This article analyzes recent outbreaks of infection associated with water-related organisms, specifically Burkholderia multivorans, in healthcare settings, focusing on contamination from ice machines. The implications for public health are expounded and potential strategies and methodologies for healthcare staff to assist in preventing such outbreaks are suggested.
Between 2021-2022, a total of 23 B. multivorans infection cases emerged from two southern California hospitals, with the root source ascertained to be contaminated ice and water from ice machines. Additionally, in an expanded time frame from 2020-2024, 23 more instances were identified across three hospitals – thirteen at a northern California institution, eight at a hospital in Colorado, and two more cases at one of the southern California hospitals. All affected hospitals were found to be using identical brands of ice machines and affiliated products such as filters, descalants, and sanitizing agents. Genome sequencing demonstrated a high genetic similarity between all clinical and environmental isolates.
The key recommendation stemming from this data is the avoidance of tap water, and ice and water from ice machines during patient care, when outbreaks of water-related organisms occur. Ice machines have been identified as potential harbors of these organisms, with related incidences of healthcare-associated infections being attributed to their use.
Further comments on infections due to Burkholderia multivorans emphasised that these bacteria are part of the Burkholderia cepacia complex, a group of water-related, Gram-negative opportunistic bacteria frequently found in soil and water. These bacteria can cause severe infections, primarily in immunocompromised patients and critically ill patients, often becoming antibiotic-resistant.
The investigation of these outbreaks examined all potential sources of infection, including the entirety of infected machines, the brands of all relevant machine supplies, the sequence type of the B. multivorans identified, and the practises of healthcare personnel.
Public health officials have strongly recommended avoiding tap water and ice during clinical activities, especially when treating immunocompromised or critically ill patients. All ice machines confirmed to have B. multivorans were removed from service. The ongoing investigation aims to pinpoint the exact sources of ice machine contamination.
Concluding from this data and the epidemiological evidence reported, it appears that contaminated ice and water dispensed from ice machines were the likely infection sources. With identical brands of ice machines implicated across multiple hospitals, this raises the possibility of a contamination source extending from a single component, or a product such as a descalant or sanitiser. However, the variations in infection locations across different hospitals suggest multiple pathways of exposure and transmission.