scholarly journals Admission Screening for Clostridium difficile Infection (CDI) in Bone Marrow Transplant Populations

2020 ◽  
Vol 41 (S1) ◽  
pp. s113-s113
Author(s):  
Jessica Tarabay ◽  
Marie Ayers ◽  
Tanushree Soni ◽  
Amelia Langston ◽  
Emily Bracewell ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Early Identification ◽  
Infection Prevention ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Admission Screening ◽  
Screening Protocol ◽  
Toxin Assay

Background:Clostridium difficile infection (CDI) is the most common healthcare-associated infection (HAI) and is often associated with increased medical costs and longer lengths of hospital stay. Previous studies have highlighted that hematopoietic stem cell transplant (HSCT) recipients are at an increased risk for CDI of up to 33% from other hospitalized patients. Studies have also supported the prevalence of asymptomatic colonization with C. difficile among HSCT patients. Asymptomatic colonization with C. difficile is a significant risk factor for transmission of infection to other patients developing hospital onset (HO-CDI). Therefore, targeted infection prevention efforts, such as early identification of patients with community-onset (CO-CDI) and patients with asymptomatic colonization with CDI in HSCT patients, may be effective in reducing the occurrence of HO-CDI. We discuss the CDI admission screening protocol in Emory University Hospital’s (EUH) bone marrow transplant (BMT) unit. Methods: As part of an infection prevention initiative, a CDI screening protocol was implemented in December 2018 for all patients that admitted to the EUH inpatient BMT unit. Upon admission, patients were screened for CO-CDI symptoms, specifically loose or unformed stools. A C. difficile toxin assay PCR would be collected within the first 3 calendar days of admission for all patients screened. Patients with symptoms were placed on isolation precautions pending results of the C. difficile toxin assay. If a patient had a positive C. difficile toxin assay result, isolation precautions would be maintained for the duration of hospitalization regardless of symptoms. Patients who are were unable to produce a stool specimen on the first 3 days of admission were excluded from the screening protocol. Patients with positive C. difficile toxin assay PCRs were classified as CO-CDI and were treated. Results: Since implementation of the CDI screening protocol, 109 CDI events were identified from January 2019 to October 2019. Moreover, 79% of positive C. difficile toxin assays were collected within the first 3 calendar days of admission. HO-CDI has decreased from 78% in 2018 to 21% during the designated time frame. Conclusions: CDI screening upon admission of BMT populations has shown a decrease among HO-CDI by early identification of CO-CDI and CO asymptomatic colonization with C. difficile. This early identification has allowed rapid implementation of infection preventions precautions, thus reducing risk of unit-based transmission.Funding: NoneDisclosures: None

scholarly journals Effectiveness of ultraviolet disinfection in reducing hospital-acquired Clostridium difficile and vancomycin-resistant Enterococcus on a bone marrow transplant unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1301-1306 ◽  
Author(s):  
Jennifer Brite ◽  
Tracy McMillen ◽  
Elizabeth Robilotti ◽  
Janet Sun ◽  
Hoi Yan Chow ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Active Surveillance ◽  
Tertiary Care ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant ◽  
Hospital Acquired

AbstractObjectiveTo determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.DesignUsing active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.SettingBone marrow transplant unit at a tertiary-care cancer center.ParticipantsStem cell transplant (SCT) recipients.InterventionTerminal disinfection of all rooms with UV regardless of isolation status of patients.ResultsDuring the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.ConclusionsUtilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.

Investigation of a Clostridium difficile cluster by multilocus sequence typing in a bone marrow transplant unit

2014 ◽  
Vol 42 (6) ◽  
pp. 691-693 ◽  
Author(s):  
Carol Hu ◽  
Richard Sunday ◽  
Jackrapong Bruminhent ◽  
Brent Bobik ◽  
John Wagner ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Multilocus Sequence Typing ◽  
Marrow Transplant

Australia and New Zealand (ANZ) outcomes of high-dose chemotherapy and stem cell transplantation for relapsed or refractory germ cell tumors (GCT) from 1999 to 2019: Multicenter registry-based study with ABMTRR.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 382-382
Author(s):  
Elizabeth Anne Connolly ◽  
Andrew James Weickhardt ◽  
Peter S. Grimison ◽  
Gillian Heller ◽  
Jeremy Howard Lewin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Germ Cell ◽  
Bone Marrow Transplant ◽  
Germ Cell Tumors ◽  
Progression Free Survival ◽  
High Dose Chemotherapy ◽  
Marrow Transplant ◽  
High Dose ◽  
Cell Transplant

