The following is a summary of “A cluster of gram-negative bloodstream infections in Connecticut hemodialysis patients associated with contaminated wall boxes and prime buckets,” published in the June 2023 issue of the Infection Control by Backman et al.
Patients on maintenance hemodialysis (HD) are at a higher risk for bloodstream infections (BSI). Researchers investigated a cluster of Delftia acidovorans infections among HD patients at Facility A’s outpatient unit. A case was defined as an HD patient at Facility A with at least one positive culture for D acidovorans between 1 February and 30 April 2018.
The investigation examined patient records, facility policies, practice observations, and environmental cultures. The cluster included two confirmed cases of D acidovorans BSI. Both patients were recently dialyzed at Station #2, where a wall box culture revealed the presence of D acidovorans. One patient also had a bloodstream infection (BSI) caused by Enterobacter asburiae, isolated from multiple other wall boxes and prime saline barrels (SPB).
Observations revealed that wastewater leaked from wall receptacles onto the floor and that SPBs were only sometimes properly disinfected and dried before reuse. Several deficiencies in hand hygiene and station sanitation were observed. No defects in water purification practices were identified, and no pathogens were detected in water cultures. Due to inadequate hand hygiene and station disinfection, the cluster of D acidovorans infections was most likely caused by indirect exposures to contaminated wall boxes and possibly SPBs.