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Pseudomonas aeruginosa Infections in the Intensive Care Unit
Facts and Control Measures
www.pal l .com/medica l
170823.1WGL
www.pall .com/medical 32
Pseudomonas aeruginosa
P. aeruginosa (PA) is a Gram-negative bacillus which,
is tolerant of a wide variety of physical conditions, has
minimal nutrition requirements, and is a major opportunistic
pathogen 1, 2. PA appears sporadically in drinking water
distribution systems, but seems to occur at a higher
frequency in premise plumbing systems compared to
water mains 3, 4.
PA is one of the most common and problematic bacteria
in healthcare facilities, and is responsible for approximately
10-20 % of hospital-associated infections (HAI) (pneumonia,
wound infections, blood stream infections and urinary
tract infections) in intensive care units (ICUs) 5-10. Length
of stay, severity of underlying disease and exposure to
invasive procedures, bacterial adherence, virulence factors,
and antimicrobial drug resistance are associated with PA
© 2016, Pall Corporation
PA may colonise biofilms in water systems and be released from the outlet.
infections in ICUs 11, 12. The incidence of HAI is 5 - 10 times
higher in ICU than general wards 13.
Although endogenous origin was considered as the most
relevant route of PA infections, in the last ten years a
significant proportion of PA isolates have been shown to
stem from the ICU environment and cross-transmission 14,15.
Several studies have shown that up to 50 % of hospital
acquired PA infections may be derived from the in-premise
water distribution system 8, 16, 17. Unlike patient and pathogen
characteristics, environmental factors such as nursing
workload or contamination of water outlets can be more
easiy managed and modified 6.
PA can colonise many types of fluids (even distilled water)
and rapidly forms biofilms 2, 14, 18-21. Moreover, PA can
PA may colonise flow straighteners and aerators as well as bottled water. PA living within biofilms typically exerts higher resistance towards chemical and thermal disinfection measures than planktonic PA, thus making PA contamination difficult to eradicate in a water system.
thrive in water fittings including the faucet body,
connectors and flow straighteners, sinks, drains, toilets,
shower heads and hoses 19, 22, 23. Automatic sensor
faucets have been shown to be more likely to become
contaminated than non-sensor manual outlets 19.
PA has been observed growing within drinking water
biofilms 3, 24, thus protected and more difficult to eradicate
than planktonic bacteria 2, 25. PA is resistant to chlorine
and other disinfectants used in water treatments 2, 26 and
may survive in the hospital ward environment even after
disinfection 27, increasing the risk of acquisition by
patients 28. PA living in biofilms exerts a higher resistance
towards disinfectants due to the mechanical protection
provided by the biofilm matrix 29 - 31. It has been shown
that the use of sublethal concentrations of chlorine-based
oxidising agents (sodium hypochlorite, chlorine dioxide,
electrochemically activated chlorine, continuous treatment
with 0.15 ppm chlorine or shock treatment with 10 ppm
chlorine for 6 hours (h)) can lead to a cyclical regrowth of
biofilm after treatment end and the survival of PA living
in the biofilm. Under unfavourable operating conditions in
a drinking water system, PA has been shown to survive
sequentially 24 h 50 parts per million (ppm) chlorine
dioxide (ClO2), 3 minutes (min) 70 °C and 24 h 50 ppm
ClO2 27.
In a large hospital in Taiwan, a comparative study on
infection rates with and without continuous treatment with
ClO2 has been described. Building 1 was continuously
treated (over 11 months) with ClO2, whereas building 2
was not treated. In both cases infections were monitored.
The overall rate of non-fermentative Gram-negative bacilli
nosocomial infections did not decline after ClO2 disinfection.
Furthermore, PA infection rates increased in both buildings,
showing no evidence for a relationship between ClO2
treatment and PA infection rates 32.
PA is a major pathogen in cystic fibrosis patients with
water being a source of infection 2, 33. PA is also the
organism most commonly detected in gastrointenstinal
endoscopy-related and bronchoscopy-associated
outbreaks 34.
