The Use of Rapid Indicators for the Detection of Organic Residues on Clinically Used Gastrointestinal Endoscopes with and without Visually Apparent Debris

2014 ◽  
Vol 35 (8) ◽  
pp. 987-994 ◽  
Author(s):  
Kavel H. Visrodia ◽  
Cori L. Ofstead ◽  
Hannah L. Yellin ◽  
Harry P. Wetzler ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Visual Inspection ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Organic Residues ◽  
Multiple Components ◽  
Multidrug Resistant Organisms ◽  
Before And After ◽  
Contamination Levels ◽  
High Level ◽  
Monitoring Protocols

BackgroundOutbreaks of multidrug-resistant organisms have been linked to endoscope reprocessing lapses. Meticulous manual cleaning before high-level disinfection (HLD) is essential in reducing residual contamination that can interfere with HLD. Current reprocessing guidelines state that visual inspection is sufficient to confirm adequate cleaning.ObjectiveOur aim was to evaluate contamination of clinically used endoscopes, using visual inspection and rapid indicator tests before and after manual cleaning. A second objective was to determine which rapid indicator instruments and methods could be used for quality improvement initiatives in endoscope reprocessing.DesignClinical use study of endoscope reprocessing effectiveness.SettingTertiary care teaching hospital with an inpatient endoscopy center.MethodsResearchers sampled endoscopes used for gastrointestinal procedures before and after manual cleaning. The external surfaces and 1 channel of each endoscope were visually inspected and tested with rapid indicators to measure protein, blood, and adenosine triphosphate (ATP) contamination levels.ResultsMultiple components were sampled during 37 encounters with 12 unique endoscopes. All bedside-cleaned endoscopes had high levels of ATP and detectable blood or protein, whether or not any residue was visible. Although there was no visible residue on any endoscopes after manual cleaning, 82% had at least 1 positive rapid indicator test.ConclusionsRelying solely on visual inspection of endoscopes prior to HLD is insufficient to ensure reprocessing effectiveness. For quality assurance initiatives, tests of different endoscope components using more than 1 indicator may be necessary. Additional research is needed to validate specific monitoring protocols.

scholarly journals 528. Longitudinal Evaluation of Chlorhexidine Resistance Among Multidrug-Resistant Organisms in Relation to Intervention of Daily Chlorhexidine Bathing in Adult Intensive Care Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S254-S254
Author(s):  
Min Ja Kim ◽  
You Seung Chung ◽  
Hojin Lee ◽  
Jin Woong Suh ◽  
Yoojung Cheong ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Laboratory ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Multidrug Resistant Organisms ◽  
Before And After ◽  
The Republic

Abstract Background Chlorhexidine digluconate (CHG), the most widely used antiseptic, has recently been applied to patient washing to decolonize the multidrug-resistant organisms (MDROs), but there are little data on susceptibilities of MDROs to CHG. The purpose of this study was to evaluate CHG resistance among MDROs before and after the intervention of daily CHG bathing in adult intensive care units (ICUs). Methods The intervention of daily body washing with 2% CHG cloths were taken in adult patients the medical or surgical ICU of 23-bed by a crossover manner for 6 months (MICU, July to December 2017; SICU, January to June 2018) in a 1,050-bed, university hospital in the Republic of Korea. Available MDRO isolates were randomly selected from clinical cultures of ICU patients within 6 months before, during and after the intervention, including MRSA, MR-CoNS, VRE, Carbapenem-resistant Pseudomonas aeruginosa (CR-PA), CR-Acinetobacter baumannii (CR-AB). Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method set by the Clinical Laboratory Standards Institute. Determination of the minimum bactericidal concentrations (MBCs) was performed by subculturing 10 µL from each well without visible microbial growth. Cumulative amounts of CHG used in both ICUs was estimated across the study period from January 2008 to June 2018. Results The cumulative CHG consumption from both ICUs increased sharply from 27,503 g to 29,556 g after one-year intervention. The ranges of MICs and MBCs of CHG among MDRO clinical isolates selected by a 6-month phase are summarized in Table 1. Particularly, CR-PA and CR-AB isolates revealed four to eight times higher MICs and MBCs compared with the majority of Gram-positives excepting some VRE isolates. On the other hand, neither MICs and MBCs ranges of CHG from the MDRO isolates nor the monthly incidence of the MDROs from both ICUs were significantly increased before and after the intervention of daily CHG bathing. Conclusion This study indicates that some Gram-negative MDRO isolates with higher MICs and MBCs of CHG might be from longstanding exposure to CHG or efflux pumps. Although 2% daily CHG bathing uses over 1,000 times higher concentrations than the lethal concentration, it might be needed to monitor CHG resistance among MDROs. Disclosures All authors: No reported disclosures.

scholarly journals 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Teppei Shimasaki ◽  
Yoona Rhee ◽  
Rachel D Yelin ◽  
Michelle Ariston ◽  
Stefanie Ollison ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Targeted Prevention ◽  
Prevention Measures ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Clinical Culture

Abstract Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had >1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with >1 MDRO. Disclosures All authors: No reported disclosures.

Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions

2019 ◽  
Vol 40 (05) ◽  
pp. 559-565 ◽  
Author(s):  
Koh Okamoto ◽  
Yoona Rhee ◽  
Michael Schoeny ◽  
Karen Lolans ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Healthcare Worker ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Research Personnel ◽  
Contact Precautions ◽  
Patient Interaction ◽  
Environmental Surfaces ◽  
Before And After ◽  
Cdc Guidelines ◽  
The Impact

AbstractObjective:We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs).Design:Prospective, observational study.Setting:The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital.Participants:HCWs who cared for patients on contact precautions for methicillin-resistantStaphylococcus aureus(MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines.Results:We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69;P= .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76;P= .025).Conclusion:When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.

scholarly journals Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s382-s383
Author(s):  
Souad Belkebir ◽  
Alaa Kanaan ◽  
Rawan Jeetawi
Keyword(s):  
Bacterial Colonization ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Diffusion Method ◽  
Infection Prevention And Control ◽  
Isolation And Identification ◽  
Active Screening ◽  
Multidrug Resistant Organisms ◽  
Positive Results

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.Funding: NoneDisclosures: None

Incidence rate of multidrug-resistant organisms in a tertiary care hospital, North Delhi

2015 ◽  
Vol 12 (4) ◽  
pp. 248-256
Author(s):  
Manoj Kumar ◽  
Sanjay Jain ◽  
Neetu Shree ◽  
Mukesh Sharma
Keyword(s):  
Incidence Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Care Hospital ◽  
Multidrug Resistant Organisms

scholarly journals 819. How effective is alcohol flush and drying cycle of automatic endoscope reprocessor (AER): Stripped Endoscope (SE) model

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S452-S452
Author(s):  
Mohamed Yassin ◽  
Heather Dixon ◽  
Michelle Nerandzic ◽  
Curtis Donskey
Keyword(s):  
Visual Inspection ◽  
Compressed Air ◽  
Usual Practice ◽  
Essential Step ◽  
Limited Efficacy ◽  
Disinfection Process ◽  
Before And After ◽  
High Level ◽  
The Impact ◽  
Water Borne

Abstract Background Endoscopic designs are more ergonomic and technically sophisticated than ever. Endoscope transmitted infections continues despite scrutiny and optimization of disinfection processes. Effective endoscopic dryness has been largely overlooked, even though it is paramount for prevention of water-borne pathogens accumulating after high level disinfection (HDL). Additionally, complete dryness is required to achieve sterilization. The aim of this study is to evaluate the dryness of the endoscopes after routine a routine disinfection process. Methods Three endoscopes were stripped from their outer sheaths to allow for visual inspection of the inside channels. SE were processed as per usual practice. After HLD in an automatic endoscope reprocessor (AER) that included an alcohol flush and drying cycle, SE were hung and observed for any water within the channels. SE were flushed with filtered compressed air. Dryness was monitored visually and by feeling for the impact of water spray at the distal tip of SE. Dryness of the channels before and after air flush was observed for the three SE for three trials each. Results All the SE were grossly wet after HLD despite the AER’s alcohol flush and drying cycle. Hanging vertically had no effect on the narrow diameter channels. Applying compressed air to each channel was effective for drying the channels based on visual inspection and water emission from the distal tip of the SE. The filtered compressed air had a flow rate of 20 L/minute for an average of 2 minutes to assure complete dryness. The nozzle for applying the filtered compressed air was ill-fitting to the openings of the cylinders and ports on the control handle, making it difficult to get a good seal for applying the filtered compressed air. Conclusion The AER’s drying cycle was not effective for drying endoscope channels. Vertical hanging had limited efficacy on endoscopic dryness. The application of filtered compressed air to individual channels was effective for drying the channels. This SE model was useful and direct for assessing the degree of moisture inside the channels. The application of filtered compressed air should be an essential step in endoscopic reprocessing regardless of the need for sterilization. Disclosures All Authors: No reported disclosures

scholarly journals Prevalence of Multidrug-Resistant Organisms Using an Antibiotic Resistant Gene Assay at a Tertiary Care Center

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Joseph Timpone ◽  
Rebecca Kumar ◽  
Deepa Lazarous ◽  
Seble Kassaye ◽  
Puneet Agarwal ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Tertiary Care Center ◽  
Antibiotic Resistant ◽  
Resistant Gene ◽  
Gene Assay ◽  
Multidrug Resistant Organisms
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