Transmission of Group A Streptococcus Limited to Healthcare Workers with Exposure in the Operating Room

2006 ◽  
Vol 27 (11) ◽  
pp. 1159-1163 ◽  
Author(s):  
Rebecca E. Chandler ◽  
Lore E. Lee ◽  
John M. Townes ◽  
Randy A. Taplitz
Keyword(s):  
Infection Control ◽  
Operating Room ◽  
Healthcare Workers ◽  
Care Center ◽  
Tertiary Care ◽  
Index Patient ◽  
Control Measures ◽  
Nosocomial Transmission ◽  
Prolonged Contact ◽  
Group A

Background.Nosocomial transmission of group A Streptococcus (GAS) has been well described. A recent report of an outbreak investigation suggested that transmission can be extensive and that standard infection control measures may not be adequate to prevent transmission from patients with severe, invasive disease to healthcare workers (HCWs).Objective.A case of pharyngitis in an HCW caring for a patient with GAS pharyngitis and necrotizing fasciitis prompted an investigation of the extent and risk factors for nosocomial transmission of GAS.Setting.A 509-bed, tertiary care center in Portland, Oregon with 631,100 patient visits (hospital and clinic) and 11,500 employees in the year 2003.Methods.HCWs with exposure to the index patient (“contacts”) were identified for streptococcal screening and culture and completion of a questionnaire regarding the location and duration of exposure, use of personal protective equipment, and symptoms of GAS infection.Results.We identified 103 contacts of the index patient; 89 (86%) submitted oropharyngeal swabs for screening and culture. Only 3 (3.4%) of contacts had a culture that yielded GAS; emm typing results and pulsed-field gel electrophoresis patterns of GAS isolates from 2 HCWs were identical to those for the isolate from the index patient. Both HCWs were symptomatic, with febrile pharyngitis and reported prolonged contact with the open wound of the patient in the operating room.Conclusions.In this investigation, nosocomial transmission was not extensive, and standard precautions provided adequate protection for the majority of HCWs. Transmission was restricted to individuals with prolonged intraoperative exposure to open wounds. As a result, infection control policy for individuals was modified only for HCWs with exposure to GAS in the operating room.

scholarly journals Analyzing Healthcare Workers’ Perspectives on Healthcare-Associated Infections and Infection Control Practices Using Video Reflexive Ethnography (VRE)

2020 ◽  
Vol 41 (S1) ◽  
pp. s116-s116
Author(s):  
Esther Paul ◽  
Ibrahim Alzaydani ◽  
Ahmed Hakami ◽  
Harish C. Chandramoorthy
Keyword(s):  
Hand Hygiene ◽  
Infection Control ◽  
Quantitative Data ◽  
Healthcare Workers ◽  
Qualitative Data ◽  
Tertiary Care ◽  
Control Measures ◽  
Infection Control Measures ◽  
Hygiene Measures ◽  
Healthcare Associated

Background: This study explores the perspectives of healthcare workers on the healthcare-associated infection (HAI) and infection control measures in a tertiary-care unit, through a self-administered questionnaire, semi-structured interviews, and reflexive sessions based on video-recorded sterile procedures performed in respondents’ work contexts. Video reflexive ethnography (VRE) is a method that provides feedback to medical practitioners through reflection analysis, whereby practitioners identify problems and find solutions. Methods: Quantitative questionnaire data were used to assess the knowledge of HAI among 50 healthcare workers and their attitude toward practice of infection control measures. Semistructured interviews based on an interview guide were used to collect qualitative data from 25 doctors and nurses. The interviews were audio recorded and transcribed verbatim immediately. Also, routine sterile procedures in the wards and intensive care unit were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was video recorded and transcribed. Both interview data and reflexive discussion of video-graph were analyzed using a thematic analysis. The quantitative data were analyzed using the Kruskal–Wallis test. Results: The quantitative data revealed no difference in the knowledge, attitude, and practice scores used to evaluate the infection control practices among the healthcare workers. We identified 4 themes from the qualitative data: (1) knowledge of HAI and infection control, (2) infection control measures in practice, (3) the shortfall in infection control measures and HAI, and (4) required implementation. Although the qualitative data indicated that the participants had excellent compliance with hand hygiene and personal protective equipment (PPE) use, the VRE and reflective sessions indicated otherwise. Some astounding lapses were revealed, like failure to engage in boundary maintenance between sterile and nonsterile areas, failure to observe proper hand hygiene measures, and use of traditional hijab face covers (used in an unsterile environment as well) instead of surgical masks. These findings demonstrate the advantage of combining VRE with qualitative and quantitative methodology to deduct the lapses in the practice of infection control among healthcare workers. Conclusions: Introduction of training programs focused on HAI and infection control measures in the educational system will help better inform medical and nursing students. Live video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to educate the healthcare workers on correct infection control practices. Lapses in the use of PPE can be a possible reason for the outbreak of MERS-CoV, an endemic disease, in this part of Saudi Arabia.Disclosures: NoneFunding: None

