scholarly journals What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Vincenzo Russotto ◽  
Andrea Cortegiani ◽  
Teresa Fasciana ◽  
Pasquale Iozzo ◽  
Santi Maurizio Raineri ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Healthcare Workers ◽  
Uv Light ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Major Health Problem ◽  
Resistant Species ◽  
Increased Risk

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial species of the previous patient. Biofilm formation, even on dry surfaces, may play a role in reducing the efficacy of terminal cleaning procedures since it enables bacteria to survive in the environment for a long period and provides increased resistance to commonly used disinfectants. No-touch methods (e.g., UV-light, hydrogen peroxide vapour) are under investigation and further studies with patient-centred outcomes are needed, before considering them the standard of terminal cleaning in ICUs. Healthcare workers should be aware of the role of environmental contamination in the ICU and consider it in the broader perspective of infection control measures and stewardship initiatives.

An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit

2002 ◽  
Vol 23 (8) ◽  
pp. 441-446 ◽  
Author(s):  
Geir Bukholm ◽  
Tone Tannæs ◽  
Anne Britt Bye Kjelsberg ◽  
Nils Smith-Erichsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Bacterial Isolates ◽  
Patient Death ◽  
Antibiotic Policy ◽  
Outbreak Period ◽  
Increased Risk ◽  
Gastric Tubes

Objective:To investigate an outbreak of multidrug-resistantPseudomonas aeruginosain an intensive care unit (ICU).Design:Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.Setting:A secondary-care university hospital with a 10-bed ICU.Patients:All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.Results:An outbreak in an ICU with multidrug-resistant isolates ofP. aeruginosabelonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.Conclusion:Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.

Control of an Outbreak of Pandrug-ResistantAcinetobacter baumanniiColonization and Infection in a Neonatal Intensive Care Unit

2007 ◽  
Vol 28 (4) ◽  
pp. 423-429 ◽  
Author(s):  
Pei-Chun Chan ◽  
Li-Min Huang ◽  
Hui-Chi Lin ◽  
Luan-Yin Chang ◽  
Mei-Ling Chen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Control Measures ◽  
Positive Culture Result ◽  
Mode Of Transmission

Objective.To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR)Acinetobacter baumanniiin a 7-day-old neonate who developed PDRA. baumanniibacteremia that was presumed to be the iceberg of a potential outbreak.Design.Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.Setting.A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.Interventions.Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDRA. baumanniiisolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.Results.One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDRA. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDRA. baumanniiin 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDRA. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.Conclusions.In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDRA. baumanniiwas suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDRA. baumannii.

An Outbreak of Carbapenem-Resistant Acinetobacter baumannii Infection in a Neonatal Intensive Care Unit: Investigation and Control

2011 ◽  
Vol 32 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Eric J. McGrath ◽  
Teena Chopra ◽  
Nahed Abdel-Haq ◽  
Katherine Preney ◽  
Winston Koo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Neonatal Intensive Care Unit ◽  
Acinetobacter Baumannii ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Carbapenem Resistant ◽  
Surveillance Cultures

Objective.To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrug-resistant) Acinetobacter baumannii infection involving 6 premature infants.Design.An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation.Setting.A 36-bed, level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan.Interventions.Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak.Results.Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results.Conclusions.The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism.

Epidemiology of Methicillin-SusceptibleStaphylococcus Aureusin the Neonatal Intensive Care Unit

2002 ◽  
Vol 23 (11) ◽  
pp. 677-682 ◽  
Author(s):  
Philip L. Graham ◽  
Anne-Sophie Morel ◽  
Juyan Zhou ◽  
Fann Wu ◽  
Phyllis Della-Latta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Control Strategies ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Increased Risk ◽  
Endemic Infections

