192866 Point-of-use water filtration reduces healthcare-associated infections in bone marrow transplant recipients

Monday, November 9, 2009: 11:20 AM

Joseph Steven Cervia, MD, MBA , Division of Infectious Diseases, Pall Medical and North Shore University Hospital, East Hills, NY
Bruce Farber, MD , Division of Infectious Diseases, North Shore University Hospital, Manhasset, NY
Donna Armellino, RN, DNP, CIC , Infectious Disease Service, North Shore University Hospital, Manhasset, NY
Joan Klocke, RN , Bone Marrow Transplant Unit, North Shore University Hospital, Manhasset, NY
Ruthee-Lu Bayer, MD , Bone Marrow Transplant Unit, North Shore University Hospital, Manhasset, NY
Morven McAlister, PhD , Pall Medical, East Hills, NY
Ilia Stanchfield , Pall Medical, East Hills, NY
Francis P. Canonica, PhD , Pall Medical, East Hills, NY
Girolamo A. Ortolano, PhD , Pall Medical, East Hills, NY
Gram-negative bacteria (GNB) are major contributors to serious morbidity and mortality in hospitalized patients. Immunocompromised individuals, such as recipients of bone marrow transplants (BMT) are at particularly high risk. Outbreaks of infection with GNB have been linked to hospital water. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in hospitalized BMT recipients in the absence of any recognized outbreak. Unfiltered water was sampled from taps in the BMT unit of a major U.S. teaching hospital, and cultured at a reference laboratory for selected waterborne pathogens. POU bacterial-retentive filters (0.2 Ám) were installed on sinks, showers and ice machines throughout the unit, and replaced every 14 days. Infection rates were tracked over a nine-month period, and compared with rates for a 16-month period prior to POU filtration. Unfiltered water samples from 50% (2 of 4) outlets sampled grew P. aeruginosa (2 of 4) and S. maltophilia (1 of 4). Clinical infection rates in the unit were significantly reduced from 1.4 total and 0.4 GNB infections per 100 patient days in the period prior to POU filtration to 0.18 total and 0.09 GNB infections per 100 patient days (p=0.0068 and p=0.0431, respectively) in the 9-month period for which filters were in place. No infections were noted in eight of those nine months; and, all infections during the POU filtration period were due to non-waterborne organisms. POU water filtration may significantly reduce infection rates in BMT recipients in the absence of any recognized outbreak.

Learning Objectives:
1. List common microbial pathogens that have been isolated from hospital tap water. 2. Discuss evidence for the importance of waterborne pathogens in the epidemiology of healthcare-associated infections in immunocompromised hosts. 3. Identify preventive measures that may be employed by healthcare institutions to protect immunocompromised individuals from healthcare-associated infections with waterborne pathogens. 4. Assess evidence for the efficacy and cost-effectiveness of such preventive measures for bone marrow transplant recipients.

Keywords: Water, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been responsible for the conduct of the research to be presented in the abstract.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Pall Medical Medical Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.