A recent investigation has revealed a disconcerting link between cockroaches and an outbreak of multidrug-resistant Enterobacter cloacae in an Intensive Care Unit (ICU), over a time span of 20 months. The study distinctly associated the strains found in these common pests to the outbreak strains. While surrounding nations’ hospitals acknowledge the potential for cockroaches to disseminate pathogens, a significant knowledge gap exists in the US due to limited research directly connecting insects with triumphant outbreaks.
As Jennifer A. Hanrahan, DO, a medical professional specializing in infectious diseases at MetroHealth Medical Center in Cleveland, observes, available research notes that insects are carriers of various organisms, although tangible evidence linking organisms culled from insects to human infections remains scarce. This lack of data has resulted in insects being broadly brushed aside as potential vectors for hospital environmental contamination.
Cockroaches, while ubiquitous across all kinds of buildings, including hospitals, pose a particular challenge when it comes to control in larger structures despite robust pest management programs. The Centers for Disease Control and Prevention (CDC) highlights that these insects feed on fixed sputum smears in laboratories, dwell in moist areas within hospital facilities, and have a proclivity for external entrances, such as loading docks.
Although merely omnipresent, the act of insects is unlikely to cause healthcare-associated infections in developed nations, the CDC warns that these pests carry pathogenic microorganisms inside their gut and on their surface which can be transmitted if established infection control strategies falter.
As a part of the investigation, Hanrahan and her team closely scrutinized medical records, culture data, and environmental infection control actions within the ICU over a 20-month stint subsequent to a suggested outbreak flagged by infection prevention staff. The staff spotted two patients in adjoining rooms with multidrug-resistant Enterobacter cloacae (MRE), implying potential cross-transmission.
An astounding number of ICU patients, about 19.5%, had contracted or were colonized with MRE, despite the hospital’s reinforced cleaning strategies. Even after leaving certain rooms unused for periods, surfaces continued to show positive results for MRE. In response to a nurse reporting occasional sightings of cockroaches in patient rooms, a cockroach was captured and later tested positive for MRE. After reinforcing pest control measures, there were no MRE cases for three months. However, a new patient contracted MRE within a week of spotting another cockroach in the ICU.
This demanding ordeal underlines the vital role of insects in healthcare-acquired infections, emphasizing the need for comprehensive pest control programs across healthcare units. Moreover, the potential risk presented by insects such as cockroaches necessitates that healthcare personnel stay vigilant and rapidly report any observable presence of these common pests.