MRSA Pediatric clone expressing ermC plus lnuA genes causing nosocomial transmission and healthcare workers colonization in a neonatal intensive care unit

2014 ◽  
Vol 25 ◽  
pp. 78-80 ◽  
Author(s):  
Diego Faccone ◽  
Ana M. Togneri ◽  
Laura Podesta ◽  
Marcela Perez ◽  
Paula Gagetti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Nosocomial Transmission

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.

scholarly journals Survey of Knowledge, Beliefs, and Practices of Neonatal Intensive Care Unit Healthcare Workers Regarding Nosocomial Infections, Central Venous Catheter Care, and Hand Hygiene

2004 ◽  
Vol 25 (9) ◽  
pp. 747-752 ◽  
Author(s):  
Allison M. Kennedy ◽  
Alexis M. Elward ◽  
Victoria J. Fraser
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Venous Catheter ◽  
Central Venous ◽  
Gram Negative ◽  
Beliefs And Practices ◽  
Knowledge And Beliefs

AbstractObjective:To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs).Design:Self-administered survey.Setting:A 55-bed NICU.Participants:NICU HCWs (N = 215).Results:The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails.Conclusions:A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.

Nosocomial Pulmonary Tuberculosis Contact Investigation in a Neonatal Intensive Care Unit

2013 ◽  
Vol 34 (7) ◽  
pp. 754-756 ◽  
Author(s):  
Kate E. Fisher ◽  
Robert Guaran ◽  
Jacqueline Stack ◽  
Sheila Simpson ◽  
William Krause ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pulmonary Tuberculosis ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Medical Officer ◽  
Tuberculosis Transmission ◽  
Contact Investigation ◽  
Smear Positive Pulmonary Tuberculosis

The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.

scholarly journals Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital

2010 ◽  
Vol 59 (6) ◽  
pp. 687-692 ◽  
Author(s):  
Ali A. Dashti ◽  
Mehrez M. Jadaon ◽  
Huda H. Gomaa ◽  
Bobby Noronha ◽  
Edet E. Udo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Disc Diffusion

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum β-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing K. pneumoniae isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February–March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the β-lactamase genes (bla TEM, bla SHV and bla CTX-M). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim–sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 β-lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing K. pneumoniae caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

A Prolonged Outbreak ofPseudomonas Aeruginosain a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?

2000 ◽  
Vol 21 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Ronald L. Moolenaar ◽  
J. Michael Crutcher ◽  
Venusto H. San Joaquin ◽  
Lucille V. Sewell ◽  
Lori C. Hutwagner ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Disease Transmission ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Acquired ◽  
Control Study ◽  
Genotype A

AbstractObjectives:To describe an outbreak ofPseudomonas aeruginosabloodstream infection (BSD and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.Design:A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.Setting and Patients:Neonates in the NICU of a university-affiliated children's hospital.Interventions:Improved hand washing and restriction of use of long or artificial fingernails.Results:Of 439 neonates admitted during the study period, 46 (10.5%) acquiredP aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained,P aeruginosawas isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-l and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization withP aeruginosa, but other variables, including exposure to nurse A-2, were not.Conclusion:Epidemiological evidence demonstrated an association between acquiringP aeruginosaand exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands withP aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.

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