scholarly journals Effectiveness of contact precautions against multidrug-resistant organism transmission in acute care: a systematic review of the literature

2015 ◽  
Vol 90 (4) ◽  
pp. 275-284 ◽  
Author(s):  
C.C. Cohen ◽  
B. Cohen ◽  
J. Shang
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Review Of The Literature ◽  
Contact Precautions

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals MRSA contamination in ambulances: a systematic review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Fattorini ◽  
C Quercioli ◽  
G Messina ◽  
N Nante
Keyword(s):  
Systematic Review ◽  
Medical Equipment ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
European Countries ◽  
Hospital Environment ◽  
Resistant Organism ◽  
Healthcare Settings ◽  
Search Terms ◽  
Potential Reservoir

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism (MDRO) frequently involved in skin, soft tissue and bone infections. Moreover, it is one of the most frequently isolated pathogen in bloodstream infections in European countries. Because of its capacity to survive on inanimate surfaces, this microorganism could be detected not only on hospital environment, but also in other healthcare settings such as ambulances. We performed a systematic review in order to study the level of MRSA contamination in ambulances (vehicle surfaces and medical equipment). Methods In March 2019 we searched studies in PubMed using the key search terms “MRSA, ambulance”. We included different designs of studies in English. Results The research yielded 18 publications: after title, abstract and full text’s analysis, 9 manuscripts were included in this review. Studies were conducted from 2007 to 2018 in USA, Egypt, Poland, Germany and South Korea. Overall, the number of ambulances sampled for MRSA was 511 (min. 3-max. 150), and 64 (12.5%) resulted contaminated by MRSA. Sampling points examined for each vehicle varied from 5 to 33, for a total of 5872 (min. 39-max. 2136) samplings performed. The amount of MRSA positive samplings was 145/5872 (2.5%) (min. 1-max. 43). Stretcher resulted the most frequently contaminated fomite (29 of the 145 MRSA positive samplings, 20%). Conclusions Despite MRSA prevalence is decreasing in Europe, recent studies showed how this MDRO could still be responsible of a remarkable burden in terms of attributable deaths and costs. Implementing effective sanitation procedures with a continuative monitoring of the processes is highly recommended in all the healthcare settings, including ambulances. Automated terminal disinfection of these vehicles, adopting technologies such as ultraviolet germicidal irradiation or hydrogen peroxide aerosol, could reduce bacterial contamination hosted on surfaces and medical equipment. Key messages Although the percentage of isolates of MRSA in European countries is decreasing, the burden this multidrug resistant organism in terms of mortality and costs remains remarkable. Ambulances must be considered as a potential reservoir of MRSA because of its ability to survive on inanimate surfaces, and adequate sanitation procedures should be frequently performed.

Management of Inpatients Colonized or Infected With Antimicrobial-Resistant Bacteria in Hospitals in the United States

2005 ◽  
Vol 26 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Rebecca H. Sunenshine ◽  
Laura A. Liedtke ◽  
Scott K. Fridkin ◽  
Larry J. Strausbaugh ◽  
Keyword(s):  
Infectious Diseases ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Emerging Infections ◽  
Contact Precautions ◽  
Surveillance Cultures ◽  
Multidrug Resistant Organisms ◽  
General Wards

AbstractBackground:Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use.Methods:The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units.Results:Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P<.001).Conclusions:Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.

scholarly journals 156. How Does Exposure to C. Diffogenic Antibiotics Impact Multidrug-resistant Organism Colonization and Environment Contamination in Nursing Homes?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S207-S207
Author(s):  
Kyle J Gontjes ◽  
Kristen Gibson ◽  
Bonnie Lansing ◽  
Julia Mantey ◽  
Karen Jones ◽  
...  
Keyword(s):  
Risk Factor ◽  
Acute Care ◽  
Independent Risk Factor ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Antibiotic Exposure ◽  
Study Enrollment ◽  
Environment Contamination ◽  
Post Acute Care