Objective:When the incidence of methicillin-susceptibleStaphylococcus aureus(MSSA) infection or colonization increased in our neonatal intensive care unit (NICU), we sought to further our understanding of the relationship among colonization with MSSA, endemic infection, and clonal spread.Design:A retrospective cohort study was used to determine risk factors for acquisition of a predominant clone of MSSA (clone “B”).Setting:A 45-bed, university-affiliated, level III-IV NICU.Patients:Infants hospitalized in the NICU from October 1999 to September 2000.Interventions:Infection control strategies included surveillance cultures of infants, cohorting infected or colonized infants, contact precautions, universal glove use, mupirocin treatment of the anterior nares of all infants in the NICU, and a hexachlorophene bath for infants weighing 1,500 g or more.Results:During the 1-year study period, three periods of increased incidence of MSSA colonization or infection, ranging from 6.4 to 13.5 cases per 1,000 patient-days per month, were observed. Molecular typing using pulsed-field gel electrophoresis demonstrated two predominant clones, clone “B” and clone “G,” corresponding to two periods of increased incidence. Multivariate analysis demonstrated that length of stay (OR, 1.035; 95% confidence interval [CI95], 1.008 to 1.062;P= .010) (increased risk per day) and the use of H2-blockers (OR, 20.44; CI95, 2.48 to 168.26;P= .005) were risk factors for either colonization or infection with clone “B,” and that the use of peripheral catheters was protective (OR, 0.06; CI95, 0.01 to 0.43;P= .005).Conclusions:Control of MSSA represents unique challenges as colonization is expected, endemic infections are tolerated, and surveillance efforts generally focus on multidrug-resistant pathogens. Future studies should address cost-effective surveillance strategies for endemic infections.

scholarly journals Successful Control of a Norovirus Outbreak in a Chilean Pediatric Intensive Care Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s393-s394
Author(s):  
Dona Benadof ◽  
Vanessa Garcia ◽  
Paulina Cifuentes ◽  
Aldo Gaggero
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Patient Care ◽  
Attack Rate ◽  
Healthcare Workers ◽  
Control Measures ◽  
Sodium Hypochlorite Solution ◽  
Strict Adherence ◽  
Viral Shedding

Background: Noroviruses are nonenveloped, single-stranded RNA viruses belonging to the Caliciviridae family; they cause high-profile outbreaks in healthcare settings, due to their contagiousness, prolonged viral shedding, and ability to survive in the environment. Methods: Description of a norovirus outbreak in a pediatric ICU with multibed rooms. We report the epidemiology, molecular diagnosis, and control. Results: In August and September 2019, an outbreak of acute gastroenteritis affected 13 patients and 26 healthcare workers at an intensive care unit of Roberto Del Río Children’s Hospital, which consists of 22 beds in a multibed-room format. Patients manifested self-limited nondysenteric diarrhea; other symptoms were vomiting (54%) and fever (23%). Healthcare workers reported diarrhea, nausea, vomiting, fever, malaise, and abdominal cramps. The mean age of the patients was 1 year old, all diaper users. The average days of diarrhea in patients was 4 days (2–6 days). There were 87 exposed patients, with an attack rate of 14.9% and 107 exposed staff, with an attack rate of 24.3%. Rotavirus and bacterial etiology were ruled out, and norovirus was subsequently diagnosed in 10 of 13 patients using qRT-PCR; 80% (8 of 10) corresponded with GII norovirus and 20% with a GI (2 of 10). Control measures included enforcement of standard precautions, strict adherence to contact precautions (use of gloves and gowns), hand hygiene before and after patients contact, and mask use if exposure to vomitus. Healthy staff were assigned for patients care. Environmental disinfection twice daily with 1.000 ppm sodium hypochlorite solution was encouraged and supervised with focus on cleaning high-touch surfaces, such as bathrooms, sinks, tables, floors and patient-care items. Active and prospective surveillance were conducted to search for new cases. Infection control practices were coupled with education to staff, patients, and visitors. The outbreak was controlled on September 18, 2019, after 23 days and several interventions, with complete recovery in all cases. Conclusions: We concluded that timely detection of a norovirus outbreak in a healthcare facility is imperative for effective infection control, especially in a multibed-room setting, because of the extended viral shedding in children and the transmission route that included aerosolized viral particles in vomitus. Molecular methods offer a rapid and definitive way to establish etiology, but these tests may not be accessible. Direct contact with infected children and contaminated surfaces and patient-care items were relevant risk factors in this outbreak (which involved both patients and healthcare workers) and contributed with its length.Funding: NoneDisclosures: None

scholarly journals Transmission Risk on a Neonatal Intensive Care Unit: Escherichia coli versus Klebsiella pneumoniae

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Tanja Artelt ◽  
Martin Kaase ◽  
Ivonne Bley ◽  
Helmut Eiffert ◽  
Alexander Mellmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Control Measures ◽  
University Hospital ◽  
Transmission Risk ◽  
Short Report ◽  
Increased Risk

Isolation precautions required for neonatal intensive care units are part of a bundle with the aim to prevent transmission, colonization, and infection with multidrug-resistant gram-negative pathogens as neonates face an increased risk of mortality and morbidity in case of infection. The following short report describes a transmission of 3MDRGN Klebsiella pneumoniae on a neonatal intensive care unit in a university hospital in Germany. This transmission occurred even though intensified infection control measures were in place, which impressively shows the importance of surveillance, outbreak management, and awareness of contributing factors regarding outbreak situations.

