Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: A possible link to contaminated hand lotion

doi:10.1016/0196-6553(95)90272-4

American Journal of Infection Control

Volume 23, Issue 6, December 1995, Pages 396-398

https://doi.org/10.1016/0196-6553(95)90272-4 Get rights and content

Abstract

This article describes a prolonged outbreak of Pseudomonas aeruginosa. The attack rate of this outbreak was 8.5%, with no associated mortality. Hand lotion contaminated with P. aeruginosa was implicated in the transmission of organisms; removal of this hand lotion ended the outbreak. Contaminated hand lotion applied to clean hands of health care workers may have led to direct inoculation of infants at high risk for infection.

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Infection in the neonate

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Isolation and Identification of Microorganisms associated with high-quality and low-quality cosmetics from different brands in Mecca region -Saudi Arabia
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Cosmetic products contain several components that are ideal for microbial growth, they exposed to contamination by pathogenic bacteria and fungi, and this may cause health risks such as skin and eye infections. In this investigation, 50 samples were obtained from various shops in Mecca region, Saudi Arabia. Collected samples include high-quality and low-quality brands of makeup. Results show that most cosmetics are contaminated with microorganisms. Bacterial and fungal isolates were identified by morphological and microscopic techniques, and confirmed by molecular methods: (16s rRNA) for bacterial isolates and (18s rRNA) for fungal isolates associated with cosmetics. In low-quality cosmetics, frequency of microbial growth is higher and more diverse than high-quality cosmetics. It has been observed the most contaminated product was in lip gloss and it follows by the lipstick. The most predominant species of bacteria are Staphylococcus aureus (27 %), E. coli (27 %), which follows by Streptococcus pneumonia (18 %), Staphylococcus epidermis (17 %), Bacilli subtilis (12 %), and Pseudomonas aeruginosa (5 %). Aspergillus sp is the most predominant fungi (57 %), which is followed by Penicillium sp. (29 %) and Rhizopus sp. (14 %). In high quality brands, the frequency of microbial growth was the highest in mascara, lip-gloss. The most predominant species of bacteria is Staphylococcus aureus (41 %), which follows by Bacilli subtilis and Pseudomonas aeruginosa and E. coli (17 %). Streptococcus pneumonia is the less dominant (5 %). There is no growth on media of fungi. Due to the large number of cosmetics brands in Mecca region and for consumer safety, this study is prepared.
Impact of bovine lactoferrin fortification on pathogenic organisms to attenuate the risk of infection for infants
2022, Food Control
Citation Excerpt :
The most well-known reservoirs of P. aeruginosa in hospitals are sinks and respiratory therapy instruments (Foca et al., 2000). Additionally, hospital staff's fingernails, arms, and hand lotions are linked with the outbreak of P. aeruginosa (Becks & Lorenzoni, 1995; Moolenaar et al., 2000). According to recent findings, P. aeruginosa outbreaks in neonatal critical care units have been connected to milk solution preparation from multidose powder preparation and feeding bottles (Sánchez-Carrillo et al., 2009).
Cronobacter and Pseudomonas spp. are pathogenic organisms that are associated with neonatal morbidities such as bacteremia, sepsis, necrotizing enterocolitis (NEC), and infant meningitis. Lactoferrin (Lf) is a known bactericidal component of fresh human milk. Infants receiving formula or pasteurized donor milk however may not be receiving lactoferrin at same concentration as mother's own milk, so it is beneficial to understand an exogenous role for dairy bovine lactoferrin (bLf). Our aim was to investigate the potential for bLf to provide a novel way to inhibit the growth of these harmful organisms in infant feeding. Subinhibitory doses, Disc-diffusion assay, Minimum Inhibitory Concentrations (MIC), Minimum Bactericidal Concentrations (MBC), and challenge experiments in powder formula were used to investigate the effects of bLf on sepsis-causing bacteria such as C. muytjensii (ATCC-51329), C. sakazakii (ATCC-12868), C. sakazakii (ATCC-9027), P. aeruginosa (ATCC-19429), and P. aeruginosa (ATCC-9027). MIC and MBC of bLf in the range of 12.5–31.25 μM were sufficient to achieve a 3 log reduction of Cronobacter in nutrient broth (P < 0.0001). Similarly, minimum concentrations of 43.75–118.75 μM bLf against Pseudomonas (P < 0.0001) were demonstrated. After bactericidal concentrations were determined, higher resistant strains such as C. sakazakii (ATCC-12868) and P. aeruginosa (ATCC-19429) were chosen as ideal candidates for the bLf supplementation challenge studies. The bLf reduced the C. sakazakii (ATCC-12868) by 3.3 log at 35 °C, 2.8 log at 23 °C, and 1.9 log at 4 °C (P < 0.0001), whereas P. aeruginosa (ATCC-19429) showed 2.4 log reduction at 35 °C, 2.8 log at 23 °C (P < 0.0001), and 1.8 log at 4 °C (P < 0.01). Results indicated that bLf could effectively inactivate the sepsis-causing organisms in reconstituted infant formula and in bacterial growth media. Fortification of infant formula with bLf may address the problems of spoilage/contamination issues and provide a safety measure for feeding infants without mother's own milk.
Epidemic outbreak of gram negatives in patients with long-term tunneled hemodialysis catheters: Adverse event on hemodialysis units
2021, Nefrologia
Does screening neonates in the neonatal intensive care unit for Pseudomonas aeruginosa colonization help prevent infection?
2018, Journal of Hospital Infection
Citation Excerpt :
There have been several high-profile outbreaks of nosocomial PA infection in neonatal intensive care units (NICUs), such as the reported Belfast outbreak (2012) which was linked to biofilm in handwash basin taps [2,3]. A variety of other sources have been linked to PA outbreaks in NICUs, including contaminated hand lotion [4], contaminated feeding bottles [5] and a blood gas analyser [6]. In August 2012, increased incidence of PA infection and colonization was noted from culture results of clinical samples amongst babies in the NICU at North Bristol NHS Trust (NBT).
Pseudomonas aeruginosa (PA) is a Gram-negative environmental organism that can cause severe infection in immunosuppressed patients, including preterm neonates. In recent years, it has become common practice to screen neonates for PA colonization.
To assess the value of screening neonates for PA in (1) predicting the risk of developing severe PA infection and (2) directing infection control practice.
Between August 2012 and September 2015, babies admitted to the neonatal intensive care unit (NICU) at North Bristol NHS Trust were screened routinely for PA colonization on admission and weekly thereafter. Data were also collected on babies who developed PA infection. Environmental samples from the NICU were tested for the presence of PA. Variable number tandem repeat (VNTR) typing was performed on all strains of PA from babies and the environment.
No babies with positive screens subsequently developed PA infection. There was no VNTR strain evidence supporting cross-infection from the environment or other babies. Conclusion: Screening neonates for PA did not identify babies who subsequently developed PA infection. Following cessation of screening in September 2015, there was no increase in the number of babies identified with PA infection.
Microbiological Quality in Cosmetics
2018, Analysis of Cosmetic Products: Second Edition
The aims of this chapter are to provide insight into the field of cosmetic microbiology and expand knowledge of the general demands on the microbiological analysis of cosmetic products. Data about legislation in the United States and the European Union and the published harmonised standards for microbiological control of cosmetic products, before, during and at end of use are presented. Moreover, information about the recall of cosmetics contaminated by microorganisms from the market and about bacterial resistance to cosmetic preservatives is given.
Hand soap contamination by Pseudomonas aeruginosa in a tertiary care hospital: No evidence of impact on patients
2016, Journal of Hospital Infection
Citation Excerpt :
Interestingly, isolates from patients 1 and 2 were closely related, suggesting a possible transmission of the strain from one patient to the other through other sources, such as environment or staff members. Several nosocomial outbreaks have been attributed to contaminated liquid soaps.7–17 All reported outbreaks occurred in settings where hand hygiene had been promoted by washing hands with soap.
During an environmental investigation of Pseudomonas aeruginosa in intensive care units, the liquid hand soap was found to be highly contaminated (up to 8 × 10⁵ cfu/g) with this pathogen. It had been used over the previous five months and was probably contaminated during manufacturing.
To evaluate the burden of this contamination on patients by conducting an epidemiological investigation using molecular typing combined with whole genome sequencing (WGS).
P. aeruginosa isolates from clinical specimens were analysed by double locus sequence typing (DLST) and compared with isolates recovered from the soap. Medical charts of patients infected with a genotype identical to those found in the soap were reviewed. WGS was performed on soap and patient isolates sharing the same genotype.
P. aeruginosa isolates (N = 776) were available in 358/382 patients (93.7%). Only three patients (0.8%) were infected with a genotype found in the soap. Epidemiological investigations showed that the first patient was not exposed to the soap, the second could have been exposed, and the third was indeed exposed. WGS showed a high number of core single nucleotide polymorphism differences between patients and soap isolates. No close genetic association was observed between soap and patient isolates, ruling out the hypothesis of transmission.
Despite a highly contaminated soap, the combined investigation with DLST and WGS ruled out any impact on patients. Hand hygiene performed with alcohol-based solution for >15 years was probably the main reason. However, such contamination represents a putative reservoir of pathogens that should be avoided in the hospital setting.

