title: Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant Pseudomonas in an intensive care unit.
abstract: Twenty intensive care patients were diagnosed as infected or colonized by Pseudomonas aeruginosa within a one-month period; a rate three to four times higher than the typical background frequency of this infection in the intensive care unit (ICU). Patients with positive respiratory specimens were mechanically ventilated, which included re-used disinfected bite blocks during intubation. Fourteen specimens from 20 positive patients originated in the respiratory tract. Seven clonal variants were isolated and identified as originating from the same strain by pulsed-field analysis. These isolates were also matched to the strain detected on the re-used bite blocks, which had been disinfected with 140ppm sodium hydrochloride. Notably, Staphylococcus aureus was also detected on bite blocks sterilized with ethylene dioxide, indicating incomplete disinfection. In immunocompromised patients, re-use of bite blocks during intubation must be prohibited. Single-use kits or intubation without the use of bite blocks is recommended.
authors.affiliation: Department of Infection Control, Fujigaoka Hospital, Showa University, Kanagawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kikuchi
authors.forename: G
authors.initials: G
authors.lastname: Nagashima
authors.forename: K
authors.initials: K
authors.lastname: Taguchi
authors.forename: H
authors.initials: H
authors.lastname: Kuraishi
authors.forename: H
authors.initials: H
authors.lastname: Nemoto
authors.forename: M
authors.initials: M
authors.lastname: Yamanaka
authors.forename: R
authors.initials: R
authors.lastname: Kawano
authors.forename: K
authors.initials: K
authors.lastname: Ugajin
authors.forename: S
authors.initials: S
authors.lastname: Tazawa
authors.forename: K
authors.initials: K
authors.lastname: Marumo
mesh_terms: D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004203:Disinfection / Q000379:methods; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics; D004866:Equipment Contamination; D017743:Equipment Reuse / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D007564:Japan / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D012121:Respiration, Artificial / Q000009:adverse effects
chemical_list: D015780:Carbapenems