ORIGINAL ARTICLE Pseudomonas aeruginosa infections due to electronic faucets in a neonatal intensive care unit Hacer Yapicioglu, 1 Tulin Guven Gokmen, 3 Dincer Yildizdas, 2 Fatih Koksal, 3 Ferda Ozlu, 1 Eren Kale-Cekinmez, 1 Kurthan Mert, 1 Birgul Mutlu, 1 Mehmet Satar, 1 Nejat Narli 1 and Aslihan Candevir 4 Department of Pediatrics, 1 Divisions of Neonatology and 2 Pediatric Intensive Care Unit, and 3 Department of Microbiology and 4 Hospital Infection Control Committee, Cukurova University, Faculty of Medicine, Adana, Turkey Aim: To evaluate the role of electronic faucets in a newborn intensive care unit during a Pseudomonas aeruginosa outbreak. Methods: After three patients had P. aeruginosa bacteremia, environmental cultures including those from patient rooms, incubator, venti- lators, total parenteral nutrition solutions, disinfection solutions, electronic and hand-operated faucet filters/water samples after removing filters and staff hands were taken. Results: Only filters of electronic faucets and water samples after removing filters and one liquid hand soap showed P. aeruginosa (3–7 ¥ 106 cfu/mL). We have removed the electronic faucets and new elbow-operated faucets were installed. Pulsed-field gel electrophoresis analysis of outbreak-blood culture isolates from two patients and isolates from electronic water faucets/one liquid hand soap indicated the presence of 90.7% genetically related subtype, probably from the same clone. Water cultures from new faucets were all clean after installation and after 7 months. Conclusion: We suggest that electronic faucets may be considered a potential risk for P. aeruginosa in hospitals, especially in high-risk units. Key words: electronic faucet; newborn; P. aeruginosa infection. Outbreaks of Pseudomonas aeruginosa in neonatal intensive care units (NICUs) can be life threatening, particularly in preterm infants. Specific environmental surfaces such as tap water, sinks, faucets and taps are well-known sources for infection or contamination. 1–3 In a review of prospective studies published between 1998 and 2005 by Trautmann et al., 4 9.7–68.1% of randomly taken water samples on different types of intensive care units (ICUs) were reported to be positive for P. aeruginosa, and 14.2–50% of infection/colonisation episodes were due to genotypes found in ICU water. In NICUs, long or artificial fingernails, 5 contaminated multi-dose vials, 6 water bath for thawing fresh frozen plasma, 7 contaminated equipment, 8 breastfeeding and contaminated feeding bottles 9–11 are reported risk factors for antibiotic-resistant P. aeruginosa infections. Electronic faucets are commonly used in public places such as toilets and restaurants mainly to prevent touching contami- nated taps. They save water and have less flushing effect than hand-operated ones. So recontamination from the sink may be another advantage. Due to these advantages, these devices have been more frequently installed in hospitals to prevent cross- contamination or recontamination, especially in ICUs. However, several studies reported that electronic faucets may be a source of P. aeruginosa and Legionella spp. infections, 12,13 and not recom- mended in high-risk units, 12,14–16 whereas one study found no P. aeruginosa growth in electronic faucets. 17 Here, we report a short-term P. aeruginosa outbreak probably due to electronic faucets in our NICU. Correspondence: Dr Hacer Yapicioglu, Cukurova University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Adana 01330, Turkey. Fax: +90 322 338 66 10; e-mail: hyapicioglu@cu.edu.tr Conflict of Interest: No conflict of interest. Accepted for publication 02 June 2011. What is already known on this topic 1 Outbreaks of Pseudomonas aeruginosa in neonatal intensive care units can be life threatening, particularly in preterm infants. 2 Specific environmental surfaces such as tap water, sinks, faucets and taps are well-known sources for infection or contamination. 3 There are a few reports about P. aeruginosa contamination in electronic faucets. However, no outbreak was reported before. What this paper adds 1 We have shown for the first time that electronic faucets may be an important source for P. aeruginosa outbreak in neonatal intensive care units. 2 Mortality of P. aeruginosa infections is high in premature babies. 3 If electronic faucets are in use, vigilance for a Pseudomonas outbreak is required. doi:10.1111/j.1440-1754.2011.02248.x Journal of Paediatrics and Child Health 48 (2012) 430–434 © 2011 The Authors Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 430