Carbapenem-Resistant Enterobacteriaceae: Frequency of Hospital Room Contamination and Survival on Various Inoculated Surfaces

2015 ◽  
Vol 36 (5) ◽  
pp. 590-593 ◽  
Author(s):  
David J. Weber ◽  
William A. Rutala ◽  
Hajime Kanamori ◽  
Maria F. Gergen ◽  
Emily E. Sickbert-Bennett
Keyword(s):  
Infect Control Hosp ◽  
Hospital Room ◽  
Carbapenem Resistant ◽  
Environmental Surfaces ◽  
Colony Forming Units ◽  
Low Levels ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) only contaminated the environmental surfaces of rooms housing CRE colonized/infected patients infrequently (8.4%) and at low levels (average, 5.1 colony-forming units [CFU]/120 cm2 per contaminated surface). Three species of CRE (Klebsiella, Enterobacter, and Escherichia) survived poorly (>85% die-off in 24 hours) when ~2 log10 CFU were inoculated onto 5 different environmental surfaces.Infect Control Hosp Epidemiol 2015;00(0): 1–4

scholarly journals 1141. Microbial Assessment of Healthcare-Associated Pathogens on Various Environmental Sites in Patient Rooms After Terminal Room Disinfection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S342-S343
Author(s):  
Hajime Kanamori ◽  
William Rutala ◽  
Maria Gergen ◽  
Emily Sickbert-Bennett ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Hospital Room ◽  
Toilet Seat ◽  
Vancomycin Resistant Enterococci ◽  
Environmental Surfaces ◽  
Colony Forming Units ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Uv C ◽  
Better Than

Abstract Background Hospital room environmental surfaces can be contaminated with healthcare-associated pathogens even if terminal room cleaning/disinfection is implemented. We examined the microbiological burden on hospital room environmental sites after standard or enhanced terminal room disinfection. Methods Microbial data from the Benefits of Enhanced Terminal Room Disinfection Study were utilized. All patient rooms were randomly assigned to standard disinfection (Quaternary ammonium [Quat]) or an enhanced disinfection (Quat/ultraviolet light [UV-C], Bleach, or Bleach/UV-C). Microbiological samples were obtained using Rodac plates (25 cm2/plate) from 8 of 10 hospital room sites, including bed rail, over-bed table, supply/medicine cart, chair, side counter, linen hamper lid, sink, toilet seat, shower floor, and bathroom floor. The number of colony forming units (CFU) of four target epidemiologically important pathogens (EIP), including multidrug-resistant Acinetobacter, Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci, was counted. A total of 3,680 samples from 736 environmental sites in all 92 patient rooms (21 standard rooms and 71 enhanced rooms) were analyzed. Results Overall, the frequency of all environmental sites positive for EIP was 11% (84/736) in all rooms, 21% (36/168) in standard rooms, and 8% (48/568) in enhanced rooms (P < 0.001) (Figure 1). Environmental sites, other than the toilet seat, in standard rooms were likely to be more frequently contaminated with EIP than in enhanced rooms (P = 0.013 for overbed table, P = 0.010 for bed rail, and P > 0.05 for other sites each). Mean CFU of EIP per room was 19.2 in all rooms, 60.8 in standard rooms, and 6.9 in enhanced rooms (P = 0.006) (Figure 2). All sites in standard rooms tended to have higher mean counts than in enhanced rooms (P = 0.001 for overbed table, P = 0.001 for bed rail, P = 0.012 for side counter, and P > 0.05 for other sites each). Conclusion Our results demonstrate that an enhanced terminal room disinfection reduced microbial burden of healthcare-associated pathogens on environmental sites better than standard room disinfection. Environmental hygiene of touchable surfaces after terminal room cleaning using Quat needs to be improved. Disclosures W. Rutala, PDI: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. D. Weber, PDI: Consultant, Consulting fee.

scholarly journals Klebsiella pneumoniae Carbapenemase (KPC)–Producing K. pneumoniae Contamination of an In-Room Sink in a New Bed Tower

2021 ◽  
Vol 1 (S1) ◽  
pp. s73-s73
Author(s):  
Bobby Warren ◽  
Becky Smith ◽  
Sarah Lewis ◽  
Deverick Anderson ◽  
Bechtler Addison
Keyword(s):  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Routine Surveillance ◽  
Colony Forming Units ◽  
Time Of Admission ◽  
Uv C ◽  
New Strategies ◽  
Carbapenem Resistant Enterobacteriaceae

