Best practice alert: Preventing spread of Stenotrophomonas
Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus that is an opportunistic pathogen, particularly among hospitalized patients. Outbreaks most often occur in ICU patients, hematologic malignancy and bone marrow transplant recipients, hemodialysis patients and neonates. Stenotrophomonas infections are associated with high morbidity and mortality in severely immunocompromised and debilitated individuals.
S. maltophilia is a water organism that survives and multiplies in aqueous environments for extended periods. Contaminated tap water, ice machines or soap have been identified as suspected sources for many hospital outbreaks as well as outbreaks associated with failures in endoscope reprocessing and handling of respiratory equipment and fluids.
Staff should be mindful of the following sources of S. maltophilia as they care for patients and maintain a safe and clean environment.
|Staff||Hospital environment||IV lines and fluids||Respiratory equipment, fluids|
|Hands (poor hand hygiene)||Ice machines||Central venous catheters||Nebulizers, including disposable|
|Nonhospital-provided hand soaps||Hospital tap water||Intravenous solutions||Respiratory tubing (condensate/circuits)|
|Disinfection solutions||Tracheal suction|
|Bronchoscopes||Pressure-monitoring devices||Urine, fluids||Dialysis machines|
|Reprocessing failures||Pressure transducer fluid||Indwelling Foley catheters, urometers|
Basic infection control measures include appropriate use of antibiotics, avoidance of prolonged or unnecessary use of foreign devices and adherence to hand hygiene practices. Strict hand hygiene and contact isolation procedures are essential to reducing clonal spread in the ICU setting.
- Ensure strict adherence to hand hygiene practices.
- Change gloves and perform hand hygiene between clean and dirty tasks.
- Do not touch the patient’s environment and then touch intravenous lines or indwelling catheters.
- Ensure clean and dirty procedures are performed in completely separated areas.
- Adhere to isolation requirements, particularly in the ICU, IMCU and CCU settings.
- Ensure strict adherence to manufacturer’s instructions for use for all equipment that comes into contact with a patient or patient’s environment.
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