scholarly journals Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1307-1315 ◽  
Author(s):  
Gili Regev-Yochay ◽  
Gill Smollan ◽  
Ilana Tal ◽  
Nani Pinas Zade ◽  
Yael Haviv ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tap Water ◽  
Medical Center ◽  
Common Factor ◽  
Control Measures ◽  
Root Cause ◽  
Infection Control Measures ◽  
Single Clone ◽  
Environmental Reservoir

AbstractBackgroundCarbapenemase-producing Enterobacteriaceae (CPE) outbreaks are mostly attributed to patient-to-patient transmission via healthcare workers.ObjectiveWe describe successful containment of a prolonged OXA-48–producing S. marcescens outbreak after recognizing the sink traps as the source of transmission.MethodsThe Sheba Medical Center intensive care unit (ICU), contains 16 single-bed, semi-closed rooms. Active CPE surveillance includes twice-weekly rectal screening of all patients. A case was defined as a patient detected with OXA-48 CPE >72 hours after admission. A root-cause analysis was used to investigate the outbreak. All samples were inoculated on chrom-agar CRE, and carbapenemase genes were detected using commercial molecular Xpert-Carba-R. Environmental and patient S. marcescens isolates were characterized using PFGE.ResultsFrom January 2016 to May 2017, 32 OXA-48 CPE cases were detected, and 81% of these were S. marcescens. A single clone was the cause of all but the first 2 cases. The common factor in all cases was the use of relatively large amounts of tap water. The outbreak clone was detected in 2 sink outlets and 16 sink traps. In addition to routine strict infection control measures, measures taken to contain the outbreak included (1) various sink decontamination efforts, which eliminated the bacteria from the sink drains only temporarily and (2) educational intervention that engaged the ICU team and lead to high adherence to ‘sink-contamination prevention guidelines.’ No additional cases were detected for 12 months.ConclusionsDespite persistence of the outbreak clones in the environmental reservoir for 1 year, the outbreak was rapidly and successfully contained. Addressing sink traps as hidden reservoirs played a major role in the intervention.

Postoperative Infections Following Cardiac Surgery: Association with an Environmental Reservoir in a Cardiothoracic Intensive Care Unit

1984 ◽  
Vol 5 (8) ◽  
pp. 378-384 ◽  
Author(s):  
Peter C. Dandalides ◽  
William A. Rutala ◽  
Felix A. Sarubbi
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Control Measures ◽  
The North ◽  
Infection Control Measures ◽  
Environmental Reservoir ◽  
Lower Infection ◽  
Control Study ◽  
Lower Infection Rate

AbstractDuring 1981, 39 nosocomial infections occurred in 27 of 223 patients undergoing cardiac surgery in the North Carolina Memorial Hospital. The peak attack rate (23.7%) occurred in August and September compared to 10.1% in January through July. A case-control study demonstrated that the only risk factor common to poor and stable health groups compared to controls was duration of stay in the cardiothoracic intensive care unit (CTICU). Microbiologic studies of the environment, personnel and patients showed that colonization or infection of patients occurred 1 to 6 days after admission to the CTICU and that nosocomial pathogens were found: 1) in and around the unit's soiled utility sink, 2) in pooled handwashing cultures of unit personnel, and 3) on contaminated clean hands and air near the soiled utility sink, plus nearby bedside air only while the water in the sink was running. Environmental and personnel hand contamination by soiled utility sink aerosols likely contributed to these infections. Infection control measures, including discontinued use of the soiled utility sink, resulted in a significantly lower infection rate (5.6%).

The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

2020 ◽  
Author(s):  
Ping Wang ◽  
Xiaocui Zou ◽  
Boting Zhou ◽  
Tao Yin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Incidence And Mortality ◽  
Changing Trend ◽  
Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

Management of an Outbreak of Vancomycin-Resistant Enterococci in the Medical Intensive Care Unit of a Cancer Center

2001 ◽  
Vol 22 (4) ◽  
pp. 217-219 ◽  
Author(s):  
Hend Hanna ◽  
Jan Umphrey ◽  
Jeffrey Tarrand ◽  
Michelle Mendoza ◽  
Issam Raad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Control Measures ◽  
Cancer Center ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

AbstractBetween November 1996 and February 1997, 17 episodes of vancomycin-resistant enterococci (VRE) infection or colonization (9 infections, 8 colonizations), all with the same or a similar genomic DNA pattern, were identified in the medical intensive care unit (MICU) of a tertiary-care cancer hospital. The cases were genotypically traced to a patient who was admitted to the hospital in September 1996 and who, by December 1996, had four different admissions to the MICU. Multifaceted infection control measures, including decontamination of the environment and of nondisposable equipment, halted the nosocomial transmission of VRE in the MICU.

