The Implications of Premise Plumbing-Based Healthcare-Associated Infections in Stacked and Independent Intensive Care Units at Emory University Hospital Midtown Restricted; Files Only
Triolo, Bella (Spring 2024)
Abstract
Background and Introduction: There is growing concern about healthcare associated infections (HAIs), particularly those associated with hospital premise-plumbing systems. The Centers for Disease Control and Prevention (CDC) has identified opportunistic pathogens such as Gram-negative bacteria, nontuberculous mycobacteria (NTM), and non-fecal coliforms, as significant concerns in this context. These pathogens can result in severe patient outcomes, necessitating the implementation of stringent water management programs in healthcare facilities, as recommended by the CDC. This study aims to investigate the relationship between plumbing styles in Emory University Hospital Midtown (EUHM) and waterborne HAIs, focusing specifically on the likelihood of an opportunistic premise-plumbing based infection within stacked ICUs (i.e., shared vertical premise plumbing) over the study period.
Methods: This study utilizes retrospective data from the Emory University Hospital Midtown Microbiology Laboratory spanning from January 2015 to December 2019. This included information on specimen collection source, organism species, and collection location. Extensive inclusion and exclusion criteria were applied to identify relevant observations. The study employed a case-control design, with case organisms defined as premise and NTM organisms, with Escherichia coli serving as the control organism. Descriptive analyses were conducted to identify trends over the study period. Statistical analyses comprised of univariate and multivariate to investigate the relationship between predictor variables (collection location, specimen collection source, and year) and the outcome (a positive culture of a case or control organism).
Results: From the initial dataset of over 16,000 observations, 4,374 were included in the final analyses after applying exclusion and inclusion criteria. The proportion of premise organisms exhibited a relative decline, while NTMs showed notable variability over the study period. Univariate analyses revealed that premise organisms were more likely to be identified in stacked and independent ICUs compared to the referent group (wards). However, multivariate analyses identified only emergency departments and dialysis units as relevant predictors for premise organisms. NTMs were less likely to be identified in stacked and independent ICUs, compared to wards, as indicated by both univariate and multivariate analyses.
Discussion: This case-control study found no association between organisms associated with premise plumbing contamination and stacked ICUs. This suggests widespread contamination of vertically shared plumbing in stacked ICUs with premise organisms was unlikely, or if present did not contribute to infections among patients in stacked ICUs. The findings imply that current water management programs may be effective in reducing transmission of premise-plumbing based organisms within stacked and independent ICUs.
Table of Contents
I. Background and Introduction
5
II. Methods
7
III. Results
11
IV. Discussion
15
V. Tables and Figures
19
VI. References
31
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