Hospital linens tied to mucormycosis outbreak at pediatric hospital
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April 9, 2014
Hospital linens were identified as the agent of transmission during an outbreak of mucormycosis that resulted in five deaths at a pediatric hospital in Louisiana, according to recent findings published in The Pediatric Infectious Disease Journal.
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CDC researchers assisted hospital staff in their investigation of the 2008-2009 mucormycosis outbreak. They sought to identify possible modes of transmission of pathogens in the environment and prevent additional infections.
The investigators inspected the hospital for potential sources of mold, including the hospital’s heating, ventilation and air conditioning systems. Because an initial investigation indicated an association with linens, they visited an off-site laundry facility that contracted with the pediatric hospital and observed the procedures and workflow of the facility. They collected environmental samples for fungal culture, and the CDC conducted genotypic and phenotypic analyses of all patient and environmental culture samples.
The investigators found hospital-associated cutaneous mucormycosis in five patients over 11 months, all of whom died. Three of the patients had conditions known to cause susceptibility to mucormycosis, while two had cardiac conditions with ongoing acidosis. The cases occurred on different hospital wards, and hospital linens were the only exposure shared between all five patients. Rhizopus species were identified in 26 (42%) of 62 environmental samples collected from clean linen and related areas, and in one (4%) of 25 samples taken from non-linen related items.
The patients were infected with Rhizopus delemar, which was also identified from cultures of clean linens and clean linen delivery bins from the laundry facility.
According to the researchers, these findings underscore the importance of proper handling and storage of clean hospital linens.
“When mucormycosis occurs in hospitalized patients, particularly when several cases occur in a temporally clustered manner or share an unusual presentation, attempts should be made to identify a mold source or route of transmission for which control measures can be implemented,” the researchers wrote. “Hospital linens should be considered as a potential vehicle for the transmission of pathogenic molds. Clean linens need to be handled and stored in a manner that prevents contamination in order to keep them clean prior to patient use.”