PA may be carried by healthy individuals (2–10 % of
individuals, mainly aural) but can be recovered from
50-60 % of hospitalised patients 2,16. PA is the main
cause of otitis externa (‘swimmer’s ear’), with a
magnitude of 2.4 million cases per year and an estimated
54 www.pall .com/medical © 2016, Pall Corporation
Bacteria living in water installation biofilms communicate and may exchange resistance genes.
Multi-Drug Resistent PA (MDR PA) in the ICU
Number of annual non-hospitalised AOE visits
2.5 Mio (8.1 visits / 1000 patients)
Mean cost per non-hospitalised AOE visit
$ 200
Direct annual healthcare costs for AOE
$ 0.5 billion
Hours of clinicians’ time annually
600,000 hours
Table 1: Cost overview of Acute Otitis Externa (AOE) in the US, 2003-2007 31.
MDR Gram-negative bacteria (MDRGN) are defined as having
3 or more antimicrobial resistance mechanisms affecting
different antibiotic classes 28. The rise of antibiotic resistance in
pathogenic bacteria is considered to be an emerging threat to
human health and therefore of concern, being associated with
increased mortality and limited treatment options 10, 38-40.
The European Antimicrobial Resistance Surveillance System
(EARSS) reported that for Gram-negative bacteria the
situation is especially worrying with high, increasing resistance
percentages reported from many parts of Europe. For PA
the weighted mean percentage for carbapenem resistance
increased significantly between 2011 and 2014 36. A post-
antibiotic era – in which common infections and minor injuries
can kill – is a real possibility for the 21st century 41.
Opportunistic Gram-negative bacteria that present
increasing resistance issues include Enterobacteriaceae
(Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia
spp., Citrobacter spp.) and the non-fermenters, PA and
Acinetobacter baumannii 42. Stenotrophomonas maltophilia
is inherently MDR, but a less common reported cause of
cross-infection 28. PA strains have developed resistance
against commonly used antibiotics, rendering effective
treatment increasingly complicated and expensive 2, 42-45.
Data collected from MDR Krankenhaus-Infektionen-
Surveillance-System (MDRO-KISS) from January 2013
through February 2014 identified 5,171 cases of MDRGN
from 341 German ICUs; 848 (16 %) of which were
carbapenem-resistent organisms (CRO) 46. Infections with
CRO are of particular concern as only a few treatment
options remain for patients and outcomes are poor 47-48.
61 % of CRO were Pseudomonas spp. (n = 516), mostly
PA (n = 493, 58 %), followed by CRE (carbapenem-
resistent Enterobacteriaceae) (n=212; 25 %) and
Acinetocacter spp. (n = 120; 14 %) dominated by
Acinetobacter baumannii (n = 115, 14 %) 46.
A point prevalence study of 56 German hospitals in 2011
found prevalence of resistance was highest in ICUs and
higher on medical ICU wards compared with surgical ICU
wards 49. Similar UK results have been found 50.
A European survey of 19,888 patients, mainly in Belgium
and France, showed the highest prevalence of HAI in
ICUs (28.1 %) 51. ICUs in acute hospitals and long-term
care facilities have higher prevalence of MDR Gram-
negative bacteria than general wards, mainly due to their
extremely vulnerable population of critically ill patients,
the high use of (invasive) procedure and prolonged use
of antibiotics 10, 28, 52. Several factors may influence the
spread of multi-drug-resistant pathogens in the ICU,
e.g. new mutations, selection of resistant strains, and
suboptimal infection control 52.
MDR PA may be clinically manifested in the lung causing
pneumonia, urinary tract, surgical site, bloodstream, cystic
fibrosis lung and burns 53-55. In a neonatal ICU in Turkey a PA
outbreak which involved 12 patients has been reported, with
electronic faucet fittings being the likely source, and 8 of 12
invasive isolates being 4 Multi-Resistant Gram-Negative 56. In
2010, Inglis et al. described an increased incidence of MDR
PA in the ICU and High Dependency Unit of an Australian
hospital with contaminated aerators and the water system
being the possible source 57. MDR PA is also a rare cause of
community-acquired infections 58.
