Pulling the plug on a pseudomonas outbreak: ancillary equipment as vectors of infection

J B Veater; C Jones-Manning; J Mellon; E Collins; D R Jenkins

doi:10.1016/j.jhin.2023.08.003

Pulling the plug on a pseudomonas outbreak: ancillary equipment as vectors of infection

J Hosp Infect. 2023 Oct:140:110-116. doi: 10.1016/j.jhin.2023.08.003. Epub 2023 Aug 9.

Authors

J B Veater¹, C Jones-Manning², J Mellon³, E Collins⁴, D R Jenkins⁵

Affiliations

¹ Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK. Electronic address: james.veater@uhl-tr.nhs.uk.
² Intensive Care, Theatres, Anaesthetics, Pain & Sleep, University Hospitals of Leicester NHS Trust, Leicester, UK.
³ Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁴ Infection Prevention, University Hospitals of Leicester NHS Trust, Leicester, UK.
⁵ Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK.

PMID: 37562595
DOI: 10.1016/j.jhin.2023.08.003

Abstract

Objectives: Outbreaks of infection related to flexible endoscopes are well described. However, flexible endoscopy also requires the use of ancillary equipment such as irrigation plugs. These are potential vectors of infection but are infrequently highlighted in the literature. This paper reports a cystoscopy-associated outbreak of Pseudomonas aeruginosa from contaminated irrigation plugs in a UK tertiary care centre.

Methods: Laboratory, clinical and decontamination unit records were reviewed, and audits of the decontamination unit were performed. Flexible cystoscopes and irrigation plugs were assessed for contamination. Retrospective and prospective case finding was performed utilizing the microbiology laboratory information management system. Available P. aeruginosa isolates underwent variable nucleotide tandem repeat (VNTR) typing. Confirmed cases were defined as P. aeruginosa infection with an identical VNTR profile to an outbreak strain.

Results: Three strains of P. aeruginosa were isolated from five irrigation plugs but none of the flexible cystoscopes. No acquired resistance mechanisms were detected. Fifteen confirmed infections occurred, including bacteraemia, septic arthritis and urinary tract infection. While failure of decontamination likely occurred because the plugs were not dismantled prior to reprocessing, the manufacturer's reprocessing instructions were also incompatible with standard UK practice. The Medicines and Healthcare Products Regulatory Agency was informed. A field safety notice was issued, and the manufacturer issued updated reprocessing instructions.

Conclusions: Ancillary equipment can represent an important vector for infection, and should be considered during outbreak investigations. Users should review the manufacturer's instructions for reprocessing ancillary equipment to ensure that they are compatible with available procedures.

Keywords: Cystoscope; Decontamination; Endoscope; Outbreak; Pseudomonas aeruginosa.

MeSH terms

Cross Infection* / complications
Cross Infection* / epidemiology
Cross Infection* / prevention & control
Disease Outbreaks
Equipment Contamination
Humans
Pseudomonas
Pseudomonas Infections* / epidemiology
Pseudomonas Infections* / prevention & control
Pseudomonas aeruginosa
Retrospective Studies