title: Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design.
abstract: BACKGROUND
  Pseudomonas aeruginosa has been increasingly recognized for its ability to cause significant hospital-associated outbreaks, particularly since the emergence of multidrug-resistant strains. Biofilm formation allows the pathogen to persist in environmental reservoirs. Thus, multiple hospital room design elements, including sink placement and design, can impact nosocomial transmission of P. aeruginosa and other pathogens.
  
  
  METHODS
  From December 2004 through March 2006, 36 patients exposed to the intensive care unit or transplant units of a tertiary care hospital were infected with a multidrug-resistant strain of P. aeruginosa. All phenotypically similar isolates were examined for genetic relatedness by means of pulsed-field gel electrophoresis. Clinical characteristics of the affected patients were collected, and a detailed epidemiological and environmental investigation of potential sources was carried out.
  
  
  RESULTS
  Seventeen of the infected patients died within 3 months; for 12 (71%) of these patients, infection with the outbreak organism contributed to or directly caused death. The source of the outbreak was traced to hand hygiene sink drains, where biofilms containing viable organisms were found. Testing by use of a commercial fluorescent marker demonstrated that when the sink was used for handwashing, drain contents splashed at least 1 meter from the sink. Various attempts were made to disinfect the drains, but it was only when the sinks were renovated to prevent splashing onto surrounding areas that the outbreak was terminated.
  
  
  CONCLUSIONS
  This report highlights the importance of biofilms and of sink and patient room design in the propagation of an outbreak and suggests some strategies to reduce the risks associated with hospital sinks.
authors.affiliation: Department of Infection Prevention and Control, University Health Network, University of Toronto, Toronto, Ontario, Canada. susy.hota@uhn.on.ca
authors.forename: Susy
authors.initials: S
authors.lastname: Hota
authors.forename: Zahir
authors.initials: Z
authors.lastname: Hirji
authors.forename: Karen
authors.initials: K
authors.lastname: Stockton
authors.forename: Camille
authors.initials: C
authors.lastname: Lemieux
authors.forename: Helen
authors.initials: H
authors.lastname: Dedier
authors.forename: Gideon
authors.initials: G
authors.lastname: Wolfaardt
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gardam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018441:Biofilms / Q000254:growth & development; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004866:Equipment Contamination; D005260:Female; D006749:Hospital Design and Construction; D006801:Humans; D006920:Hygiene; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms; D010802:Phylogeny; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000635:transmission; D011550:Pseudomonas aeruginosa / Q000235:genetics; D055815:Young Adult