Transmission pathways of PA
Enterobacteriaceae, PA and Acinetobacter spp. may be
transferred among vulnerable patients by staff vectors
and contaminated equipment. PA and MDR PA are
commonly transmitted by contact and aspiration, with
the premise plumbing system being one infection source.
In such epidemiology, a single clone or small number
of clones cause infections in multiple patients without
obvious links and over a prolonged period, sometimes
extending several years with gaps of several months
between cases 18.
Patient exposure typically occurs while showering,
bathing, drinking and through contact with medical
equipment rinsed with contaminated water 18, 59. During
daily routines, water is used for personal hygiene. ICU
patients often have multiple access devices such as
catheters, drains and tracheal tubes. These portals
represent potential entrance sites for bacteria. Droplets
of contaminated water can inadvertently come into
contact with those entrance sites 14, 18, 60-61. Rogues
et al. reported 14 % of ICU healthcare professionals’
hands were Pseudomonas positive, when washed
with contaminated tap water and 12 % positive, when
the last contact was with a Pseudomonas positive
patient 14. Patient-to-patient transmission can occur
outpatient cost of approximately $ 500 million (table 1) 35.
Moreover, PA is a frequent cause of skin infections such
as folliculitis 36. With patients being released earlier from
hospital, PA is increasingly recognized as a problematic
water pathogen outside of hospital settings.
Due to the increasing numbers of immunocompromised
patients and inherent resistance of PA to many antibiotics,
hospitals are often facing the real problem of PA infection
management as an important public health concern 37.
clinical samples isolated from the patients affected 19.
In a review from different European ICUs a genomic
identity between tap water and colonised/infected
patients has been shown in 19.2 – 50 % of the
reported cases 80.
A prospective multicenter study performed in 10 French
ICUs evaluated the contributions of ICU environmental
risk factors for PA acquisition and revealed previously
contaminated faucet water in the room, and nursing
workload were next to individual patient risk factors 6.
In a Spanish NICU, PA outbreak was described with 9
infections and 1 colonisation. PA had been detected in
tap water, which had been used to warm up mothers’
milk. After introduction of sterile water instead of tap
water, no further infection cases appeared 81.
www.pall .com/medical 76
There are 4 main presentations of PA infection:
a) Bacteremia in immunocompromised individuals
b) Pneumonia in cystic fibrosis patients
c) Community-acquired ear and pneumonia infections
d) Hospital-acquired outbreaks, mainly associated with
contaminated solutions or medical devices 66.
In all 4 presentations, water containing PA may be an
infection source.
Studies have shown that clinical strains of environmental
bacteria, including PA and/or their modes of resistance,
often originate from the natural environment, including
within soil and water 67, 68. Multidrug-resistant bacteria
have been detected from various water sources, including
drinking water or tap water 69. Antibiotic resistant bacteria,
at least for some classes of antibiotics, may be more
prevalent in tap water than in the water source 44, 69-71.
Vincenti et al. suggest that high bacterial resistance rates
Water-associated PA infections
could develop when the original environmental clone
already had high rates of antibiotic resistance 40.
A cross-sectional study evaluating the recovery of
Non-Fermenting Gram-Negative Bacteria (NFGNB)
in water sources from the hospital environment was
performed in different wards of a tertiary care centre
and assessed the antibiotic resistance profile 40. Of
3268 water samples collected, 4.6 % were positive
for NFGNB with PA being the most represented
strain (34.9 %) followed by P. fluorescens (17.5 %)
and Stenotrophomonas maltophilia (10.7 %) 40. More
than half (55.6 %) of isolated strains showed antibiotic
resistance with up to 56 % of PA in the bronchoscopy
unit being antibiotic resistant (48 % MDR and 8 %
extensively drug-resistant) 40, 67, 72.
