Highly Resistant Gram-Negative Microorganisms Incidence Density and Occurrence of Nosocomial Transmission (TRIANGLe Study)

2011 ◽  
Vol 32 (4) ◽  
pp. 333-341 ◽  
Author(s):  
I. Willemsen ◽  
S. Elberts ◽  
C. Verhulst ◽  
M. Rijnsburger ◽  
M. Filius ◽  
...  
Keyword(s):  
Molecular Typing ◽  
Transmission Rate ◽  
Epidemiological Data ◽  
University Hospital ◽  
Nosocomial Transmission ◽  
Incidence Density ◽  
University Hospitals ◽  
Gram Negative ◽  
Transmission Index ◽  
Horizontal Spread

Objectives.The objectives of this study were to determine the incidence density and the occurrence of horizontal spread of highly resistant gram-negative rods (HR-GNRs) in Dutch hospitals. The factors that influence these outcome measures were also investigated.Methods.All patients with HR-GNRs, as determined by sample testing, who were hospitalized in 1 of 18 hospitals during a 6-month period (April through October 2007) were included in this study. For all available isolates, the species was identified, susceptibility was determined (including the presence of extended-spectrumβ-lactamases [ESBLs]), and molecular typing was performed. On the basis of a combination of species identification, molecular typing, and epidemiological data, the occurrence of nosocomial transmission was determined.Results.The mean incidence density of patients with HR-GNRs was 55 per 100,000 patient-days (cumulative incidence, 39 per 10,000 patients admitted). A facility being a university hospital was a statistically significant (P= .03) independent determinant of a higher incidence of patients with HR-GNRs. The majority of HR-GNR isolates were ESBL producers. The adjusted transmission index—the ratio between secondary and primary cases—in the participating hospitals ranged from 0.0 to 0.2. The overall adjusted transmission index of HR-GNRs was 0.07. No determinants for a higher transmission index were identified.Discussion.The nosocomial transmission rate of HR-GNRs was relatively low in all hospitals where well-established transmission-based precautions were used. The incidence density of patients with HR-GNRs was higher in university hospitals, probably due to the patient population and the complexity of the care provided.

Highly Resistant Microorganisms in a Teaching Hospital: The Role of Horizontal Spread in a Setting of Endemicity

2008 ◽  
Vol 29 (12) ◽  
pp. 1110-1117 ◽  
Author(s):  
Ina Willemsen ◽  
Marlies Mooij ◽  
Marsha van der Wiel ◽  
Diana Bogaers ◽  
Madelon van der Bijl ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Transmission ◽  
Incidence Density ◽  
Reproduction Rate ◽  
Gram Negative ◽  
Relative Contribution ◽  
Admission Data ◽  
Horizontal Spread

Objective.To determine the incidence density of highly resistant organisms (HROs) and the relative contribution of horizontal spread in a setting of endemicity.Methods.Prospective surveillance was performed among hospitalized patients during an 18-month period. Enterobacteriaceae, non-fermentative gram-negative bacilli,Staphylococcus aureus, Streptococcus pneumoniae,andEnterococcus faecium—all considered highly resistant, according to Dutch guidelines—were included. Epidemiological linkage and nosocomial transmission were determined on the basis of molecular typing and hospital admission data.Results.From 119 patients, we recovered a total of 170 unique HRO isolates, as follows:Escherichia coli,96 isolates;Klebsiellaspecies, 11 isolates;Enterobacterspecies, 8 isolates;Proteusspecies, 9 isolates;Citrobacterspecies, 5 isolates;Pseudomonasspecies, 5 isolates;Aci-netobacterspecies, 3 isolates;Morganellaspecies, 2 isolates;Salmonellaspecies, 1 isolate;Serratiaspecies, 1 isolate;S. pneumoniae,20 isolates; andS. aureus,9 isolates. No vancomycin-resistantE. faeciumwas found. The incidence density was 4.3 HRO isolates per 10,000 patient-days. The majority of HRO isolates were unique, and nosocomial transmission was observed 4 times for highly resistant gram-negative bacilli (case reproduction rate, 0.05) and 4 times for penicillin-nonsusceptibleS. pneumoniae(case reproduction rate, 0.29). A stay on the intensive care unit was the main determinant for the recovery of an HRO.Conclusion.Nosocomial transmission of HROs was observed 8 times during the 18-month period. The intensive care unit was identified as the main reservoir of horizontal spread of HROs. This study shows that nosocomial transmission of HROs is largely preventable using transmission precautions.

scholarly journals The impact of real-time whole genome sequencing in controlling healthcare-associated SARS-CoV-2 outbreaks