Abstract Background Antimicrobial stewardship program (ASP) outcomes are often measured in the acute care setting, less is known about the effect of acute care antibiotic exposures on multidrug-resistant organism (MDROs) colonization of nursing home (NH) patients. We assessed exposure to antibiotics commonly associated with Clostridioides difficile (C. diffogenic agents) on post-acute care patient colonization and room environment contamination (Figure 1). Figure 1. Conceptual Diagram of Hospital Antibiotic Exposure’s Influence on Patient Colonization and Room Environment Contamination with Multidrug-Resistant Organisms Methods MDRO surveillance of post-acute care patients in 6 NHs between 2013–16. We screened patient hands, nares, oropharynx, groin, perianal area, and high-touch room environment surfaces for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and resistant Gram-negative bacilli (rGNB). C. diffogenic agents were defined as fluoroquinolones, 3rd/4th generation cephalosporins, penicillin combinations, lincosamides, and carbapenems. Multivariable logistic regression was used to assess whether hospital antibiotic exposure is an independent risk factor for MDRO colonization and room environment contamination on study enrollment. Results We enrolled 618 patients: average age was 74.4 years; 57.4% female; 62.3% white; 9.9% had indwelling devices (Table 1). Three hundred-fifty patients (56.6%) were MDRO colonized on enrollment: 98 (15.9%), MRSA; 208 (33.7%); VRE; 196 (31.7%), rGNB. Sixty-eight percent of patient rooms were MDRO contaminated: 166 (26.9%), MRSA; 293, (47.4%). VRE; 182 (29.5%), rGNB. A majority (59.4%) of patients were exposed to an antibiotic before admission. Of which, 239 (65.1%) were exposed to a C. diffogenic antibiotic. In multivariable analysis, C. diffogenic antibiotic exposure was an independent risk factor for MDRO colonization (OR, 1.94; 95% CI, 1.35–2.79), MDRO room environment contamination (OR, 1.94; 95% CI, 1.43–2.63), VRE colonization (OR, 4.23; 95% CI, 2.59–6.90), and VRE room environment contamination (OR, 2.58; 95% CI, 2.00–3.33). Table 1. Clinical Characteristics and MDRO Burden on Study Enrollment, Stratified by Hospital Antibiotic Exposure Status Multivariable Analysis of Hospital Antibiotic Exposure Status as Risk Factor for Proximal and Distal MDRO Outcomes Conclusion Hospital exposure to antibiotics is associated with an increased risk of VRE colonization and room environment contamination on NH study enrollment. These observations highlight the potential influence of hospital-based ASPs on MDRO prevalence and transmission in NHs. Disclosures All Authors: No reported disclosures

scholarly journals The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

2019 ◽  
Vol 69 (9) ◽  
pp. 1566-1573 ◽  
Author(s):  
James A McKinnell ◽  
Raveena D Singh ◽  
Loren G Miller ◽  
Ken Kleinman ◽  
Gabrielle Gussin ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Acute Care ◽  
Orange County ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Healthcare Intervention ◽  
Healthcare Facilities ◽  
Care Facilities ◽  
Acute Care Facilities

Abstract Background Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. Methods A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase–producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. Results Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs &lt;1%, P &lt; .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. Conclusions The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

