Reduction of MRSA and VRE Acquisition by Bundling Daily 2% Chlorhexidine Gluconate (CHG) Bath and Active Surveillance Culture (ASC) for MRSA at a Tertiary Care Hospital

2009 ◽  
Vol 37 (5) ◽  
pp. E85-E86 ◽  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Chlorhexidine Gluconate ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Active Surveillance Culture

scholarly journals 2455. Outbreak of carbapenemase-producing Enterobacteriaceae in cardiology units associated with contaminated water dispenser and sink drain in Korea

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S849-S850
Author(s):  
Jiwon Jung ◽  
Hye-Suk Choi ◽  
Jeong-Young Lee ◽  
Min Jee Hong ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care ◽  
Water Environment ◽  
Water System ◽  
Contact Tracing ◽  
Contact Precaution ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Patient Room ◽  
Large Outbreak

Abstract Background There is a growing concern about the importance of hospital water environment for the transmission of carbapenemase-producing Enterobacteriaceae (CPE). Herein, we report a large outbreak in cardiology units involving intensive care units (ICU) and wards at a tertiary care hospital. Methods During a CPE outbreak between July and December 2018, contact tracing and environmental sampling were performed. For outbreak control, we performed education to healthcare workers, hand hygiene enforcement, active surveillance test, preemptive isolation, chlorhexidine bathing for CPE positive patients, and deep terminal cleaning including UV and hydrogen peroxide non-touch disinfection. Patients with CPE were isolated at a single room with dedicated staffs, contact precaution was implemented, and when case patients were located in multi-patient room, we performed surveillance culture for exposed patients in the room. Results A total of 87 patients with CPE infection or colonization were identified at two cardiology ICUs and three cardiology wards. CPE from the first two index patients were identified from sputum culture suspecting pneumonia, and the remaining 85 patients were identified to harbor CPE through surveillance culture (exposed patients n = 22, active surveillance test n = 63). Diverse organisms were identified; organisms with blakpc (n = 13), blaNDM-1 (n = 55), blaVIM or blaIMP (n = 12), blaOXA-48 (n = 3), and co-producing organisms (n = 4). We performed environmental culture; KPC-producing Escherichia coli was isolated from water dispenser in ICU and NDM-1 producing Citrobacter freundii and Enterobacter cloacae were isolated from sinks in the patient room. Outbreak ended after the removal of water dispenser and the replacement of sink drain with pouring bleach to the sink drain. Conclusion Water dispenser and sink drain were suspected for the possible reservoirs of CPE in this outbreak. Replacement of plumbing system and use of bleach for pouring to sink as well as the removal of water dispenser was needed to control outbreak. Investigation of water system is warranted for finding the source of CPE. Disclosures All authors: No reported disclosures.

scholarly journals 817. Appropriate Sites for the Active Surveillance of Carbapenemase-producing Enterobacteriaceae

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S501-S502
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study. Methods Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. The study patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95). Conclusion The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Combining surveillance of the stool with other sites may be needed for detecting CPE. Disclosures All Authors: No reported disclosures

scholarly journals Appropriate sites for the active surveillance of carbapenemase-producing Enterobacteriaceae

2021 ◽  
Author(s):  
Joung Ha Park ◽  
Hye-Suk Choi ◽  
Hyejin Yang ◽  
Hyun-Ju Lee ◽  
Sun Hee Kwak ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Surgical Intensive Care Unit ◽  
Study Cohort ◽  
Care Hospital ◽  
Negative Group ◽  
Limited Data ◽  
Surgical Intensive Care ◽  
Transmission Rates

Abstract Background: Active surveillance tests for carbapenemase-producing Enterobacteriaceae (CPE) are recommended in patients showing risk factors for colonization by these bacteria. There are limited data however on whether surveillance tests for anatomic sites other than the stool would be useful to detect CPE colonization, and we investigated this in our present study.Methods: Retrospective analysis was performed on cases at our tertiary care hospital during a 5-year period. Patients with CPE colonization had been admitted to our surgical intensive care unit (SICU) or sub-ICU for liver transplantation in this period and undergone surveillance tests for both the stool and other sites. Patients were grouped as stool CPE negative (but which included CPE positive cases from initial sputum and other site tests) or positive. Results: Among the total study cohort of 158 patients, 138 (87.3%) were included in the stool CPE positive group and the remaining 20 (12.7%) in the stool CPE negative group. While the sensitivity of CPE surveillance testing of the stool was 87.3% (95% CI 81.1-92.1), the sensitivity when combining stool and sputum samples was 93.7% (88.7-96.9). The transmission rates were similar for patients showing CPE positivity in the stool, sputum and other sites, at 4.8% (27/557), 4.7% (3/64), and 6.7% (1/15), respectively (p = 0.95).Conclusions: The sensitivity of CPE detection in a stool sample is suboptimal for ruling out CPE colonization and the transmission rates are similar between stool-positive or -negative cases. Thus, combining surveillance of the stool with other sites may be needed for detecting CPE.