2021 ◽  
Author(s):  
Harriet Billam ◽  
Rodric V Francis ◽  
Mitch Clarke ◽  
Carl Yates ◽  
Theocharis Tsoleridis ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Point Of Care ◽  
Patient Flow ◽  
Epidemiological Data ◽  
Control Measures ◽  
Nosocomial Transmission ◽  
Whole Genome ◽  
University Hospitals ◽  
The Impact

Background Nosocomial infections have posed a significant problem during the COVID-19 pandemic, affecting bed capacity and patient flow in hospitals. Effective infection control measures and identifying areas of highest risk is required to reduce the risk of spread to patients who are admitted with other illnesses. This is the first pandemic where whole genome sequencing (WGS) has been readily available. We demonstrate how WGS can be deployed to help identify and control outbreaks. Aims & Methods Swabs performed on patients to detect SARS-CoV-2 underwent RT-PCR on one of multiple different platforms available at Nottingham University Hospitals NHS Trust. Positive samples underwent WGS on the GridION platform using the ARTIC amplicon sequencing protocol at the University of Nottingham. Results Phylogenetic analysis from WGS and epidemiological data was used to identify an initial transmission that occurred in the admissions ward. It also showed high prevalence of asymptomatic staff infection with genetically identical viral sequences which may have contributed to the propagation of the outbreak. Actions were taken to help reduce the risk of nosocomial transmission by the introduction of rapid point of care testing in the admissions ward and introduction of portable HEPA14 filters. WGS was also used in two instances to exclude an outbreak by discerning that the phylotypes were not identical, saving time and resources. Conclusions In conjunction with accurate epidemiological data, timely WGS can identify high risk areas of nosocomial transmission, which would benefit from implementation of appropriate control measures. Conversely, WGS can disprove nosocomial transmission, validating existing control measures and maintaining clinical service, even where epidemiological data is suggestive of an outbreak.

scholarly journals Patient Clothing as a Healing Environment: A Qualitative Interview Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5357
Author(s):  
Seon-Ju Kam ◽  
Young-Sun Yoo
Keyword(s):  
Emotional Response ◽  
Positive Emotions ◽  
Design Method ◽  
Medical Center ◽  
Emotional Responses ◽  
University Hospital ◽  
Hospital Environment ◽  
University Hospitals ◽  
Pattern Design ◽  
Qualitative Interview Study

Patients’ emotional responses to the hospital environment can be considered as important as medical technology and equipment. Therefore, this study investigated their experiences to determine whether the pattern using hospital identity (HI) elements, a widely used design method for patient clothing in university hospitals, can affect their emotional response and contribute to healing. It aimed to identify whether controlling the motif characteristics, arrangement, and spacing in this pattern design, and the direction between motifs, could be a method to design patient clothing for healing. To investigate patients’ emotional response and suggestions for patient clothing design, an interview-based qualitative approach was used. In-depth interviews were conducted with 12 patients discharged from Kyung Hee University Hospital Medical Center (KHUMC), Seoul. The interview questions consisted of two parts. One part featured questions about participants’ emotional responses to the medical environment and their latest patient clothing experience, and the other featured questions about their emotional response to, and suggestions for, the healing expression of pattern design using HI. The results confirmed that the motif characteristics, arrangement, and spacing, and the direction between motifs, influenced patients’ positive emotions and contributed to the healing effect. Therefore, when the HI elements of a medical institution are applied in the design of patient clothing with the characteristics of a healing design, patients perceive this as providing stability and comfort. The design of patient clothing becomes a medium that not only builds the brand image of medical institutions, but also enhances the quality of medical services centered on patient healing.

scholarly journals Long-Term Follow-Up After Maxillary Sinus Balloon Sinuplasty and ESS

2021 ◽  
pp. 014556132098603
Author(s):  
Anni Koskinen ◽  
Marie Lundberg ◽  
Markus Lilja ◽  
Jyri Myller ◽  
Matti Penttilä ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Revision Surgery ◽  
University Hospital ◽  
Sinus Surgery ◽  
Control Group ◽  
University Hospitals ◽  
Balloon Sinuplasty ◽  
Long Term Follow Up

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.

scholarly journals Benchmarking experience to improve paediatric healthcare: listening to the voices of families from two European Children’s University Hospitals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilaria Corazza ◽  
Kendall Jamieson Gilmore ◽  
Francesca Menegazzo ◽  
Valts Abols
Keyword(s):  
Children And Adolescents ◽  
Quality Care ◽  
University Hospital ◽  
Free Text ◽  
University Hospitals ◽  
Post Discharge ◽  
Important Indicator ◽  
Published Evidence ◽  
Patient Reported ◽  
Electronic Administration

