Impact of active surveillance and infection control measures on carbapenem-resistant Gram-negative bacterial colonization and infections in intensive care

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

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Spread of Carbapenemase Producing Klebsiella pneumoniae Isolates in Our Hospital: Investigation of Molecular Typing and Clonal Relationship

Türk Mikrobiyoloji Cemiyeti Dergisi ◽

10.5222/tmcd.2021.09226 ◽

2021 ◽

Author(s):

Reyhan Kiş ◽

Ebru Demiray Gündüz ◽

Ayşe Nur Sarı ◽

Zeynep Gülay

Keyword(s):

Intensive Care ◽

Klebsiella Pneumoniae ◽

Carbapenem Resistance ◽

Hospital Staff ◽

Control Measures ◽

Automated System ◽

Microbiology Laboratory ◽

Clonal Relationship ◽

Infection Control Measures ◽

Carbapenem Resistant

Objective: Carbapenem resistance has been reported with increasing frequency among members of Enterobacterales, especially in the last 10 years. Screening and detection of carbapenemase-producing isolates is important in terms of both directing the treatment and preventing its spread. In our study, it was aimed to determine the carbapenemase types and molecular epidemiological relationships of carbapenem resistant Klebsiella pneumoniae isolates, which were isolated sequentially from the samples sent to microbiology laboratory of our hospital. Method: A total of 32 carbapenem-resistant K. pneumoniae isolates of the samples sent to microbiology laboratory between July and September 2014, were included in the study. In addition to classical methods, identification of isolates at species level was made with BD Phoenix ID/AST automated system. Carbapenemase types (blaOXA-48, blaNDM, blaIMP, blaKPC, blaVIM and blaGES) of the isolates were investigated by PCR. The clonal relationship between the isolates was assessed with PFGE. Results: It was noted that 18 isolates were obtained from intensive care units, 9 from inpatient and 5 from outpatient departments. The blaOXA48 gene was found in all isolates while the other carbapenemase genes were not found. It was determined that strains were isolated from 32 patients in our hospital had 12 different PFGE pulsotypes, named as A-L. Among these, the most common ones were B (n=18) and closely related B1 pattern (n=2). The remaining isolates were represented by 11 different types. It was observed that the first isolate with B pulsotype was responsible for the spread of the outbreak from General Intensive Care Unit. Conclusion: It has been thought that the spread of carbapenem- resistant K. pneumoniae isolates in the hospital was probably occurred through the transfer of isolates from patients with gastrointestinal colonization to other patients through hospital staff. Therefore, the spread of the isolates in hospitals can be limited by detecting colonization with active surveillance programs and by applying contact isolation and effective infection control measures.

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The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

10.21203/rs.3.rs-17412/v1 ◽

2020 ◽

Author(s):

Ping Wang ◽

Xiaocui Zou ◽

Boting Zhou ◽

Tao Yin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Control Measures ◽

Icu Patients ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Incidence And Mortality ◽

Changing Trend ◽

Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

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Effectiveness of Structured Training Programme on Infection Control Measures among Housekeeping Workers in Selected Intensive Care Units at Tertiary Hospital

Journal of Nursing Science & Practice ◽

10.37591/jonsp.v10i2.2214 ◽

2020 ◽

Author(s):

Rashmi Vijaya ◽

Ankita Sharma ◽

Anoop Daga ◽

L. Gopichandran

Keyword(s):

Intensive Care ◽

Infection Control ◽

Intensive Care Units ◽

Training Programme ◽

Tertiary Hospital ◽

Control Measures ◽

Infection Control Measures

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510. Exposure Investigation Following a Confirmed Case of Candida auris and Multiple Carbapenemase-Producing Carbapenem-Resistant Organisms

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.579 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S247-S247

Author(s):

Frances Nicholson ◽

Melanie Curless ◽

Maggie Schiffhauer ◽

Sean Zhang ◽

Patricia Simner ◽

...

Keyword(s):

Infection Control ◽

Index Patient ◽

The United States ◽

Point Prevalence ◽

Control Measures ◽

Candida Auris ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Surveillance Cultures ◽

Routine Surveillance

Abstract Background Co-infections of Candida auris and carbapenemase-producing carbapenem-resistant Gram-negative organisms (CP-CRO) are an increasing global concern and rarely seen in the United States. We report the case of a 59-year-old male, with recent hospitalization in India, admitted to our facility with C. auris isolated from urine and axilla/groin specimens and CP-CRO from five body sites. Methods Travel screening in the emergency department identified a patient at high risk for colonization/infection with multidrug-resistant organisms (MDRO). Contact precautions were initiated. Eight CP-CRO isolates were subsequently identified from clinical and routine surveillance cultures from five separate sites. Of the isolates, seven contained one or more carbapenemase-producing genes detected by Xpert Carba-R assay (Cepheid, Sunnyvale, CA) (Table 1). The microbiology laboratory alerted the infection control department of a presumptive positive C. auris from a clinical urine culture from the same patient. Enhanced mitigation strategies were initiated in regards to cleaning and disinfection. An exposure investigation was also conducted using a point prevalence approach. Surveillance cultures were obtained from inpatients currently admitted to the same unit as the index patient. Axilla/groin specimens were collected for C. auris testing, and rectal specimens were collected for CP-CRO gene testing (CRE Real-Time PCR). Results Eighteen patients in addition to the index patient were hospitalized on the acute medicine unit. One patient refused testing for CP-CRO; therefore, 17 patients were tested for CP-CRO, and 18 patients were tested for C. auris. Neither CP-CRO nor C. auris were recovered from any patient. Conclusion A patient co-infected with C. auris and multiple CP-CRO was identified by clinical and routine surveillance cultures at Johns Hopkins Hospital. Travel screening allowed proactive isolation upon presentation. Enhanced infection control measures were implemented and a point prevalence surveillance study was conducted on the general acute care medicine inpatient unit. No transmission of either C. auris or CP-CRO was detected, likely due in part to rapid identification and strict infection control measures. Disclosures All authors: No reported disclosures.

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