Water Health Educator
Water Health Educator
Promoting advocacy for access to clean water
Disease Focus: Pseudomonas
Pseudomonas – A Brief
By Nicole Kraatz
Pseudomonas is a variety of infections caused by a bacteria normally found in soil or water throughout the environment. The most common of these infections that affect humans is classified as Pseudomonas aeruginosa. This was first discovered by Carle Gessard in 1882 during an experiment using ultra violet lighting. Pseudomonas may cause a variety of different infections such as pneumonia, urinary tract infections, wound infections, septicemia and gastrointestinal infections. Pseudomonas aeruginosa is known to be an opportunistic pathogen, meaning it can lead to other serious infections that may eventually require hospitalizations.
Because pseudomonas strains can lead to a variety of different infections, the symptoms and area of infections depend on the illness caused by the specific strain. For example, if the pseudomonas strain causes pneumonia in a patient, symptoms may include a cough, fever or shortness of breath. If the particular infection causes severe illness, symptoms may include high fever, chills, confusion and shock. Many of those that contract an infection from a pseudomonas strain are those that are immunocompromised. It is also possible for people to contract a nosocomial infection from pseudomonas.
Pseudomonas infections can generally be treated with antibiotics. However, it can be difficult at times to find the right antibiotics as the bacteria strains are constantly evolving and becoming resistant to certain medicines. Pseudomonas can be prevented by regular hygiene practices such as hand washing, proper cleaning of hospital equipment as well as environmental cleanup. It is important to isolate patients currently infected with pseudomonas as to prevent future nosocomial infections.
Pseudomonas aeruginosa Bacterial Interactions
by Olivia Yang
Pseudomonas is a genus of bacteria commonly found in moist environments like lakes and rivers. Pseudomonas aeruginosa, in particular, causes significant infections and demonstrates resistance to numerous antibiotics, making it difficult to eliminate. Those with compromised immune systems, especially patients with cancer, HIV, and cystic fibrosis, are especially susceptible to infection by this opportunistic pathogen.
P. aeruginosa is the most common pathogen in humans. The pathogen can cause infections in the urinary tract, bones and joints, respiratory system, skin, soft tissue, as well as other organs and body systems. Hot tubs and inadequately chlorinated pools are some of the places where one can be exposed to P. aeruginosa infection, more so if one carries wounds in hands or feet.
Pseudomonas aeruginosa is also one of the most common bacteria to cause healthcare associated infections. In hospitals, P. aeruginosa can be found in disinfectants, sinks, antiseptic solutions, ventilators, catheters, food, taps, and mops. Transmission occurs via patient to patient interactions, in contact with contaminated equipment, and through contaminated food and water. 30-50% of P. aeruginosa infections in an ICU are associated with contaminated water. Because sinks and pipes are ideal sites for bacterial propagation, households and hospitals with poor water treatment systems are in grave danger.
Furthermore, if infected, hospital inpatients who are in the process of convalescing from surgeries could become severely ill and even die. In critical care units, particularly during surgery, the risk of infection increases because of incisions and the use of invasive devices. If the equipment or hands of hospital personnel are contaminated, patients with open wounds or serious burns are more susceptible to severe and potentially life-threatening infections. Hospitals can minimize the possibility of contamination by implementing detailed infection control and training their staffs to adhere to proper hygiene regimes.
In fighting the rising cases of Pseudomonas infections, compounded by the absence of a general use vaccine yet, the importance of preventative measures cannot be emphasized enough. Closing the lid before flushing the toilet, disinfecting bathrooms and doorknobs, thoroughly washing hands, and avoiding potentially contaminated spaces like swimming pools, public bathrooms, hot tubs, and puddles can all go a long way towards lowering the risk of infection.
