A recent study published by the American Journal of Infection Control (AJIC) has offered fresh insights into the multi-species outbreak of carbapenemase-producing Enterobacterales (CPE) which took place on the pediatric ward of Toho University Omori Medical Center in Tokyo, 2017. This publication underlines the persistent threat to public health posed by CPE due to its resistance to commonly used antibiotics. Moreover, it pinpoints common hospital sinks and water sources as key hotspots for contamination.
Astonishingly, the outbreak hinged on the detection of CPE in a single patient in June 2016. By March the following year, it was evident that an outbreak was under way, continuing till October 2017. The outbreak saw 19 pediatric patients infected with CPE, prompting a widespread response from the infection prevention team, which comprised medical professionals across disciplines including doctors, nurses, pharmacists, and microbiologists.
Their investigation led them to the identification of nine sinks contaminated with CPE. Six were in hospital rooms, while others were located in a nursing center, a waste room, and even an ice machine. In a bid to curtail the spread of CPE, all sinks in the affected ward were replaced in June 2017 and thoroughly disinfected using hydrogen peroxide. Despite these measures, CPE persisted, indicating potential transmission from one sink to another via interconnected drains and plumbing systems.
Infection prevention efforts, therefore, extended to recommendations for hand disinfection post interaction with sinks, introduction of disposable cleaning tools, ban on mouth-washing using sink water, as well as implementation of disinfection and drying techniques for items exposed to sink water. These comprehensive measures finally resulted in no further detection of CPE in patient samples or environmental surveillance past October 2017.
The intensive, iterative infection control protocols put in place eventually put an end to the CPE outbreak. This episode underscores the significance of maintaining strict cleanliness and hygiene protocols around sinks and water-related areas in hospital wards given their potential role in CPE transmission. Further, it highlights the need for holistic, multifaceted approaches to infection prevention, with conventional measures such as replacing contaminated sinks sometimes proving ineffectual against resistant strains like CPE.