Question

rene Matthews, an infection control nurse has 3 patients in her hospital that have all contracted post-procedure bacterial septicemia. All 3 have fevers and low blood pressure. These 3 patients are in separate areas of the hospital, in different units, and they have all undergone different procedures. As far as Irene can tell, the only thing these patients have in common is the infectious agent, Klebsiella pneumoniae. Irene reviewed what she knows about gram-negative K. pneumoniae bacteria. Although this bacteria is part of normal intestinal microbiota, outside its typical environment it can cause serious infection. K. pneumoniae accounts for about 8% of all health-care associated infections. Irene surmises that the bacteria had to come from the hospital somewhere.

1. Why does Irene believe the bacteria came from the hospital somewhere?

2. What is causing the patients’ fever and low blood pressure?

As Irene was checking on the patients she noticed another patient being feed ice chips by a relative. On a hunch, Irene requests that the ice machines be swabbed and cultured. Her hunch turns out correct: the samples are positive for K. pneumoniae. Bacteria growing in the hospital’s water pipes entered the ice machine with incoming water.

3. How can K. pneumoniae grow in water pipes?

4. Why weren’t more people (i.e. medical staff) in the hospital sick?

5. In your opinion, how could similar outbreaks be prevented at this hospital in the future?

Answer 1

1. The patients are in different areas of the hospital and they have contracted the infection after a surgical procedure . All the patients must have got the infection from any contaminated things they are using in the post-op period . And klebsiella organism is a present in hospital setups and it is one of the most important causes of nosocomial pneumonia in hospitals.

2. The cause for fever and low blood pressure could be due to septicemia or septic shock . From the lungs the organism can spread to others parts of the body and can cause generalized septicemia leading to septic shock . Fever and hypotension are symptoms of septicemia.

3. Hospital acquired klebsiella is known to be present in water pipes , water drinking machines and hospital surfaces. They are ubiquitous organisms . They can be almost found everywhere in a infected area like a hospital environment . They are anaerobic and grow well in 35-37 degrees and in a pH of 7.2 . Drinking water and water pipes may contain favourable environment for the growth of the organism and supports the growth of it .

4. This type of infection attacks people with low immunity or immunosuppressed . Patients after a infection and surgery are generally immunosuppressed and they get attacked easily. The medical staffs have been exposed to the organism and have developed considerable amount of immunity and resistance . And moreover medical staffs are well protected by following the safety precautions to prevent an infection.

5.

• Sterilize and disinfect the hospital at particular intervals.
• Hand and equipment hygiene .
• Provide infection control education to everyone in the hospital.
• Create an infection control policy.
• Use of vaccines to prevent some infection.
• Carry out inspection at regular intervals and check for any hospital acquired infection.
• Make sure clean drinking water supply and foods cooked in clean environment.