Sharing is not always a good thing: Use of a DNA marker to investigate the potential for ward-to-ward dissemination of healthcare-associated pathogens

2018 ◽  
Vol 40 (2) ◽  
pp. 214-216 ◽  
Author(s):  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Annette L. Jencson ◽  
Ali Abdulfatah Gweder ◽  
Curtis J. Donskey
Keyword(s):  
Dna Marker ◽  
Pathogen Transmission ◽  
Medical Ward ◽  
Good Thing ◽  
Portable Equipment ◽  
Healthcare Facilities ◽  
Healthcare Associated ◽  
Physician Work

AbstractA DNA marker inoculated onto portable equipment on a medical ward was disseminated to other wards when equipment was shared and to a physician work room and the hospital cafeteria by personnel. These results demonstrate the plausibility of pathogen transmission in healthcare facilities in the absence of shared ward exposure.

Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens

2021 ◽  
pp. 1-6
Author(s):  
Sarah N. Redmond ◽  
Basya S. Pearlmutter ◽  
Yilen K. Ng-Wong ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Veterans Affairs ◽  
Portable Equipment ◽  
Healthcare Facilities ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Vancomycin Resistant Enterococci ◽  
Observational Cohort ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Objective: To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. Design: Observational cohort study and simulations of pathogen transfer. Setting: A Veterans’ Affairs hospital. Participants: Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. Methods: Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients’ socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. Results: Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. Conclusions: Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.

scholarly journals 1142. Use of DNA Markers to Assess the Potential for Pathogen Transmission from Physicians’ White Coats

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S343-S343
Author(s):  
Daniel Van Aartsen ◽  
Manish Thakur ◽  
Khalid M Dousa ◽  
Anubhav Kanwar ◽  
Jennifer Cadnum ◽  
...  
Keyword(s):  
Dna Markers ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Clinical Settings ◽  
Dress Code ◽  
Indirect Contact ◽  
Environmental Surfaces ◽  
Polymerase Chain ◽  
Healthcare Associated

Abstract Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer. Methods We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces. Results Ninety percent of observed patient encounters included one or more direct or indirect contacts between a physician’s white coat and a patient or the environment. Direct contact occurred on average 1.7 times per encounter and indirect contact (i.e., physicians’ hands contacting the coat prior to touching the patient or environment) occurred on average 2.3 times per encounter. The figure shows the frequency and distribution of sites of direct and indirect contact with white coats. Of 11 patient encounters with DNA-contaminated white coats, five (45%) resulted in transfer of one or both DNA markers; there were three transfers from sleeve cuffs and three from coat pockets. Conclusion Contaminated white coats may be an under-appreciated source for transmission of healthcare-associated pathogens. Our results provide support for the bare below the elbows policy, but also highlight the potential for indirect transfer of pathogens from other sites on white coats. Disclosures All authors: No reported disclosures.

Use of viral DNA surrogate markers to study routes of transmission of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Manish Thakur ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Annette L. Jencson ◽  
Jessica Bingham ◽  
...  
Keyword(s):  
Dna Markers ◽  
Veterans Affairs ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Healthcare Personnel ◽  
Portable Equipment ◽  
Environmental Surfaces ◽  
Observational Cohort ◽  
Healthcare Associated

Abstract Background: The hands of healthcare personnel are the most important source for transmission of healthcare-associated pathogens. The role of contaminated fomites such as portable equipment, stethoscopes, and clothing of personnel in pathogen transmission is unclear. Objective: To study routes of transmission of cauliflower mosaic virus DNA markers from 31 source patients and from environmental surfaces in their rooms. Design: A 3-month observational cohort study. Setting: A Veterans’ Affairs hospital. Methods: After providing care for source patients, healthcare personnel were observed during interactions with subsequent patients. Putative routes of transmission were identified based on recovery of DNA markers from sites of contact with the patient or environment. To assess plausibility of fomite-mediated transmission, we assessed the frequency of transfer of methicillin-resistant Staphylococcus aureus (MRSA) from the skin of 25 colonized patients via gloved hands versus fomites. Results: Of 145 interactions involving contact with patients and/or the environment, 41 (28.3%) resulted in transfer of 1 or both DNA markers to the patient and/or the environment. The DNA marker applied to patients’ skin and clothing was transferred most frequently by stethoscopes, hands, and portable equipment, whereas the marker applied to environmental surfaces was transferred only by hands and clothing. The percentages of MRSA transfer from the skin of colonized patients via gloved hands, stethoscope diaphragms, and clothing were 52%, 40%, and 48%, respectively. Conclusions: Fomites such as stethoscopes, clothing, and portable equipment may be underappreciated sources of pathogen transmission. Simple interventions such as decontamination of fomites between patients could reduce the risk for transmission.