scholarly journals TB Risk Perceptions among Medical Residents at a Tertiary Care Center in India

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Geeta S. Pardeshi ◽  
Dileep Kadam ◽  
Ajay Chandanwale ◽  
Andrea Deluca ◽  
Pranali Khobragade ◽  
...  
Keyword(s):  
Infection Control ◽  
Risk Perceptions ◽  
Care Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Medical Residents ◽  
Drug Resistant ◽  
Infection Control Measures ◽  
Infection Control Guidelines ◽  
Tb Infection Control

Setting. Government tertiary health care center in India.Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace.Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data.Results. Out of 305 resident doctors approached, 263 (94%) completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64%) residents, 13 (5%) reported a prior history of TB, and 175 (69%) respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78%) and drug-resistant TB (88%). The key themes identified were concerns about developing drug-resistant TB (n=100; 50%); disease and its clinical consequences (n=39; 20%); social and professional consequences (n=37; 19%); exposure to TB patients (n=32; 16%); poor infection control measures (n=27; 14%); and high workload and its health consequences (n=16; 8%).Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.

Nosocomial Transmission of New Delhi Metallo-β-Lactamase-1-Producing Klebsiella pneumoniae in Toronto, Canada

2013 ◽  
Vol 34 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Christopher F. Lowe ◽  
Julianne V. Kus ◽  
Natasha Salt ◽  
Sandra Callery ◽  
Lisa Louie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Care Center ◽  
Cohort Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Nosocomial Transmission ◽  
Infection Prevention And Control ◽  
New Delhi ◽  
Retrospective Case

Design.An analysis of a cluster of New Delhi metallo-β-lactamase-l-producing Klebsiella pneumoniae (NDMl-Kp) and a retrospective case-cohort analysis of risk factors for acquisition in contacts of NDM1-Kp-positive patients.Setting.A 1,100-bed Canadian academic tertiary care center.Patients.Two index patients positive for NDMl-Kp as well as 45 contacts (roommates, ward mates, or environmental contacts) were investigated.Methods.Retrospective chart reviews of all patients colonized or infected with NDM1-Kp as well as contacts of these patients were performed in order to describe the epidemiology and impact of infection prevention and control measures. A case-cohort analysis was conducted investigating 45 contacts of NDM1-Kp-positive patients to determine risk factors for acquisition of NDM1-Kp. Rectal swabs were screened for NDMl-Kp using chromogenic agar. Presence of blaNDM-1 was confirmed by multiplex polymerase chain reaction. Clonality was assessed with pulsed-field gel electrophoresis (PFGE) using restriction enzyme XbaI.Results.Two index cases carrying NDM1-Kp with different PFGE patterns were identified. Nosocomial transmission to 7 patients (4 roommates, 2 ward mates, and 1 environmental contact) was subsequenüy identified. Risk factors for acquisition of NDM1-Kp were a history of prior receipt of certain antibiotics (fluoroquinolones [odds ratio (OR), 16.8 (95% confidence interval [CI], 1.30-58.8); P = .005], trimethoprim-sulfamethoxazole [OR, 11.3 (95% CI, 1.84-70.0); P = .01], and carbapenems [OR, 16.8 (95% CI, 1.79-157.3); P = .04]) and duration of exposure to NDM1-Kp-positive roommates (26.5 vs 6.7 days; P< .001).Conclusion.Two distinct clones of NDM1-Kp were transmitted to 7 inpatient contacts over several months. Implementation of contact precautions, screening of contacts for NDM1-Kp carriage, and attention to environmental disinfection contributed to the interruption of subsequent spread of the organism. The appropriate duration and frequency of screening contacts of NDMl-Kp-positive patients require further study.