Of ten patients affected in a multiresistant PA outbreak
in a UK adult ICU, typing revealed 2/3 strains of PA
© 2016, Pall Corporation
via air among patients with cystic fibrosis 62 or via patient
hand and environmental contamination 63. Contaminated
bottled water or contaminated water from drinking water
dispensers has also been described as a source of hospital-
associated Pseudomonas infections in ICUs and Bone Marrow
Transplantations (BMTs) 64, 65.
Waterborne bacteria including PA may cause infection by consumption via drinking, inhalation of aerosols and application via contact.
detected in water samples matched strains isolated
from patients 73.
Cystic fibrosis (CF) patients become colonised with PA
early in life, and the prevalence of colonisation increases
with age: 60- 80 % of CF patients are infected 74.
Although a proportion of CF patients are infected with
PA from other patients (cohabitating hospital wards), the
main recognised source of infection is water 75, 76.
Pseudomonas can persist in hospital water systems
for expanded time periods and can result in outbreak
situations 26, 39, 73, 77-79. In a PA outbreak in a neonatal unit
in Northern Ireland, where 4 neonates died, the typing
data of the strains from 2 neonatal units linked the PA
strains recovered from the biofilm on the faucet surface
and flow straightener, and/or the water samples to the
Water as an infection source may be proven by comparison of patient and environmental sample DNA.
www.pall .com/medical 98 © 2016, Pall Corporation
Wound cleansing and PA
Special Notes
Patients with chronic wounds may be frequently
colonised by multiple bacterial species including PA,
thus delaying or even preventing the wound healing
process. A longitudinal analysis of continuous ulceration
in a cohort of chronic wound patients found that
patients with ≥ 3 x confirmations of PA in their swabs
had a longer wound duration compared to all patients
analyzed 82. Biopsy from chronic venous leg ulcers
were investigated by culture and Fluorescence-In-Situ-
Hybridization using Peptide Nucleic Acid probes (PNA-
FISH). PA was found to aggregate as microcolonies
and these wounds had significantly higher numbers of
neutrophils present which may be one factor supporting
persistent inflammatory response and impaired healing 83.
Diabetic foot infections can process rapidly to irreversible
septic gangrene necessitating amputation. An analysis
of the polymicrobial nature of diabetic foot infections
from 69 swabs and 73 tissues of 42 diabetic patients
showed PA as the most frequent aerobic bacteria with
a 30.95 % distribution 84. Moreover, antibiotic resistance
is considered to be a major threat in the treatment of
diabetic foot infections 85.
Infections are a causal agent of morbidity and mortality for
burn patients 86, 87. In a study of 176 burn care centres in
North America, Pseudomonas spp. was seen as the most
life threatening infections in thermally injured patients 86.
A 6 year antibiotic susceptibility study in a US Burn Centre
to analyse MDR isolates revealed Acinetobacter baumanii
as the most prevalent organism, followed by PA 87.
Additionally, transmission of resistance genes between
Pseudomonas species and from Pseudomonas spp. to
other Gram-negative organisms has been demonstrated
and recognised in the burn population 86. Zhang & Liu
analysed 84 patients with 134 burn related sepsis and
wound infections, and found multiresistant PA and
Acinetobacter spp. the most frequent 86.
Water for wound cleansing should be free of facultative
pathogens 88-90. The European Practice Guidelines for
burn care state that removal of slough, non vital tissue and
necrosis should be by abundantly cleaning and cleansing
the wound with tap water (filtered), saline solution or sterile
water in combination with mechanical debridement in order
to reduce the bacterial load 90. For the cleansing of wounds
in immunocompromised patients, only sterile NaCl / Ringer
solution or 0.2 µm filtered water should be used in Germany 89.
By cleansing wounds with unfiltered or non-sterile water, waterborne microorganisms may colonise wounds, leading to infections.
Chronic lung infections are associated with increased
morbidity and mortality for individuals with underlying
respiratory conditions such as cystic fibrosis (CF) and
chronic obstructive pulmonary disease (COPD) 54, 55, 58, 91.