382 Background: High dose chemotherapy (HDCT) with autologous stem-cell transplant (ASCT) is effective in advanced germ cell tumours (GCT) that are refractory to, or progress after, first-line therapies. Five-year overall survival in North American and European series range from 48-60%1,2,3. This study aimed to assess ANZ outcomes for quality assurance. Methods: Retrospective multi-centre audit of all male patients with GCT who underwent HDCT and ASCT from 1999-2019. Patients were identified from the Australasian Bone Marrow Transplant Recipient Registry. Primary outcomes included overall and progression- free survival (OS, PFS). Results: 111 patients were identified at 13 centres, each treating a median (range) of 7 (1-27) patients. Median (range) age was 30 (14-68) years. 88 (79%) had testicular primary. 16% were pure seminoma. Median time from first diagnosis to first stem cell cycle was 11 months (range 3 months-38 years). Prior to ASCT, 35% had primary refractory disease and 65% had relapsed. IPFSG risk score was very low in 5%, low in 13%, intermediate in 36%, high in 25%, and very high in 21%. HDCT regimen was CE in 78% (as part of TI-CE regimen in 38%), Carbop-EC-T in 6%, ICE in 6%, CEC in 5% and other in 4%. 89% completed all planned HDCT and ASCT cycles. Five treatment related deaths occurred. Progressive disease on treatment occurred in 14%. At median follow-up time 4.4 years (95% CI: 2.9 to 6.0), 51% were disease-free, 13% alive with disease, 34% deceased. 3 patients displayed late progression over 2 years after ASCT. The estimated 1, 2 and 5-year PFS rates were 62%, 57% and 52% respectively and OS rates were 73%, 65% and 61%. Survival by IPFSG and IGCCG risk categories are displayed in the table below. Conclusions: This is the first registry-based audit of HDCT for metastatic GCT from ANZ, which has demonstrated our outcomes are comparable with best international practice. References: Gossi Bone Marrow Transplant 2018;53:820-825. Adra J Clin Onc 2017; 35(10):1096-1102. Feldman J Clin Onc 2010; 28(10):1706-13. [Table: see text]

scholarly journals Screening for Asymptomatic Clostridium difficile Among Bone Marrow Transplant Patients: A Mixed-Methods Study of Intervention Effectiveness and Feasibility

2018 ◽  
Vol 39 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Anna K. Barker ◽  
Benjamin Krasity ◽  
Jackson Musuuza ◽  
Nasia Safdar
Keyword(s):  
Bone Marrow ◽  
Mixed Methods ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Systems Engineering ◽  
Tertiary Care ◽  
Marrow Transplant ◽  
Mixed Methods Study ◽  
Organizational Level ◽  
Positive Polymerase Chain Reaction

OBJECTIVETo identify facilitators and barriers to implementation of a Clostridium difficile screening intervention among bone marrow transplant (BMT) patients and to evaluate the clinical effectiveness of the intervention on the rate of hospital-onset C. difficile infection (HO-CDI).DESIGNBefore-and-after trialSETTINGA 505-bed tertiary-care medical centerPARTICIPANTSAll 5,357 patients admitted to the BMT and general medicine wards from January 2014 to February 2017 were included in the study. Interview participants included 3 physicians, 4 nurses, and 4 administrators.INTERVENTIONAll BMT patients were screened within 48 hours of admission. Colonized patients, as defined by a C. difficile–positive polymerase chain reaction (PCR) stool result, were placed under contact precautions for the duration of their hospital stay.METHODSInterview responses were coded according to the Systems Engineering Initiative for Patient Safety conceptual framework. We compared pre- and postintervention HO-CDI rates on BMT and general internal medicine units using time-series analysis.RESULTSStakeholder engagement, at both the person and organizational level, facilitates standardization and optimization of intervention protocols. While the screening intervention was generally well received, tools and technology were sources of concern. The mean incidence of HO-CDI decreased on the BMT service postintervention (P<.0001). However, the effect of the change in the trend postintervention was not significantly different on BMT compared to the control wards (P=.93).CONCLUSIONSWe report the first mixed-methods study to evaluate a C. difficile screening intervention among the BMT population. The positive nature by which the intervention was received by front-line clinical staff, laboratory staff, and administrators is promising for future implementation studies.Infect Control Hosp Epidemiol 2018;39:177–185

The Clinical Effectiveness and Financial Impact of Utilizing Peripheral Blood Progenitor Cells as Rescue Therapy following Autologous Bone Marrow Transplant

1996 ◽  
Vol 12 (1) ◽  
pp. 172-179 ◽  
Author(s):  
Andrew J. Kucharski ◽  
Richard Ghalie ◽  
Sharon Greenstein ◽  
Karl Matuszewski
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Peripheral Blood ◽  
Rescue Therapy ◽  
Autologous Bone Marrow ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Autologous Bone Marrow Transplant ◽  
Autologous Bone ◽  
Total Charges

AbstractThe use of peripheral blood progenitor cell transplant as rescue therapy after high-dose chemotherapy and autologous bone marrow transplant significantly decreases transfusion, laboratory, room, and total charges. An improvement in clinical indicators also points toward decreased patient morbidity. Additional cost reductions may be realized by greater utilization of outpatient care, thereby further reducing room and total charges.

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007

2010 ◽  
Vol 31 (05) ◽  
pp. 522-527 ◽  
Author(s):  
Petra Wiersma ◽  
Sarah Schillie ◽  
Harry Keyserling ◽  
J. Renee Watson ◽  
Anindya De ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Infection Prevention ◽  
Patient Flow ◽  
Conditional Logistic Regression ◽  
Bloodstream Infections ◽  
Marrow Transplant ◽  
Single Use ◽  
Gram Negative Organisms ◽  
Preservative Free

Objective.To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.Methods.All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.Results.Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.Conclusion.We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.

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