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Hi Everyone,
Thanks for your responses. Cath, thanks for referring this on to Bill – I
look forward to hearing what he has to contribute.
None of the patients have been affected by this organism. We are culturing
it in very low numbers [<100cfu] from the Automated Flexible Endoscope
Reprocessor [AER] only, however as it is being initially reported as a gram
negative bacilli or a pseudomonas species, alarm bells have rung and we have
asked for the organism to be identified so we can take appropriate action to
protect our patients.
Unfortunately the GENCA (2010) guidelines do not have a flow chart to assist
in the response to positive cultures of an AER, so the approach we have
taken from a risk management perspective is to follow the recommendations
for a contaminated endoscope and have consulted the microbiologists from
the various pathology labs.
My original thoughts were that it could be arising from the filters or
potentially be contaminating the fluid pathway of the AER, however the
affected machines are different models [same brand], different disinfectant
[for one] and the clients are not all using the same brands of filters. They
are however, located in a similar geographical area.
My primary question is – given the organism has low pathogenicity, do we
really need to be concerned if the count is <100cfu?
Thoughts anyone?
Regards
Terry McAuley
Sterilisation & Infection Prevention and Control Consultant
STEAM Consulting
E: terry@steamconsulting.com.au
W: http://www.steamconsulting.com.au
A: PO BOX 779
Endeavour Hills
VIC Australia 3802
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Of Cath Murphy
Hi Terry
Interesting question and interesting set of responses.
I have sent it along to Bill Rutala to see his opinion. Will keep you posted
on any reply.
Out of interest have you seen any illness among pts that could correlate
with this org (I note the at risk group you mention)?
Regards
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
Adjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au
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Of Terry McAuley
Hi Everyone,
I have had a recent spate where a number of my endoscopy procedure centre
clients have reported culturing of “Pseudomonas species” or Gram negative
bacilli after the monthly water testing of the Automated Endoscope
Reprocessors.
Upon further investigation, the organism has been identified as Cupriavidis
pauculus. This organism is often associated with ultra filtration systems
and although it has low pathogenicity it is a risk to immunocompromised
patients.
Despite repeated water line disinfections, filter changes, disinfectant
dumps etc this bug keeps cropping up over and over again. We find that we
have cleared it in the next test after filter changes etc etc but then a
month later – we get a positive result again.
Whilst in low numbers, it is causing some concern regarding potential risks
to patients. In all cases we are not growing the organism form the
endoscopes.
I am wondering if anyone else has been experiencing the same issues?
If so – what did you do about it both in terms of managing the machines and
the risks to patients?
If you have cultured this organism, did you manage to identify the cause of
the problem?
Happy to chat offline.
Regards
Terry McAuley
Sterilisation & Infection Prevention and Control Consultant
STEAM Consulting
E: terry@steamconsulting.com.au
W: http://www.steamconsulting.com.au
A: PO BOX 779
Endeavour Hills
VIC Australia 3802
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