scholarly journals Detection of Possible Medical Product-Related Infection or Pathogen Transmission—United States, 2015–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s30-s31
Author(s):  
Isaac Benowitz ◽  
Joseph Perz ◽  
Julia Marders
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Medical Devices ◽  
Medical Product ◽  
Pathogen Transmission ◽  
Healthcare Associated Infections ◽  
Healthcare Facilities ◽  
Biological Products ◽  
Medical Products ◽  
Healthcare Associated

Background: Medications, medical devices, biological products, and other medical products can cause healthcare-associated infections related to contamination in production or transportation (intrinsic contamination) or contamination at the point of use (extrinsic contamination). Rapid identification of contaminated medical products can lead to actions to decrease further patient harm. We sought to describe events that prompted public health investigations of contaminated medical products in healthcare facilities. Methods: We reviewed records of CDC consultations with health departments and healthcare facilities from January 2015 through August 2019 to identify public health investigations in which medical products were identified as a likely source of patient infection or pathogen transmission to at least 1 patient. We collected data on products, contamination type, pathogens, route of patient exposure, healthcare setting where exposure occurred, and resulting actions. Results: There were 34 investigations involving medications (n = 15, 44%), medical devices (n = 12, 35%), biological products (n = 3, 9%), and other medical products (n = 4, 12%). Intrinsic contamination was suspected in 15 investigations (44%), with 13 (87%) based on isolation of a pathogen from unopened products and 2 (13%) based on isolation of similar pathogens from patients in contact with a medical product at multiple facilities. Extrinsic contamination was suspected in 19 investigations (56%) based on evidence of pathogen transmission at a single healthcare facility and concurrent infection control gaps at that facility supporting a mechanism of contamination. The most common pathogens prompting investigation were nontuberculous mycobacteria (n = 9, 26%), Burkholderia spp (n = 7, 21%), Klebsiella spp (n = 3, 9%), Serratia spp (n = 2, 6%), and other environmental and commensal organisms. Patients were most commonly exposed in hospitals (n = 19, 56%) and outpatient settings (n = 9, 26%). The most common patient exposures that resulted in transmission of the pathogen were infusions and injections (n = 15, 44%), diagnostic and therapeutic procedures (n = 9, 26%), and surgery (n = 5, 15%). Patient were notified and offered testing in at least 6 investigations (18%) . Interventions included product removal, healthcare provider alerts, patient notification and testing, modification of injection safety practices and other general infection control practices, correction of improper storage and handling, and changes in product design, manufacturing processes, or instructions for use. Conclusions: Public health investigations identified intrinsic and extrinsic contamination of medications, devices, and other products as a cause of healthcare-associated infections. Healthcare facilities should consider contaminated products in investigations of healthcare-associated infections, take steps to identify local infection control concerns, and alert public health authorities to events that could suggest widespread contamination.Funding: NoneDisclosures: None

scholarly journals Can Copper Products and Surfaces Reduce the Spread of Infectious Microorganisms and Hospital-Acquired Infections?

Materials ◽  
2021 ◽  
Vol 14 (13) ◽  
pp. 3444
Author(s):  
Joji Abraham ◽  
Kim Dowling ◽  
Singarayer Florentine
Keyword(s):  
Infection Control ◽  
Hospital Admissions ◽  
Copper Alloys ◽  
Well Being ◽  
Mortality Rates ◽  
Pathogen Transmission ◽  
Control Measures ◽  
Traditional Use ◽  
Healthcare Facilities ◽  
Infection Control Measures

