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Mucormycosis Outbreak Associated With Hospital Linens

May 06 2014

An outbreak of mucormycosis over an 11 month period led to the deaths of 5 children in the New Orleans Children’s Hospital. According to a report just published in Paediatric Infectious Disease Journal. Environmental sampling from all areas and surfaces in the hospital was examined subsequently, but an initail failure to link the cases led to significant delays.  Three of the cases had conditions which can result in immunosuppression, and were therfore susceptible to fungal infections like mucormycosis, while 2 had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas and from 1 (4%) of 25 samples from non linen-related items. All the patients here were infected with Rhizopus delemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility.

The identification of hospital linens as a vehicle for carrying Rhizopus delemar into contact with susceptible patients has underpinned the need for careful laundering, packaging and transportation of hospital linen, minimising exposure to environmental contamination.

Poor practices at the Hospital were reported a year before the outbreak: mis-use of linen for cleaning purposes,  poor storage- dirty linen was found  in trashcarts and trash found in linen carts, at the same time the Hospital requested linen not be delivered  in sealed plastic bags – a contravention of normal recommended practises and federal guidelines.
Additional factors to be considered are the flooding of the laundry used by the Childrens Hospital as a result of Hurricane Katrina in 2005 .Floors and drywall had been replaced at that time,  but no checks for underlying mould problems were recorded. In addition proper filters were missing from ventilation fans – which could have prevented dust and fungal spores entering from outside. The combined effect of these poor practices would have contributed to the linen contamination by a deadly mould which then went on to infect vulnerable children.

The children’s hospital has since implemented  a number of measures to prevent this happening – resterilizing areas of the hospital - including where linen is stored, changing the delivery site for the linen,  it is now stored and delivered  in sealed bags and using sterile linen for at risk patients.   

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