Hiding in Plain Sight: Contaminated Ice Machines Are a Potential Source for Dissemination of Gram-Negative Bacteria and Candida Species in Healthcare Facilities.

BACKGROUND Contaminated ice machines have been linked to transmission of pathogens in healthcare facilities. OBJECTIVE To determine the frequency and sites of contamination of ice machines in multiple healthcare facilities and to investigate potential mechanisms of microorganism dispersal from contaminated ice machines to patients. DESIGN Multicenter culture survey and simulation study. SETTING The study took place in 5 hospitals and 2 nursing homes in northeastern Ohio. METHODS We cultured multiple sites on ice machines from patient care areas. To investigate potential mechanisms of microbial dispersal from contaminated ice machines, we observed the use of ice machines and conducted simulations using a fluorescent tracer and cultures. RESULTS Samples from 64 ice machines in the 5 hospitals and 2 nursing homes (range, 3-16 per facility) were cultured. Gram-negative bacilli and/or Candida spp were recovered from 100% of drain pans, 52% of ice and/or water chutes, and 72% of drain-pan grilles. During the operation of ice machines, ice often fell through the grille, resulting in splattering, with dispersal of contaminated water from the drain pan to the drain-pan grille, cups, and the hands of those using the ice machine. Contamination of the inner surface of the ice chute resulted in contamination of ice cubes exiting the chute. CONCLUSIONS Our findings demonstrate that ice machines in healthcare facilities are often contaminated with gram-negative bacilli and Candida species, and provide a potential mechanism by which these organisms may be dispersed. Effective interventions are needed to reduce the risk of dissemination of pathogenic organisms from ice machines. Infect Control Hosp Epidemiol 2018;39:253-258.