Strict Infection Control Leads to Low Incidence of Methicillin-ResistantStaphylococcus aureusBloodstream Infection over 20 Years

2015 ◽  
Vol 36 (6) ◽  
pp. 702-709 ◽  
Author(s):  
Andreas F. Widmer ◽  
Botond Lakatos ◽  
Reno Frei
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Multiple Infection ◽  
Case Report Form ◽  
Contact Precautions

OBJECTIVEMethicillin-resistantStaphylococcus aureus(MRSA) is a worldwide issue associated with significant morbidity and mortality. Multiple infection control (IC) approaches have been tested to control its spread; however, the success of the majority of trials has been short-lived and many efforts have failed. We report the long-term success of MRSA control from a prospective observational study over 20 years.SETTINGUniversity Hospital Basel is a large tertiary care center with a median bed capacity of 855 and 5 intensive care units (ICUs); currently, the facility has >32,000 admissions per year.METHODSThe IC program at the University Hospital Basel was created in 1993, after 2 MRSA outbreaks. The program has included strict contact precautions with single rooms for MRSA-colonized or -infected patients, targeted admission screening of high-risk patients and healthcare workers at risk for carriage, molecular typing of all MRSA strains and routine decolonization of MRSA carriers including healthcare workers. We used the incidence of MRSA bloodstream infections (BSIs) to assess the effectiveness of this program. All MRSA cases were prospectively classified using a standardized case report form in nosocomial and nonnosocomial cases, based on CDC definitions.RESULTSBetween 1993 and 2012, 540,669 blood samples were cultured. The number of blood cultures increased from 865 per 10,000 patient days in 1993 to 1,568 per 10,000 patient days in 2012 (P<.001). We identified 1,268 episodes ofS. aureusBSI from 1,204 patients. MRSA accounted for 34 episodes (2.7%) and 24 of these (1.9%) were nosocomial. MRSA BSI incidence varied between 0 and 0.27 per 10,000 patient days and remained stable with no significant variation throughout the study period (P=.882).CONCLUSIONSLong-term control of MRSA is feasible when a bundle of IC precautions is strictly enforced over time.Infect Control Hosp Epidemiol2015;00(0): 1–8

scholarly journals Infection Control Measures for Operative Procedures in Severe Acute Respiratory Syndrome–related Patients

2004 ◽  
Vol 100 (6) ◽  
pp. 1394-1398 ◽  
Author(s):  
Victor Wei Ter Chee ◽  
Mark Li-Chung Khoo ◽  
Sow Fong Lee ◽  
Yeow Choy Lai ◽  
Ngek Mien Chin
Keyword(s):  
High Risk ◽  
Severe Acute Respiratory Syndrome ◽  
Infection Control ◽  
Operating Room ◽  
Healthcare Workers ◽  
Operative Procedures ◽  
Control Measures ◽  
World Health ◽  
Infection Control Measures ◽  
First Case

Background Singapore reported its first case of Severe Acute Respiratory Syndrome (SARS) in early March 2003 and was placed on the World Health Organization's list of SARS-affected countries on March 15, 2003. During the outbreak, Tan Tock Seng Hospital was designated as the national SARS hospital in Singapore to manage all known SARS patients. Stringent infection control measures were introduced to protect healthcare workers and control intrahospital transmission of SARS. Work-flow processes for surgery were extensively modified. Methods The authors describe the development of infection control measures, the conduct of surgical procedures, and the management of high-risk procedures during the SARS outbreak. Results Forty-one operative procedures, including 15 high-risk procedures (surgical tracheostomy), were performed on SARS-related patients. One hundred twenty-four healthcare workers had direct contact with SARS patients during these procedures. There was no transmission of SARS within the operating room complex. Conclusions Staff personal protection, patient risk categorization, and reorganization of operating room workflow processes formed the key elements for the containment of SARS transmission. Lessons learned during this outbreak will help in the planning and execution of infection control measures, should another outbreak occur.