Exogenous Sources ofPseudomonas aeruginosain Intensive Care Unit Patients Implementation of Infection Control Measures and Follow-Up With Molecular Typing

2006 ◽  
Vol 27 (9) ◽  
pp. 953-957 ◽  
Author(s):  
Christiane Petignat ◽  
Patrick Francioli ◽  
Immaculée Nahimana ◽  
Aline Wenger ◽  
Jacques Bille ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Pfge Pattern ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Exogenous Origin

Background.In 1998, a study in the intensive care unit (ICU) of our institution suggested possible transmission of Pseudomonas aeruginosa from faucet to patient and from patient to patient. Infection-control measures were implemented to reduce the degree ofP. aeruginosacolonization in faucets, to reduce the use of faucet water in certain patient care procedures, and to reduce the rate of transmission from patient to patient.Objective.To evaluate the effect of the control measures instituted in 1999 to preventP. aeruginosainfection and colonization in ICU patients.Design.Prospective, molecular, epidemiological investigation.Setting.A 870-bed, university-affiliated, tertiary care teaching hospital.Methods.The investigation was performed in a manner identical to the 1998 investigation. ICU patients with a clinical specimen positive forP. aeruginosawere identified prospectively. Swab specimens from the inner part of the ICU faucets were obtained for the culture on 9 occasions between September 1997 and December 2000. All patients and environmental isolates were typed by pulsed-field gel electrophoresis (PFGE).Results.Compared with the 1998 study, in 2000 we found that the annual incidence of ICU patients colonized or infected withP. aeruginosahad decreased by half (26.6 patients per 1,000 admissions in 2000 vs 59.0 patients per 1,000 admissions in 1998), although the populations of patients were comparable. This decrease was the result of the decreased incidence of cases in which an isolate had a PFGE pattern identical to that of an isolate from a faucet (7.0 cases per 1,000 admissions in 2000, vs 23.6 per 1,000 admissions in 1998) or from another patient (6.5 cases per 1,000 admissions in 2000 vs 16.5 cases per 1,000 admissions in 1998), whereas the incidence of cases in which the isolate had a unique PFGE pattern remained nearly unchanged (13.1 cases per 1,000 admissions in 2000 vs 15.6 cases per 1,000 admissions in 1998).Conclusions.These results suggest that infection control measures were effective in decreasing the rate ofP. aeruginosacolonization and infection in ICU patients, confirming thatP. aeruginosastrains were of exogenous origin in a substantial proportion of patients during the preintervention period.

Statins and Perioperative Cardiac Complications

2018 ◽  
pp. 60-64
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Strong Evidence ◽  
Substantial Reduction ◽  
Bloodstream Infections ◽  
Control Measures ◽  
Cardiac Complications ◽  
Infection Control Measures ◽  
Safety Initiative

This case focuses on reducing catheter-related bloodstream infections in the intensive care unit (ICU) by asking the question: Can rates of catheter-related bloodstream infections be reduced by implementing a safety initiative involving five simple infection-control measures by ICU staff? Implementation of a safety initiative involving five simple infection-control measures by ICU staff was associated with a substantial reduction in catheter-related bloodstream infections. While it is not certain that the safety initiative—rather than other factors—was responsible for the observed reduction, the study provides strong evidence that this safety initiative should be implemented widely.

scholarly journals Effects of infection control measures on acquisition of five antimicrobial drug-resistant microorganisms in a tetanus intensive care unit in Vietnam

2013 ◽  
Vol 39 (4) ◽  
pp. 661-671 ◽  
Author(s):  
Constance Schultsz ◽  
Martinus C. J. Bootsma ◽  
Huynh T. Loan ◽  
Tran T. T. Nga ◽  
Le T. P. Thao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Antimicrobial Drug ◽  
Control Measures ◽  
Drug Resistant ◽  
Infection Control Measures

Control of Simultaneous Outbreaks of Carbapenemase-Producing Enterobacteriaceae and Extensively Drug-ResistantAcinetobacter baumanniiInfection in an Intensive Care Unit Using Interventions Promoted in the Centers for Disease Control and Prevention 2012 Carbapenemase-Resistant Enterobacteriaceae Toolkit

2014 ◽  
Vol 35 (7) ◽  
pp. 810-817 ◽  
Author(s):  
Kyle B. Enfield ◽  
Nujhat N. Huq ◽  
Megan F. Gosseling ◽  
Darla J. Low ◽  
Kevin C. Hazen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Disease Control ◽  
Control Measures ◽  
Surgical Trauma ◽  
Infection Control Measures ◽  
Resistance Plasmids ◽  
Centers For Disease Control ◽  
The Impact

ObjectiveWe describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistantAcinetobacter baumannii(XDR-AB).DesignBefore-after intervention study.SettingFifteen-bed surgical trauma intensive care unit (ICU).MethodsWe investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence ofblaKPCand resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.ResultsThe IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemicblaKPCresistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P= .001), and no more cases of XDR-AB were identified.ConclusionsUse of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.

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