Outbreak experience: An interview with Olga Guzman

What was the first sign that your facility might be experiencing a waterborne outbreak?

In 2014, we received reports of a pattern of positive cultures in the facility.

What was the pathogen?

Pseudomonas aeruginosa.

What were the first steps you took to remediate the outbreak? And any additional steps after that?

The first thing we did was check the aerators on all the faucets. We wanted to confirm if aerators were present on all of the faucets, and when we did, we noticed evidence of black residue on some aerators. We decided to collect environmental samples on those faucets that had black reside on the aerator.

Who was involved in the team to manage the outbreak?

We had a cross-functional team involved that included members of the following departments: Pediatric Infectious Disease Doctor, Neonatal Intensive Care Unit (NICU) leadership, Hospital administration, Infection Prevention, an outside consulting firm, and the hospital laboratory.

How did your experience with the outbreak change your water management plan?

There was no water management plan prior to the outbreak. After the outbreak, a new national Kaiser Permanente water management standard was developed.

Was the source of the outbreak ever confirmed?

In this case, it was confirmed that the potable water was responsible for the outbreak in the unit.

Do you have advice for healthcare facilities that have not experienced an outbreak?

• Develop a comprehensive water management plan
• Establish a multidisciplinary water management team and meet regularly to ensure adherence to the plan
• Develop a risk assessment to determine if point-of-use filtration and/or a secondary disinfection system is needed

Explore our Water filtration solutions

Author's bio

Olga Guzman - RN Hospital Epidemiology & Infection Prevention

Olga Guzman has worked as an RN in field of Hospital Epidemiology and Infection Prevention and Control for over 17 years. She currently works as the Director of the Infection Prevention and Control Department at Kaiser Permanente in the San Bernardino County area in Southern California. She obtained her BSN and graduate studies towards her MBA from Loma Linda University in 1994 and is currently certified in Infection Prevention. She served as the Inland Empire APIC local chapter as President and past president and board member. Her experience with a NICU pseudomonas outbreak in a new construction allowed her to work with team from the CDC and develop partnerships with many biofilm experts and water management safety consultants. Due to this experience, she participated in developing the first National Kaiser Permanente Water Safety Management Guidelines in 2015. She has shared the lessons learn at many of the Local APIC chapters in the area and participated as a speaker at the “In-Premise Water System Educational Symposia in 2017 in Southern California and at the “water as a Source of Healthcare-Associated Infection: Science and Evidence to Support Water Management Programs” Seattle Washington, educational symposium in 2019 and other matter related webinars.

Marissa Khoukaz - Former Business Development Manager — Hospital Water

Marissa was a Business Development Manager for hospital water and managed the prefiltration portfolio globally for Pall Medical, part of Cytiva. She worked with high-risk units to reduce waterborne pathogen risk to patients.