Pseudomonas in Norway
By Nora Rideg
The Norwegian Institute of Public Health (NIPH) was alerted by the University Hospital of North-Norway in Tromsø about a troubling cluster of bloodstream infections (BSIs) caused by Pseudomonas aeruginosa in three patients with severe COVID-19 on 19 November 2021. The outbreak had spread to multiple hospitals across Norway, pointed to a common source of infection. These infections occurred within a few days of each other, with all cases showing an indistinguishable strain of Pseudomonas aeruginosa.
On 18 March 2022, Oslo University Hospital identified the outbreak strain in disposable pre-moistened washcloths used extensively in hospital wards. Testing revealed Pseudomonas in several hundred items from four different lots. The NIPH, Norwegian Hospital Procurement Trust, and the Norwegian Food Safety Authority (NFSA) coordinated to prevent the use of these contaminated products and issued a recall. By April 2022, the outbreak had spread to 38 hospitals across Norway, involving 339 confirmed cases and contributing to at least seven deaths.
The infection spread through contact with contaminated washcloths and potentially other non-sterile products, such as liquid soaps, hand creams, and lubricating gels used in medical procedures. Pseudomonas aeruginosa thrives in humid environments and can survive on moist surfaces, making the washcloths an ideal medium for its proliferation. These products, used extensively in hospital settings for patient hygiene, were found to be contaminated due to inadequate sterilization practices by the manufacturer, which failed to meet necessary hygiene standards.
Pseudomonas aeruginosa poses a significant threat to hospitalized patients, especially those with severe conditions such as cancer, cystic fibrosis, and burns. It can cause a range of infections, including urinary tract infections, pneumonia, bloodstream infections, and severe wound infections. The high mortality rate linked to Pseudomonas aeruginosa infections stems from weakened host defenses, bacterial resistance to antibiotics, and the production of bacterial toxins and enzymes. Pseudomonas maltophilia also causes various infections, such as pneumonia, endocarditis, and meningitis, particularly in individuals with compromised immune systems.
Norway's government implemented several measures to address the Pseudomonas aeruginosa outbreak in hospitals. To manage the outbreaks, there was a push for systematic monitoring to identify issues sooner, emphasizing the need for automated methods over manual monitoring. The response also revealed gaps in national communication and coordination, leading to a recommendation for a national outbreak guide for hospitals to clarify roles and responsibilities. Rapid access to genetic engineering tools was considered crucial for identifying microbial clones during outbreaks. It was also found that Norway’s microbiology laboratories lacked experience and resources for examining environmental samples, which prompted the NIPH to raise these concerns with the Ministry of Health and Care Services. The outbreak had significant implications for patient safety, highlighting the need for robust systems to quickly investigate and manage such incidents. Quick detection and response involved notifying the Norwegian Institute of Public Health (NIPH) and stopping the use of contaminated products. The Norwegian Food Safety Authority (NFSA) banned the affected product lots and coordinated with the manufacturer and EU authorities for a broader recall. The situation underscores the need for effective monitoring systems and prompt action to address potential sources of infection. Future evaluations in Norway will focus on improving safety protocols for non-sterile products used in healthcare settings to prevent similar outbreaks.
References:
Asfeldt, A. M., Myrbakk, T., Grimnes, G., Kildal, A. B., Pedersen, T. A., Littauer, P., Bogetvedt, T., Kroken, B. A., Nerskogen, B. J., Høgli, J. U., & Åsheim, S. (2023). From local to national outbreak of Pseudomonas aeruginosa. Tidsskrift for Den Norske Legeforening. https://doi.org/10.4045/tidsskr.23.0045
Gravningen, K., Kacelnik, O., Lingaas, E., Pedersen, T., Iversen, B. G., & Pseudomonas outbreak group (2022). Pseudomonas aeruginosa countrywide outbreak in hospitals linked to pre-moistened non-sterile washcloths, Norway, October 2021 to April 2022. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 27(18), 2200312. https://doi.org/10.2807/1560-7917.ES.2022.27.18.2200312
Iglewski, B. H. (1996, January 1). Pseudomonas. Medical Microbiology. 4th edition. https://www.ncbi.nlm.nih.gov/books/NBK8326/