Successive outbreaks of Group A streptococcus (GAS) in care of the elderly settings; lessons learned

2011 ◽  
Vol 13 (2) ◽  
pp. 38-43 ◽  
Author(s):  
T Inkster ◽  
P Wright ◽  
H Kane ◽  
E Paterson ◽  
S Dodd ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Infection Control ◽  
Healthcare Workers ◽  
Group A Streptococcus ◽  
The Elderly ◽  
Rapid Identification ◽  
Lessons Learned ◽  
Control Measures ◽  
Infection Control Measures ◽  
Group A

Group A streptococcal (GAS) outbreaks in care of the elderly settings are rare. We describe two successive outbreaks involving care of the elderly patients. The first outbreak involved 18 patients and the second involved six patients and two healthcare workers. We describe the difficulties encountered controlling GAS outbreaks in care of the elderly settings and how the lessons learned from the first outbreak influenced management of the second incident. Stringent infection control measures including isolation until completion of treatment and re-screening for evidence of eradication were required to bring outbreak one under control. These measures were adopted early in outbreak two and we suspect that these measures and the rapid identification of carriers brought this second outbreak under control quickly.

scholarly journals Description of a Hospital Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital in Saudi Arabia

2016 ◽  
Vol 37 (10) ◽  
pp. 1147-1155 ◽  
Author(s):  
Hanan H. Balkhy ◽  
Thamer H. Alenazi ◽  
Majid M. Alshamrani ◽  
Henry Baffoe-Bonnie ◽  
Yaseen Arabi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Saudi Arabia ◽  
Infection Control ◽  
Healthcare Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Control Measures ◽  
Care Hospital ◽  
Infection Control Measures ◽  
Large Tertiary Care

BACKGROUNDSince the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported.OBJECTIVETo describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia.METHODSWe conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV.RESULTSOf the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak.CONCLUSIONMERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary.Infect Control Hosp Epidemiol 2016;1–9

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

scholarly journals Risk Factors for Occupational Transmission of Tuberculosis among Healthcare Workers in Zambia

2020 ◽  
pp. 59-65
Author(s):  
Namaunga Kasumu Chisompola ◽  
Kapambwe Mwape Kamanga ◽  
Pipina Vlahakis Matafwali
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Healthcare Workers ◽  
Critical Role ◽  
Nosocomial Transmission ◽  
Infection Prevention And Control ◽  
Original Research ◽  
Healthcare Facilities ◽  
Prolonged Contact ◽  
And Control

Healthcare workers (HCWs) play a critical role in the management and control of nosocomial transmission of tuberculosis (TB). At the same time, working in TB healthcare facilities such as hospital wards, diagnostic and treatment facilities increases the risk of acquiring TB due to occupational exposure in HCWs. The risk is further heightened in high TB prevalence populations, such as Zambia, as HCWs are exposed both occupationally and in the community. This review aims to provide a better understanding of the risk factors associated with occupational transmission of TB in HCWs in Zambia, by synthesising available data on TB in HCWs in Zambia and the surrounding region. A search of peer reviewed original research on the transmission of TB among HCWs in Zambia was conducted in PubMed and Google Scholar. Studies were eligible for inclusion in the analysis if they described TB amongst HCWs in Zambia, risk factors for TB in HCWs, and nosocomial transmission of TB in Zambia and the surrounding region. The prevalence of TB in HCWs has been demonstrated to be higher than that of the general population. Transmission of TB in healthcare facilities is driven by several factors centred on the lack of adherence to TB infection prevention and control (IPC) practices. Nosocomial transmission of TB in HCWs is further driven by the HIV epidemic and the rise in lifestyle diseases such as diabetes mellitus. However, there is very scarce data on the association of diabetes mellitus and TB among HCWs in Zambia. Prolonged contact with TB patients on wards has been demonstrated to play a vital role in occupational transmission of TB amongst nurses in Zambia. To curb the transmission of TB in HCWs several measures will require implementation such as; administrative support, IPC training and annual TB and HIV screening for all HCWs.

Sign in / Sign up

Export Citation Format

Share Document