level presumed transmission of KPC points to persistent environmental sources. Additional study is needed to understand the prevalence of CRE in hospital sinks, factors that drive drain colonization, and contribution of CRE in a sink to nosocomial transmission.

    Sarah S. Lewis, MD MPH1, Jessica Seidelman, MD2, Kirk Huslage, MSPH, BSN, RN, CIC2, Charlene Carriker, RN BSN CIC3, Amy Hnat, BSN, RN1, Erica Lobaugh-Jin, BSN, RN, CIC1, Christopher Sova, RN, BSN1, Bonnie Taylor, RN, BSN, MPH1, Nancy Strittholt, RN, BSN, CIC3, Sheila Vereen, RN BSN CIC3, Robbie Willis, BA, RN4, Christy Campbell, RN3, Rachel Addison, MT (ASCP), MPH5, Kevin Hazen, Ph.D., D(ABMM), FIDSA, FAAM6, Amy Mathers, MD7, Kasi Vegesana, BS8, Joanne Carroll, MT9, Shireen Kotay, Ph.D.9, Arthur W. Baker, MD, MPH10, Daniel Sexton, MD, FIDSA, FSHEA11, Deverick J. Anderson, MD, MPH, FIDSA, FSHEA12 and Becky Smith, MD1,2, (1)Infection Prevention and Hospital Epidemiology, Duke University Medical Center, Durham, NC, (2)Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, (3)Duke University Medical Center, Durham, NC, (4)Infection Prevention Hospital Epidemiology, Duke University Medical Center, Durham, NC, (5)Duke Infection Control Outreach Network, Durham, NC, (6)Pathology, Duke University Health System, Durham, NC, (7)University of Virginia Health System, Charlottesville, VA, (8)Health System Information Technology, University of Virginia Medical Center, Charlottesville, VA, (9)University of Virginia Medical Center, Charlottesville, VA, (10)Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, (11)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (12)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC


    S. S. Lewis, None

    J. Seidelman, None

    K. Huslage, None

    C. Carriker, None

    A. Hnat, None

    E. Lobaugh-Jin, None

    C. Sova, None

    B. Taylor, None

    N. Strittholt, None

    S. Vereen, None

    R. Willis, None

    C. Campbell, None

    R. Addison, None

    K. Hazen, None

    A. Mathers, None

    K. Vegesana, None

    J. Carroll, None

    S. Kotay, None

    A. W. Baker, None

    D. Sexton, None

    D. J. Anderson, None

    B. Smith, None

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