Statewide Surveillance of Carbapenem-Resistant Enterobacteriaceae in Michigan

2014 ◽  
Vol 35 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Brenda M. Brennan ◽  
Joseph R. Coyle ◽  
Dror Marchaim ◽  
Jason M. Pogue ◽  
Martha Boehme ◽  
...  
Keyword(s):  
Data Collection ◽  
Acute Care ◽  
Multidrug Resistant ◽  
Fourth Generation ◽  
Public Health Issue ◽  
Resistant Organism ◽  
Recent Infection ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background.Carbapenem-resistant Enterobacteriaceae (CRE) are clinically challenging, threaten patient safety, and represent an emerging public health issue. CRE reporting is not mandated in Michigan.Methods.The Michigan Department of Community Health–led CRE Surveillance and Prevention Initiative enrolled 21 facilities (17 acute care and 4 long-term acute care facilities) across the state. Baseline data collection began September 1, 2012, and ended February 28, 2013 (duration, 6 months). Enrolled facilities voluntarily reported cases of Klebsiella pneumoniae and Escherichia coli according to the surveillance algorithm. Patient demographic characteristics, laboratory testing, microbiology, clinical, and antimicrobial information were captured via standardized data collection forms. Facilities reported admissions and patient-days each month.Results.One-hundred two cases over 957,220 patient-days were reported, resulting in a crude incidence rate of 1.07 cases per 10,000 patient-days. Eighty-nine case patients had test results positive for K. pneumoniae, whereas 13 had results positive for E. coli. CRE case patients had a mean age of 63 years, and 51% were male. Urine cultures (61%) were the most frequently reported specimen source. Thirty-five percent of cases were hospital onset; sixty-five percent were community onset (CO), although 75% of CO case patients reported healthcare exposure within the previous 90 days. Cardiovascular disease, renal failure, and diabetes mellitus were the most frequently reported comorbid conditions. Common ris k factors included surgery within the previous 90 days, recent infection or colonization with a multidrug-resistant organism, and recent exposures to antimicrobials, especially third- or fourth-generation cephalosporins.Conclusions.CRE are found throughout Michigan healthcare facilities. Implementing a regional, coordinated surveillance and prevention initiative may prevent CRE from becoming hyperendemic in Michigan.

scholarly journals A systematic review on the relationship between international migration and antimicrobial resistance

2020 ◽  
Author(s):  
Anne Sophie Peters ◽  
Báltica Cabieses ◽  
Orlando Ramirez ◽  
Eleonora Uphoff ◽  
María Paz Acuña ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Resistance ◽  
International Migration ◽  
Host Country ◽  
Human Mobility ◽  
Local Population ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Antimicrobial Drug Resistance ◽  
Bacterial Drug Resistance

Abstract Introduction: Antimicrobial drug resistance (AMR) is considered a serious threat to public health worldwide. The relation between AMR and human mobility, particularly international migration, has drawn attention from the scientific community in recent years. However, several aspects about this relation remain unclear. Therefore, we aimed at expanding and updating previous systematic review studies, with a novel focus on the AMR prevalence in migrants compared to the local population of the host country, to examine external validity of previous findings.Methods: We searched in Ovid MEDLINE all types of observational studies, without language or year of publication restrictions. We aimed at exploring differences in countries´ bacterial drug resistance rates based on immigration rates. All types of AMR were included, except for those related to HIV/AIDS and Tuberculosis. The comparator group of interest was the local population of the host country. The study protocol is registered with PROSPERO, number CRD42018114436. Results: After screening of 322 articles, 15 papers were selected for data extraction, including 1930 migrants. Compared to the local population, higher rates of methicillin-resistant Staphylococcus aureus, Panton-Valentine leucocidin positive strains, multidrug-resistant Gram-negative bacteria, vancomycin-resistant Enterococcus, and having at least one multidrug-resistant organism were found in migrants in 12 of the 15 papers. Rates of AMR did not differ significantly in two studies and only one of them reported a lower burden of AMR in migrants.Conclusions: Higher prevalence of AMR in migrants were presented in the majority of the included articles, addressing the emerge of the circulation of resistant strains within this group. More detailed descriptions, including time span and route taken by migrants to arrive to country of destination and length of stay by the time of inclusion are essential to gain a deeper understanding of the relation in between AMR and migration. Countries with high migration rates outside Europe should be encouraged to implement strategies for screening of both local population and migrants in countries.

scholarly journals Patient Hand Colonization With MDROs Is Associated with Environmental Contamination in Post-Acute Care

2017 ◽  
Vol 38 (9) ◽  
pp. 1110-1113 ◽  
Author(s):  
Payal K. Patel ◽  
Julia Mantey ◽  
Lona Mody
Keyword(s):  
Risk Factors ◽  
Acute Care ◽  
Environmental Contamination ◽  
Urinary Catheter ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Prolonged Hospital Stay ◽  
Prolonged Hospital ◽  
Post Acute Care

We assessed multidrug-resistant organism (MDRO) patient hand colonization in relation to the environment in post-acute care to determine risk factors for MDRO hand colonization. Patient hand colonization was significantly associated with environmental contamination. Risk factors for hand colonization included disability, urinary catheter, recent antibiotic use, and prolonged hospital stay.Infect Control Hosp Epidemiol 2017;38:1110–1113

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