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Mansoor Asma ◽  
Sohani Komal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Hygiene ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Vap Bundle

Abstract Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

scholarly journals Active surveillance culture in a critical care unit of a tertiary care hospital of West Bengal, India: a prospective study

2019 ◽  
Vol 6 (1) ◽  
pp. 18 ◽  
Author(s):  
Leelavati Thakur ◽  
Chinmaya Dash ◽  
Sulekha Sinha
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Base Line ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Esbl Producer ◽  
Klebsiella Species

Background: Hospital-acquired infections are a common and serious public health problem and their management and control are essential to minimize hospital-related morbidity and mortality. The aim was to acquire the base line data regarding prevalence of Multi Drug Resistant (MDR) organism in a tertiary care institution and to help in ensuring proper practice guidelines like contact isolation, cohorting and sterile barrier precaution. The study design was an observational descriptive hospital based cross sectional study.Methods: The study was conducted in a critical care unit of a tertiary care hospital for a duration of 6months. Patients with the age more than 18yrs, duration of stay more than 48hrs were included in the study. Categorical data are expressed in percentages.Results: In the study 111 patients more than 18 yrs of age were enrolled of which 68 were male and 43 females. The sample collected from the axillary site were 110, nasal site 108, urine 96 and respiratory site 95. The culture positivity for pathogenic organisms were maximum for axillary site (95.5%) followed by nasal site (83.33%), respiratory site (36.8%) and urine (26%). Of all the organisms isolated multidrug resistance were as follows: MRSA 63% and MSSA 37% (of all S. aureus), MR CoNS 41.32% (of all CoNS), ESBL producer 22.2% and carbapenemase producer 22.2% (of all Klebsiella species), ESBL producer 37.5% and carbapenemase producer 31.26% (of all E. coli), non albicans Candida 57.14% (of all Candida species).Conclusions: Early identification of the causative pathogen in nosocomial and community-acquired infection is crucial for initiating the correct antibiotics as well as preventing further spread.

scholarly journals Active surveillance for carbapenemase-producing Klebsiella pneumoniae and correlation with infection in subjects attending an Italian tertiary-care hospital: a 7-year retrospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042290
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Monica Martinelli ◽  
Sara Montecchini ◽  
Silvia Covan ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Active Surveillance ◽  
Rectal Swab ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Contact Precautions ◽  
Rectal Swabs ◽  
Potential Reservoir ◽  
Risk Patients

ObjectivesThe distribution of carbapenemase-producing Klebsiella pneumoniae (CPKP) phenotypes and genotypes in samples collected during 2011–2018 was evaluated. The association between patients with CPKP-positive rectal swab and those with CPKP infection, as well as the overall analysis of CPKP-infected patients, was performed.SettingThe study was performed in a tertiary-care hospital located in Northern Italy.ParticipantsTwo groups were considered: 22 939 ‘at-risk’ patients submitted to active surveillance for CPKP detection in rectal swabs/stools and 1094 CPKP-infected patients in which CPKP was detected in samples other than rectal swabs.ResultsCPKP-positive rectal swabs were detected in 5% (1150/22 939). A CPKP infection was revealed in 3.1% (719/22 939) of patients: 582 with CPKP-positive rectal swab (50.6% of the 1150 CPKP-positive rectal swabs) and 137 with CPKP-negative rectal swab. The 49.4% (568/1150) of the patients with CPKP-positive rectal swab were carriers. The overall frequency of CPKP-positive patients (carriers and infected) was almost constant from 2012 to 2016 (excluding the 2015 peak) and then increased in 2017–2018. blaKPC was predominant followed by blaVIM. No difference was observed in the frequency of CPKP-positive rectal swab patients among the different material groups. Among the targeted carbapenemase genes, blaVIM was more significantly detected from urine than from other samples.ConclusionsThe high prevalence of carriers without evidence of infection, representing a potential reservoir of CPKP, suggests to maintain the guard about this problem, emphasising the importance of active surveillance for timely detection and separation of carriers, activation of contact precautions and antibiotic treatment guidance on suspicion of infection.

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