Cupriavidis pauculus

[Anonymous]

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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[Julie Hunt]

Dear Terry,

I have seen this organism identified twice in water sampled from a showerhead, when screening for MRPA.

In one case repeated flushing, cleaning & disinfection did not help to clear the organism and as it was in a shower in a haematology unit we ended up changing the shower head and hose, no further problems to date.

I’ve not seen it in water tested from the Automated Endoscope Reprocessors.

As water is not generally screened for these types of organisms within a HCF if is impossible to know if this occurs commonly or not, it was the only time we have found it in our sampling and we have taken hundreds of samples over the past year.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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[Glenys Harrington]

Hi Terry,

I’d be looking for a design flaw in the Automated Endoscope Reprocessors
that is hindering contact of the cleaning and disinfecting agents with every
potentially contaminated surface particularly given that it sound like it is
in more that on processor. Is that correct?

Cross sectional drawing of the Automated Endoscope Reprocessor components
might be useful in identifying sections of the reprocessor that are
hindering contact of the cleaning and disinfecting agents.

See John Hopkins experience with design flaws in a bronchoscopes:

N Engl J Med. 2003 Jan
16;348(3):221-7.

An outbreak of Pseudomonas aeruginosa infections associated with flexible
bronchoscopes

http://www.ncbi.nlm.nih.gov/pubmed/12529462

and

“Bronchoscope pseudomonas outbreak rattles John Hopkins”

http://www.endonurse.com/articles/2002/05/bronchoscope-pseudomonas-outbreak-
rattles-johns-h.aspx

regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may
contain confidential information intended only for the use of the individual
or entity named above. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or
duplication of this transmission is strictly prohibited. If you have
received this communication in error, please notify us by telephone or email
immediately and return the original message to us or destroy all printed and
electronic copies. Nothing in this transmission constitutes an agreement of
any kind unless otherwise expressly indicated.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is
discouraged by ACIPC. If you wish to discuss specific reference to products
or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives –
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[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
[Description: twitter logo][Description: FB logo][Description: icp icon]

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Anonymous]

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may
contain confidential information intended only for the use of the individual
or entity named above. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or
duplication of this transmission is strictly prohibited. If you have
received this communication in error, please notify us by telephone or email
immediately and return the original message to us or destroy all printed and
electronic copies. Nothing in this transmission constitutes an agreement of
any kind unless otherwise expressly indicated.

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

Description: twitter logo
Description: FB logo
Description: icp icon

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may
contain confidential information intended only for the use of the individual
or entity named above. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution or
duplication of this transmission is strictly prohibited. If you have
received this communication in error, please notify us by telephone or email
immediately and return the original message to us or destroy all printed and
electronic copies. Nothing in this transmission constitutes an agreement of
any kind unless otherwise expressly indicated.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is
discouraged by ACIPC. If you wish to discuss specific reference to products
or services by brand or commercial names, please do this outside the list.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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