Pathogen transfer and infection in the built environment are globally significant events, leading to the spread of disease and an increase in subsequent morbidity and mortality rates. There are numerous strategies followed in healthcare facilities to minimize pathogen transfer, but complete infection control has not, as yet, been achieved. However, based on traditional use in many cultures, the introduction of copper products and surfaces to significantly and positively retard pathogen transmission invites further investigation. For example, many microbes are rendered unviable upon contact exposure to copper or copper alloys, either immediately or within a short time. In addition, many disease-causing bacteria such as E. coli O157:H7, hospital superbugs, and several viruses (including SARS-CoV-2) are also susceptible to exposure to copper surfaces. It is thus suggested that replacing common touch surfaces in healthcare facilities, food industries, and public places (including public transport) with copper or alloys of copper may substantially contribute to limiting transmission. Subsequent hospital admissions and mortality rates will consequently be lowered, with a concomitant saving of lives and considerable levels of resources. This consideration is very significant in times of the COVID-19 pandemic and the upcoming epidemics, as it is becoming clear that all forms of possible infection control measures should be practiced in order to protect community well-being and promote healthy outcomes.

scholarly journals Timing and Route of Contamination of Patient Rooms With Healthcare-Associated Pathogens

2020 ◽  
Vol 41 (S1) ◽  
pp. s412-s412
Author(s):  
Sarah Redmond ◽  
Jennifer Cadnum ◽  
Basya Pearlmutter ◽  
Natalia Pinto Herrera ◽  
Curtis Donskey
Keyword(s):  
Acute Care Hospital ◽  
Current Control ◽  
Pathogen Transmission ◽  
Control Measures ◽  
Effective Control ◽  
Portable Devices ◽  
Care Hospital ◽  
Spa Typing ◽  
Persistent Problem ◽  
Healthcare Associated

Background: Transmission of healthcare-associated pathogens such as Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) is a persistent problem in healthcare facilities despite current control measures. A better understanding of the routes of pathogen transmission is needed to develop effective control measures. Methods: We conducted an observational cohort study in an acute-care hospital to identify the timing and route of transfer of pathogens to rooms of newly admitted patients with negative MRSA nares results and no known carriage of other healthcare-associated pathogens. Rooms were thoroughly cleaned and disinfected prior to patient admission. Interactions of patients with personnel and portable equipment were observed, and serial cultures for pathogens were collected from the skin of patients and from surfaces, including those observed to come in contact with personnel and equipment. For MRSA, spa typing was used to determine relatedness of patient and environmental isolates. Results: For the 17 patients enrolled, 1 or more environmental cultures became positive for MRSA in rooms of 10 patients (59%), for C. difficile in rooms of 2 patients (12%) and for vancomycin-resistant enterococci (VRE) in rooms of 2 patients (12%). The patients interacted with an average of 2.4 personnel and 0.6 portable devices per hour of observation. As shown in Figure 1, MRSA contamination of the floor occurred rapidly as personnel entered the room. In a subset of patients, MRSA was subsequently recovered from patients’ socks and bedding and ultimately from the high-touch surfaces in the room (tray table, call button, bedrail). For several patients, MRSA isolates recovered from the floor had the same spa type as isolates subsequently recovered from other sites (eg, socks, bedding, and/or high touch surfaces). The direct transfer of healthcare-associated pathogens from personnel or equipment to high-touch surfaces was not detected. Conclusions: Healthcare-associated pathogens rapidly accumulate on the floor of patient rooms and can be transferred to the socks and bedding of patients and to high-touch surfaces. Healthcare facility floors may be an underappreciated source of pathogen dissemination not addressed by current infection control measures.Funding: NoneDisclosures: None

Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms

2021 ◽  
pp. 1-5
Author(s):  
Jennifer L. Cadnum ◽  
Basya S. Pearlmutter ◽  
Annette L. Jencson ◽  
Hanan Haydar ◽  
Michelle T. Hecker ◽  
...  
Keyword(s):  
Bacterial Pathogens ◽  
Outpatient Clinics ◽  
Acinetobacter Baumanii ◽  
Healthcare Facilities ◽  
Fluorescent Markers ◽  
Clostridioides Difficile ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Cleaning And Disinfection ◽  
Surgery Center

