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GUIDE TO INFECTION
CONTROL IN THE HOSPITAL
CHAPTER 49
Pseudomonas aeruginosa
Author
H. Wisplinghoff, MD
Harald Seifert, MD
Chapter Editor
Michael Steven, MD, MPH
Cover heading - Topic Outline
Topic outline - Key Issues Known Facts Controversial Issues Suggested Practice Suggested Practice in Under-Resourced Settings Summary References Chapter last updated: June, 2018
KEY ISSUE
Pseudomonas aeruginosa is an important nosocomial pathogen that causes serious nosocomial infections and contributes significantly to morbidity and mortality. Antimicrobial resistance including carbapenem- and multidrug-resistance (MDR) also continues to increase, further limiting therapeutic options.
H1 KNOWN FACTS
- P. aeruginosa is an aerobic Gram-negative rod that can be isolated from soil, water, plants, animals, and humans, where it is uncommonly encountered as part of the normal transient flora. Human colonization occurs mostly at moist sites such as perineum, axilla, and ear. High concentrations of P. aeruginosa , among other pathogens, may also be found in the subungual areas of the hands.
- Even though colonization in healthy individuals outside the hospital is rare, colonization rates may exceed 50% in patients with severe burns (skin), on mechanical ventilation (lower respiratory tract), receiving chemotherapy (GI-tract) or antimicrobial agents (any site) and the prevalence rates of P. aeruginosa have been on the rise in recent years.
- Minimal nutritional requirements, the ability to grow in distilled water, and tolerance against a wide range of physical conditions contribute to the success of this opportunistic pathogen. Hospital reservoirs are predominantly moisture-associated and include sinks, showers, respiratory equipment, IV fluids, disinfectants, food mixers, and vegetables. Outbreaks have been traced to a variety of sources including respiratory therapy equipment, endoscopes, contaminated mattresses, disinfectants, contaminated water supplies, IV solutions, and environmental sources such pools used for physical therapy or hydrotherapy.
- Adherence to standard infection control guidelines should limit the spread of P. aeruginosa. However, special attention is warranted in risk- patients and hospital environments with endemic P. aeruginosa. Measures include:
- Hand disinfection between patient contacts using antiseptic agents (e.g., chlorhexidine or alcohol-based disinfectants).
- Wearing gloves when attending a patient, especially in ventilated patients, patients with severe burns and patients known to be colonized with P. aeruginosa.
- Mechanical cleaning of all medical equipment before sterilization, especially equipment used for mechanical ventilation, and endoscopes.
- Proper sterilization of all respiratory therapy equipment including nebulizers and resuscitation bags.
- Using sterile fluids for nebulizers and preventing contamination of medication nebulizers and humidifiers.
- Using sterile water instead of tap water to rinse tracheal suction catheters.
- Avoiding the use of stock solutions for preparation of IV fluids.
- Avoiding the reuse of a previously opened vial of water or sodium chloride solution for injection.
- Appropriate handling and storage of medical solutions.
- Surveillance, i.e., monitoring the prevalence of P. aeruginosa , especially of MDR strains.
- Detecting and eliminating potential reservoirs of cross-transmission.
- If a cluster of infections due to P. aeruginosa is detected, potential reservoirs including all medical solutions such as IV fluids and sterile water should be screened in order to quickly detect and eliminate a potential reservoir. High-risk patients such as burn patients and immunocompromised patients should be monitored closely so that appropriate infection control measures can be implemented early.
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