The process of chronic colonisation allows pathogens
to adapt over time to cope with changing selection
pressures, co-infecting species and antimicrobial
therapies 92. COPD is a leading cause of mortality
worldwide and is associated with morbidity related to
acute COPD exacerbations (AECOPD) 91. In an evaluation
of 401 patients with AECOPD, 54 (13 %) had a positive
PA sputum culture. Resistant PA was isolated in 35/54
(66 %) and these patients were statistically more likley
(P = 0.03) to have been exposed to cortocosteroids and
antibiotics. Sensitive PA (PA-S) was isolated in 18/54
(34 %) of patients, and the presence of PA-S was found
to be associated with higher mortality, possibly due to
increased virulence in PA-S strains causing acute infections 91. PA is often isolated in advanced stages of COPD. Of
181 COPD patients analysed, 29 (16 %) had PA in their
sputum. After 3 years, 17/29 (58.6 %) patients had died,
compared to 53/152 (34.9 %) non-PA patients (P < 0.004).
PA is a prognostic marker of 3 year mortality in COPD
patients 93.
Clinical observations link respiratory virus infection and PA
colonisation in chronic lung disease, including cystic fibrosis
and COPD. The development of PA into highly antibiotic-
resistant biofilm communities promotes airway colonisation
and accounts for disease progression in patients 94.
(34 %) of patients, and the presence of PA-S was found
increased virulence in PA-S strains causing acute infections
. PA is often isolated in advanced stages of COPD. Of
181 COPD patients analysed, 29 (16 %) had PA in their
sputum. After 3 years, 17/29 (58.6 %) patients had died,
compared to 53/152 (34.9 %) non-PA patients (P < 0.004).
Clinical observations link respiratory virus infection and PA
ibrosis
and COPD. The development of PA into highly antibiotic-
ilm communities promotes airway colonisation
Cystic fibrosis and COPD patients often carry chronic PA colonisation.
Lung disorders and PA
Cystic fibrosis and COPD patients use nebulisers as an
integral part of treatment regimens. Nebuliser hygiene
is an important, but complicated and time consuming
task for patients 95. Home nebulisers may become
colonised 96, 99 and are a potential source of infection as
bacteria may colonise both plastic surfaces and human
lungs via the formation of biofilms. Woodhouse et al.
have shown that the use of sterilising grade filtered water
for rinsing of repeatedly used nebulisers significantly
reduces bacterial contamination 100. Moreover, several
recommendations support use of sterile water for rinsing
of nebulisers, as tap water may harbour non-tuberculous
mycobacteria, fungi or PA 101, 102.
www.pall .com/medical 1110 © 2016, Pall Corporation
PA infection prevention in the hospital ICU
Water has been demonstrated to be a common source of
PA colonisation and infections 8, 37, 58, 80 using genotyping
methods and comparing environmental with patients’ PA
strains 14, 80. Control of environmental PA transmission is
critical, and the rise of antibiotic resistance in pathogenic
bacteria including PA, is considered to be an emerging
threat to human health 34, 38, 42. The intensive use of
antibiotics is creating selective pressure favouring the
acquisition and spread of antibiotic resistance among
bacteria 40. High awareness for attention to hand hygiene,
especially with soap and water, is necessary 28.
Installation of Point-of-Use (POU) Water Filters has been
shown to be an effective aid in reducing waterborne PA
infection rates 18, 28, 103-107 as well as reducing critical PA
contamination events 78, 108-112 (table 2). A review, which
assessed the evidence that healthcare water systems are
associated with PA infections, was performed by Loveday
et al 18. From 196 relevant peer reviewed studies, 25 met
the criteria for data strength but only two studies provided
plausible evidence for effective control measures. Both
studies included Point-of-Use Water Filters 77, 104.
Walker et al. suggest hospitals determine which patients
are at risk in augmented units and undertake a review of
not just the water system, but also environmental cleaning
practices and related best practice to assess possible
faucet contamination with patients’ bacteria, to evaluate
patient contact with water on particular wards, and to
assess other control measures that may be required in
order to minimise risks to patients 19.