Abstract Objective: To investigate the frequency of environmental contamination in hospital areas outside patient rooms and in outpatient healthcare facilities. Design: Culture survey. Setting: This study was conducted across 4 hospitals, 4 outpatient clinics, and 1 surgery center. Methods: We conducted 3 point-prevalence culture surveys for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridioides difficile, Candida spp, and gram-negative bacilli including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumanii, and Stenotrophomonas maltophilia in each facility. In hospitals, high-touch surfaces were sampled from radiology, physical therapy, and mobile equipment and in emergency departments, waiting rooms, clinics, and endoscopy facilities. In outpatient facilities, surfaces were sampled in exam rooms including patient and provider areas, patient bathrooms, and waiting rooms and from portable equipment. Fluorescent markers were placed on high-touch surfaces and removal was assessed 1 day later. Results: In the hospitals, 110 (9.4%) of 1,195 sites were positive for 1 or more bacterial pathogens (range, 5.3%–13.7% for the 4 hospitals) and 70 (5.9%) were positive for Candida spp (range, 3.7%–5.9%). In outpatient facilities, 31 of 485 (6.4%) sites were positive for 1 or more bacterial pathogens (range, 2% to 14.4% for the 5 outpatient facilities) and 50 (10.3%) were positive for Candida spp (range, 3.9%–23.3%). Fluorescent markers had been removed from 33% of sites in hospitals (range, 28.4%–39.7%) and 46.3% of sites in outpatient clinics (range, 7.4%–82.8%). Conclusions: Surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens. Improvements in cleaning and disinfection practices are needed to reduce contamination.

Managing Our Microbial Mark

2016 ◽  
Vol 42 (2-3) ◽  
pp. 393-428
Author(s):  
Ann Marie Marciarille
Keyword(s):  
United States ◽  
Infection Control ◽  
The United States ◽  
West African ◽  
Healthcare Associated Infections ◽  
Healthcare Facilities ◽  
Quality Reporting ◽  
Reporting Systems ◽  
Control Procedures ◽  
Healthcare Associated

The narrative of Ebola's arrival in the United States has been overwhelmed by our fear of a West African-style epidemic. The real story of Ebola's arrival is about our healthcare system's failure to identify, treat, and contain healthcare associated infections. Having long been willfully ignorant of the path of fatal infectious diseases through our healthcare facilities, this paper considers why our reimbursement and quality reporting systems made it easy for this to be so. West Africa's challenges in controlling Ebola resonate with our own struggles to standardize, centralize, and enforce infection control procedures in American healthcare facilities.

scholarly journals 1213. How Often Is Portable Equipment Cleaned in an Acute Care Setting?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S436-S436
Author(s):  
Y Karen Ng Wong ◽  
Heba Alhmidi ◽  
Thriveen Sankar Chittoor Mana ◽  
Annette Jencson ◽  
Jennifer Cadnum ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Vital Signs ◽  
Acute Care Setting ◽  
Portable Equipment ◽  
Effective Strategies ◽  
Frequency Of Use ◽  
Before And After ◽  
Healthcare Associated

Abstract Background Portable medical equipment that is shared among patients may frequently become contaminated with healthcare-associated pathogens. Cleaning of these devices may be suboptimal. Here, we aim to determine how frequently mobile equipment is cleaned after being used in an acute care setting. Methods Frequency of use and cleaning practices were surveyed by observation. Thirty pieces of mobile equipment from 4 wards including workstations, EKGs, vital signs monitor, and doppler ultrasounds were disinfected with a sporicidal disinfectant. Samples were taken before and after cleaning for recovery of methicillin-resistant Staphylococcus aureus (MRSA), C. difficile spores, and Gram-negative bacilli. After disinfection, each piece of equipment was tagged with a colored tag to indicate the ward location and a fluorescent gel marker (FGM) was applied to study the frequency of cleaning of portable equipment. Mobile equipment was checked for colored tags and fluorescent gel removal five, 12, and 20 days after application. Results Mobile equipment was infrequently cleaned and moved readily from ward to ward. In 9 of 10 observations, mobile equipment was used and not cleaned after use. Point prevalence sampling showed that 27.5% of mobile equipment had one or more pathogens on them. At day 5, only 30% of equipment marked with FGM had been cleaned and after 20 days, 23% of marked mobile equipment remained uncleaned (figure). 4 pieces of mobile equipment traveled from their original ward to a different ward. Conclusion Our findings demonstrate that portable equipment is frequently used and infrequently cleaned. These items can become contaminated with clinically relevant pathogens. We also saw that portable equipment frequently traveled from ward to ward. There is potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. There is a need for effective strategies to disinfect portable equipment between patients. Disclosures All authors: No reported disclosures.

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