Control of an Outbreak of Multidrug-ResistantAcinetobacter baumannii-calcoaceticusColonization and Infection in an Intensive Care Unit (ICU) Without Closing the ICU or Placing Patients in Isolation

2006 ◽  
Vol 27 (7) ◽  
pp. 654-658 ◽  
Author(s):  
Mark Wilks ◽  
Anne Wilson ◽  
Simon Warwick ◽  
Elizabeth Price ◽  
Daniel Kennedy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Outbreak Strain ◽  
Suction System ◽  
Infection Control Measures ◽  
Large Tertiary Care ◽  
Cleaning Equipment

Objective.To describe the control of multidrug-resistantAcinetobacter baumannii-calcoaceticus(MDRABC) colonization and infection in an intensive care unit (ICU).Setting.An 18-bed ICU in a large tertiary care teaching hospital in London.Interventions.After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.Results.The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.Conclusion.This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.

Cross-Transmission of Multidrug-ResistantAcinetobacter baumanniiClonal Strains Causing Episodes of Sepsis in a Trauma Intensive Care Unit

2008 ◽  
Vol 29 (5) ◽  
pp. 410-417 ◽  
Author(s):  
Antonios Markogiannakis ◽  
George Fildisis ◽  
Sofia Tsiplakou ◽  
Alexandras Ikonomidis ◽  
Alexandra Koutsoukou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Environmental Samples ◽  
Genetic Relatedness ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Modes Of Transmission ◽  
Care Workers ◽  
Cross Transmission ◽  
Successful Control

Objective.To investigate the mode of transmission of imipenem-resistantAcinetobacter baumanniistrains causing episodes of sepsis.Setting.A 7-bed trauma intensive care unit (ICU) in an orthopedic hospital in Greece.Design.During a 14-week period (from January 10 to April 16, 2006), clinical specimens, along with samples taken on a weekly basis from the ICU environment and from the hands of health care workers (HCWs), were prospectively tested for imipenem-resistantA. baumannii.Pulsed-field gel electrophoresis was used to study the genetic relatedness of the isolates recovered from these specimens and samples.Results.During the survey, imipenem-resistantA. baumanniiwas identified in 14 hospitalized patients, from whom 40 multidrug-resistant and imipenem-resistantA. baumaniiisolates were recovered. These pathogens caused episodes of bacteremia and sepsis in all but one of the patients and contributed to the death of 3 patients. Samples for culture were obtained from the environment and from the hands of HCWs; 29 imipenem-resistantA. baumanniiisolates were recovered from the environment, and 12 from HCWs. One predominant genotype and 2 less predominant genotypes were detected among the 81 imipenem-resistantA. baumanniiisolates. All 3 of these genotypes were found among patients and HCWs and were recovered from environmental samples.Interventions.Control measures consisted of the closure of the ICU and the transfer of the patients to other units. The ICU was disinfected, and adherence to proper hand hygiene protocol was reinforced. These same clonal isolates were not recovered from clinical or environmental samples during the month after the reopening of the ICU.Conclusions.The extensive dissemination of imipenem-resistantA. baumanniiclonal strains causing episodes of bacteremia and/or sepsis resulted from modes of transmission via multiple contaminated surfaces and objects and transiently colonized HCWs' hands. Closure of the ICU and its meticulous environmental decontamination led to the successful control of the outbreak.

Aggressive Control Measures for ResistantAcinetobacter baumanniiand the Impact on Acquisition of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusin a Medical Intensive Care Unit

2004 ◽  
Vol 25 (2) ◽  
pp. 167-168 ◽  
Author(s):  
Marc-Oliver Wright ◽  
Joan N. Hebden ◽  
Anthony D. Harris ◽  
Cari B. Shanholtz ◽  
Harold C. Standiford ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Medical Intensive Care Unit ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Regression Analyses ◽  
Multivariable Regression ◽  
Medical Intensive Care ◽  
The Impact

AbstractThe medical ICU implemented aggressive control measures following an outbreak of multidrug-resistant, clonalAcinetobacter baumannii.Multivariable regression analyses comparing acquisition (6 months preceding to 6 months during or following the outbreak) revealed decreased VRE and MRSA acquisition. Aggressive control measures can reduce VRE, and perhaps MRSA, transmission.

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