In a 10 year Swiss study, an increase of hot water
temperature to 149 °F (65 °C), eradication of
multiresistant PA strains from the environment, and use
of Point-of-Use Water Filters in burns and solid transplant
organ patient rooms, have been found to be effective
infection prevention measures in intensive care units 9.
In an Italian haemato-oncological unit a significant
increase of PA positive blood cultures was observed and
environmental tests revealed contamination of
> 50 % showerheads, faucets, basins and bidets.
Measures such as 5 minutes water flushing did not result
in a decrease in infection rate. Installation of POU water
filters led to a significant reduction in septicemia rate 103.
In a surgical ICU, endemic PA infections were observed for
a period of > 24 months, with tap water being persistently
colonised with a single PA clonotype. Different measures
to reduce the rate of new PA infections cases, including
selective digestive tract decontamination, enhanced
hygiene measures and alcohol-based hand disinfection
after handwashing, did not reduce the occurrences.
Installation of POU water filters led to a significant reduction
of colonisation and infection rates. The rate of PA positive
patients reduced from 15.5 % in the non-filtration period
to 4.3 % in the filter period (p ≤ 0.0001). Moreover, overall
infections were reduced by 22 % and PA infections by
56 % 104. It may be argued that eradication of PA is not
possible in an adult ICU, as already colonised patients
may be admitted or there may be transmission between
patients from poor hygiene practice. However, providing
hygienically controlled water in the ICU for infection
prevention purposes should be prioritised 104.
Comparison of a 5-month period with POU water filters
installed at all outlets in a subacute care unit with 29 beds
showed a significant reduction in ventilator-associated
pneumonia (VAP) cases (p = 0.0087), positive cultures
for Pseudomonas (p = 0.0004) and upper respiratory
colonisation with Pseudomonas (p = 0.0179) 110.
Barna et al. reported the reduction of PA infection rates
to 0/100 ICU patient days during the filtration period of
4 weeks versus 2.7/100 patient days over 4 weeks
without filters 105.
A reduction of nosocomial PA infections in burn patients
from 10 % to 2.5 % 106 and a 50 % reduction of Gram-
negative bacteria infections in a bone marrow transplant
unit have been reported after installation of POU water
filters 107. Furthermore, a prospective clinical study in a
liver transplant unit comparing Gram-negative infection
and colonisation rates before and after installation of
POU water filters reported a reduction of infection and
colonisation rates of 47 % per 1,000 patient days during
the filtration period 111.
Tap water was implicated as the source of a PA outbreak
in a US Neonatal ICU where 31 cases and 3 deaths were
reported 113. PA case clusters occurred before POU water
filters were installed, and after they were removed. Residing
in a room without a POU water filter was the strongest risk
factor for patients having a positive PA culture.
Country
Italy
France
Germany
France
US
US
Hungary
China
US
Patient Unit
Haematology
ICU
Surgical ICU
Burns Unit
BMT Unit
Subacute Care Unit
ICU
Liver Transplantant Unit
Neonatal ICU
Effect of POU Filtration
Reduction of PA positive blood cultures from 8 % and 18 % to 2.7 %
Reduction of PA infections from 8.7/1000 patient days to 3.9/1000 patient days
Reduction of PA colonisation by 85 % and infections by 56 %
Reduction of PA infections from 10 % to 2.5 %
50 % reduction of Gram-negative bacteria infections
90.2 % reduction in VAP cases 68.3 % and 58.6 % reduction of PA positivity in sputum and nasal samples respectively
Reduction of PA infections from 2.7/100 to 0/100 patient days
47 % reduction of Gram-negative infection and colonisation rates per 1,000 patient days
Reduction of positive PA cultures from 1-4 per week to 0 per week
Citation
Vianelli et al., 2006 103
Van der Mee-Marquet, 2005 112
Trautmann et al., 2008 104
Legrand et al., 2009 106
Cervia et al., 2010 107
Holmes et al., 2010 110
Barna et al., 2014 105
Zhou et al., 2014 111
Bicking Kinsey, 2017 113
Table 2: Reduction of patient infection /colonisation with Point-of-Use Water Filters.
