Background: Microbiological monitoring of disinfection of high-touch surfaces identified heavy growth of Serratia marcescens and Achromobacter xylosoxidans not present on surfaces before disinfection, suggesting contamination of the disinfectant used.
Methods: An investigation included interview of the housekeeper involved, level of bacterial contamination of the in-use quaternary ammonium (Quat) disinfectant, bactericidal activity of the contaminated disinfectant, pulsed field gel electrophoresis of S.marcescens and Achromobacter isolates, survival of S. marcescens on dry surfaces, and genome sequencing to identify possible Quat resistance genes.
Results: The housekeeper, who seldom cleaned patient rooms, had used the disinfectant for months without emptying and drying the bucket between uses. The contaminated disinfectant contained 9.3 × 10 CFU of S. marcescens plus A. xylosoxidans. The log reduction of S. marcescens by fresh Quat was 10-fold lower than that achieved against a control strain (S. marcescens ATCC 13380). Genome sequencing of S. marcescens isolates identified the following genes previously shown to encode for efflux pumps associated with Quat resistance: sdeXY, sdeAB, smfY, and a sugE-like gene.
Conclusions: Failure to follow existing guidelines and manufacturer's instructions for use resulted in contamination by A. xylosoxidans and by S. marcescens that possessed multiple genes associated with Quat resistance.
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