Abstract Background Patient Reported Experience Measures (PREMs) are recognized as an important indicator of high quality care and person-centeredness. PREMs are increasingly adopted for paediatric care, but there is little published evidence on how to administer, collect, and report paediatric PREMs at scale. Methods This paper describes the development of a PREMs questionnaire and administration system for the Meyer Children’s University Hospital in Florence (Meyer) and the Children’s Clinical University Hospital in Riga (CCUH). The system continuously recruits participants into the electronic administration model, with surveys completed by caregivers or adolescents at their convenience, post-discharge. We analyse 1661 responses from Meyer and 6585 from CCUH, collected from 1st December 2018 to 21st January 2020. Quantitative and qualitative experience analyses are included, using Pearson chi-square tests, Fisher’s exact tests and narrative evidence from free text responses. Results The large populations reached in both countries suggest the continuous, digital collection of paediatric PREMs described is feasible for collecting paediatric PREMs at scale. Overall response rates were 59% in Meyer and 45% in CCUH. There was very low variation in mean scores between the hospitals, with greater clustering of Likert scores around the mean in CCUH and a wider spread in Meyer for a number of items. The significant majority of responses represent the carers’ point of view or the perspective of children and adolescents expressed through proxy reporting by carers. Conclusions Very similar reported scores may reflect broadly shared preferences among children, adolescents and carers in the two countries, and the ability of both hospitals in this study to meet their expectations. The model has several interesting features: inclusion of a narrative element; electronic administration and completion after discharge from hospital, with high completion rates and easy data management; access for staff and researchers through an online platform, with real time analysis and visualization; dual implementation in two sites in different settings, with comparison and shared learning. These bring new opportunities for the utilization of PREMs for more person-centered and better quality care, although further research is needed in order to access direct reporting by children and adolescents.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

2003 ◽  
Vol 24 (6) ◽  
pp. 415-421 ◽  
Author(s):  
Joel T. Fishbain ◽  
Joseph C. Lee ◽  
Honghung D. Nguyen ◽  
Jeffery A. Mikita ◽  
Cecilia P. Mikita ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Transmission Rate ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Nosocomial Transmission ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Average Hospital ◽  
Methicillin Resistant ◽  
History Of

AbstractObjective:To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.Design:A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.Setting:Tertiary-care military medical facility.Participants:All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.Results:Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.Conclusions:Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

scholarly journals Group B streptococcus colonization of pregnant women and their children observed on obstetric and neonatal wards of the University Hospital in Krakow, Poland

2009 ◽  
Vol 58 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Magdalena Strus ◽  
Dorota Pawlik ◽  
Monika Brzychczy-Włoch ◽  
Tomasz Gosiewski ◽  
Krzysztof Rytlewski ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Molecular Typing ◽  
Horizontal Transmission ◽  
Group B Streptococcus ◽  
Normal Pregnancy ◽  
University Hospital ◽  
Hospital Environment ◽  
Eastern Region ◽  
Group B ◽  
Complicated Pregnancy

The study was arranged to assess the actual rates of colonization of pregnant women and their children with group B streptococcus (GBS) in a Polish university hospital. Resistance of these cocci to macrolides and clindamycin was also tested and routes of transmission of GBS were followed in some cases using molecular typing. Colonization with GBS was checked in 340 pregnant women living in the south-eastern region of Poland (Małopolska) in the years 2004–2006. Women with a complicated pregnancy were more often colonized than those with a normal pregnancy (20.0 % versus 17.2 %). Moreover, women with a complicated pregnancy were twice as often colonized with GBS strains with the MLSB phenotype indicating resistance to macrolides and clindamycin. Regarding neonatal colonization by GBS, we found that neonates born from the colonized mothers with a complicated pregnancy were more often colonized with GBS than those from the mothers with a normal pregnancy (35 % versus 26.7 %). By molecular typing of the GBS strains isolated from mothers and their newborns we have been able to suggest the possibility of horizontal transmission of the strains from the hospital environment to newborns. Our results clearly indicate that rates of GBS colonization among pregnant women and neonates in a Polish university hospital have reached levels comparable to those reported in other European clinical centres.

The Resident in the Non-university Hospital

PEDIATRICS ◽  
1962 ◽  
Vol 29 (4) ◽  
pp. 678-679
Author(s):  
H. William Fink
Keyword(s):  
Medical Students ◽  
Medical School ◽  
University Hospital ◽  
Community Hospitals ◽  
University Hospitals ◽  
Pediatric Practice ◽  
The Future

I write with concern for the future of good community hospitals with qualified attending pediatricians and plenty of patient material but no residents. In the ever-increasing competition for residents, such hospitals are slowly being strangled by the more fortunate university hospitals with their access to medical students and interns. I fear that the ultimate consequences will be the downgrading of pediatric practice throughout the county in those areas where there is not a medical school.

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