12 © 2016, Pall Corporation
POU Water Filters are barriers against waterborne microorganisms and may aid in reducing PA rates in high risk patient groups.
World Health Organisation (WHO) recommendations
are recognised globally for drinking water quality
requirements, and POU water filtration is listed as one
suggested control measure for hospitals 114. In addition
POU Water Filtration recommended as a control measure against waterborne bacteria
there are national and regional drinking water guidelines,
several of which have integrated POU filtration as one
control method to prevent transmission of waterborne
pathogens to patients and users 28, 89, 115-121.
Health care-associated infections (HAIs) can be associated
with increased costs in the range of $7,453 - $15,155
per infected patient 122 (table 3). Chronic PA infections in
the cystic fibrosis population increased baseline costs by
39%. 123 PA is a major cause of pneumonia in the ICU and
following a 6 year study period, patients with PA infection
were calculated to have a higher total mean hospitalisation
cost at $213,104 vs non infected patients at $33,851
(P<0.001) 124. Additionally PA infected patients spent nearly
2 weeks longer in intensive care, and approximately 7 weeks
longer in hospital than non-infected patients. MDR-PA had
the highest mean incremental cost, which was approximately
7 x the cost of a non-infected patient 125.
The use of POU water filters was shown to prevent 7.6
infections per 100 patients staying ≥ 3 days in the ICU, and
Financial implications of PA infections and POU Water Filtration
preventing 23 infection cases per year 104. Given a moderate
estimate of the additional cost of any type of nosocomial
infection in the range of $3,000, POU water filtration resulted
in savings of $69,000 and a net saving of $64,000 when
applied in the 12 bed ICU 104.
A comparison of 5 month filtration period in a subacute
care unit with 29 rooms versus 1 month non-filtration period
found a reduction in total patient costs of $248,136 with net
cost savings of $231,036 110. After a PA outbreak affecting
17/67 patients, Bou et al. calculated €18,408 per case of
PA infection, thus being 66 % higher than non-infected
patients (p = 0.002). Based on these figures a conservative
estimate of the extra cost attributable to PA infection in
the ICU reached €312,936. The extra length of ICU stay
attributable to PA infection was 70 days (p = 0.0001) 115.
n.a.Year
2008
2009
2010
Preventable Infections by Use of POU Water Filters
23 per year
n.a.
16 in 5 months
Costs due to Infections
$3,000 per infectionper patient
Average increase of total ICU cost for € 18,408
n.d.
Water Filter Costs
$5,000 pa for a 12 bed ICU
n.a.
$17,100 for 5 months for 25 POU
Table 3: Cost of nosocomial PA infections and net cost savings with use of POU Water Filters as the control measure. n.a.= not applicable; n.d. = not defined.
www.pall .com/medical 13
Net Cost Savings
$64,000 p.a.
n.a.
$231,046 for 5 months
Citation
Trautmann et al., 2008 104
Bou et al., 2009 126
Holmes et al., 2010 110
- PA is an opportunistic bacterium developing
antimicrobial resistance and playing a major role in
hospital acquired infections
- Tap water is a common source of PA infections in
healthcare environments
Conclusion
- POU Water Filters interrupt the transmission pathway
between tap water and patients, and are
recommended as an effective control measure which
may aid in reducing PA colonisation and infection
- Prevention of PA infections leads to cost savings
Typical medical applications of sterilising grade POU Water Filters.
Food & drinkpreparation
Handwashing
Endoscopic reprocessing
Showerunit
Woundcare
14 © 2016, Pall Corporation www.pall .com/medical 15
Continued over
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12. Boyer et al., “Pseudomonas aeruginosa acquisition on an intensive care unit: relationship between antibiotic selective pressure and patients’ environment”, Crit Care, 15:R55, 2011
13. Cornejo-Juárez et al., “The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit”, Int J Infect Dis, 31:31-4, 2015
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