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American Journal of Infection Control

Abstract

References (8)

Septicemia due to Klebsiella pneumoniae originating from a hand-cream dispenser

N Engl J Med

Hand-lotions: a potential nosocomial hazard

N Engl J Med

Survival of Candida albicans in hand creams

N Z Med J

Infection in the neonate

Cited by (81)

Isolation and Identification of Microorganisms associated with high-quality and low-quality cosmetics from different brands in Mecca region -Saudi Arabia

Impact of bovine lactoferrin fortification on pathogenic organisms to attenuate the risk of infection for infants

Epidemic outbreak of gram negatives in patients with long-term tunneled hemodialysis catheters: Adverse event on hemodialysis units

Does screening neonates in the neonatal intensive care unit for Pseudomonas aeruginosa colonization help prevent infection?

Microbiological Quality in Cosmetics

Hand soap contamination by Pseudomonas aeruginosa in a tertiary care hospital: No evidence of impact on patients

Practice forumPseudomonas aeruginosa outbreak in a neonatal intensive care unit: A possible link to contaminated hand lotion

Abstract

Septicemia due to Klebsiella pneumoniae originating from a hand-cream dispenser

N Engl J Med

Hand-lotions: a potential nosocomial hazard

N Engl J Med

Survival of Candida albicans in hand creams

N Z Med J

Infection in the neonate

Practice forum
Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: A possible link to contaminated hand lotion