Nosocomial infection with Pseudomonas aeruginosa results in significant morbidity and mortality for patients in the intensive care unit (ICU).
General requirements for infection with Pseudomonas aeruginosa:
(1) one or more defects in the host defenses
(2) exposure to a source of Pseudomonas aeruginosa
(3) initial colonization of patient's skin, gut or respiratory tract
(4) medical fomite
Defect in host defenses may include:
(1) old age
(2) full thickness burn
(3) diabetes mellitus
(4) transplant or other immunosuppression
(5) immunodeficiency
(6) chronic lung disease
Source of Pseudomonas aeruginosa:
(1) water or moisture, including sinks, showers, bath tubs, or pools
(2) fruits, plants or soil
(3) contaminated hospital or personal care solutions (soaps, cleaning solutions, contact lens solutions, eye drops, distilled water, disinfectants, etc.)
(4) improperly cleaned medical equipment such as endoscopes
(5) clothing or shoes
(6) colonized family member, health care worker or patient
Initial colonization may occur with:
(1) prolonged hospitalization
(2) poor adherence to handwashing or hygiene practices by healthcare workers
(3) suppression of normal flora
(4) moist body surface
Medical fomites may include:
(1) tracheal or endotracheal tube
(2) urinary catheter
(3) central line
(4) nasogastric tube
(5) respiratory care equipment (nebulizers, etc)