Group Name: Duke Center for Antimicrobial Stewardship and Infection PreventionBackground: Wastewater drains in hospital patient rooms have been identified as environmental reservoirs for multidrug-resistant organisms, and they have been linked to outbreaks of carbapenem-resistant Enterobacteriaceae (CRE). We studied the colonization of wastewater drains in a new hospital bed tower. Methods: A patient care unit in a new bed tower opened on July 18, 2020. In-room sinks were located in each hospital room opposite the patient head wall. Patients admitted to this unit underwent weekly rectal cultures to survey for carbapenemase-producing CRE. Additionally, infection preventionists performed routine surveillance of all clinical cultures for CRE. Cultures were performed from all patient room sinks in this unit monthly beginning September 14, 2020. Samples were obtained from the drain cover, handles, and top of bowl using sponges soaked in neutralizing buffer and processed using the stomacher technique. The tail-pipe was sampled using a flocked mini-tip swab soaked in neutralizing buffer; the P-trap water was sampled with sterile tubing attached to a 50-mL syringe. All samples were plated on HARDYCHROM-ESBL and KPC Colorex media and were incubated at 37°C for 24 hours. Results: The first identified CRE-positive patient was admitted to the new unit on December 4, 2020; urine culture obtained at the time of admission grew KPC–producing Klebsiella pneumoniae (KPC-KP). The sink in this patient’s room had been sampled 3 prior times (most recently on November 9, 2020) and was negative for CRE. On December 7, 2020, KPC-KP was found on the drain cover (6,750 colony-forming units, CFU) and in the sink’s P-trap (1,840 CFU) of the index patient’s room during routine sink surveillance. Additional samples from other room surfaces were taken on December 9, 2020, and KPC-KP was recovered from the computer keyboard (452 CFU) and patient bedrails (880 CFU). The patient was discharged from this room December 13, 2020, and the room underwent enhanced terminal room cleaning including UV-C light. On the next routine sink sampling on January 4, 2021, KPC-KP was recovered again in the index room sink P-trap (9,800 CFU) but at no additional sites. MLST was performed, and all isolates were ST-258. Conclusions: In a new bed tower with no prior evidence of CRE-positive patients, the first identified case of a CRE (KPC-KP) in a patient resulted in widespread environmental contamination of the room after only 3 days of hospitalization and contamination of the in-room sink drain that persisted after 1 month. Given the ease with which CRE colonizes wastewater drains, new strategies are needed to mitigate drain colonization and to prevent CRE transmission to subsequent patients.Funding: NoDisclosures: None

scholarly journals Antimicrobial Activity of Lactobacillus Species Against Carbapenem-Resistant Enterobacteriaceae

2019 ◽  
Vol 10 ◽  
Author(s):  
Chi-Chung Chen ◽  
Chih-Cheng Lai ◽  
Hui-Ling Huang ◽  
Wen-Yu Huang ◽  
Han-Siong Toh ◽  
...  
Keyword(s):  
Antimicrobial Activity ◽  
Lactobacillus Species ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Investigation and Containment of New Delhi Metallo-β-Lactamase (NDM)–Producing Carbapenem-Resistant Enterobacteriaceae (CRE) in a Hospital Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s305-s305
Author(s):  
Karoline Sperling ◽  
Amy Priddy ◽  
Nila Suntharam ◽  
Adam Karlen
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Outpatient Surgery ◽  
The United States ◽  
Multidrug Resistant ◽  
New Delhi ◽  
Point Prevalence Study ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Carbapenem Resistant Enterobacteriaceae

Background: With increasing medical tourism and international healthcare, emerging multidrug resistant organisms (MDROs) or “superbugs” are becoming more prevalent. These MDROs are unique because they are resistant to antibiotics and can carry special resistance mechanisms. In April 2019, our hospital was notified that a superbug, New Delhi Metallo-β-lactamase(NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE), was identified in a patient who had been transferred to another hospital after being at our hospital for 3 weeks. Our facility had a CRE admission screening protocol in place since 2013, but this patient did not meet the criteria to be screened on admission. Methods: The infection prevention (IP) team consulted with the Minnesota Department of Health (MDH) and gathered stakeholders to discuss containment strategies using the updated 2019 CDC Interim Guidance for Public Health Response to Contain Novel or Targeted Multidrug-resistant Organisms (MDROs) to determine whether transmission to other patients had occurred. NDM CRE was classified under tier 2 organisms, meaning those primarily associated with healthcare settings and not commonly identified in the region, and we used this framework to conduct an investigation. A point-prevalence study was done in an intensive care unit that consisted of rectal screening of 7 patients for both CRE and Candida auris, another emerging MDRO. These swabs were sent to the Antibiotic Resistance Laboratory Network (ARLN) Central Regional Lab at MDH for testing. An on-site infection control risk assessment was done by the MDH Infection Control Assessment and Response (ICAR) team. Results: All 7 patients were negative for both CRE and C. auris, and no further screening was done. During the investigation, it was discovered that the patient had had elective ambulatory surgery outside the United States in March 2019. The ICAR team assessment provided overall positive feedback to the nursing unit about isolation procedures, cleaning products, and hand hygiene product accessibility. Opportunities included set-up of soiled utility room and updating our process to the 2019 MDH recommendation to screen patients for CRE and C. auris on admission who have been hospitalized, had outpatient surgery, or hemodialysis outside the United States in the previous year. Conclusions: Point-prevalence study results showed no transmission of CRE and highlighted the importance of standard precautions. This event supports the MDH recommendation to screen for CRE any patients who have been hospitalized, had outpatient surgery, or had hemodialysis outside the United States in the previous year.Funding: NoneDisclosures: None

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