A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement

2016 ◽  
Vol 37 (11) ◽  
pp. 1315-1322 ◽  
Author(s):  
Mirian de Freitas DalBen ◽  
Elisa Teixeira Mendes ◽  
Maria Luisa Moura ◽  
Dania Abdel Rahman ◽  
Driele Peixoto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Tertiary Care ◽  
Real Life ◽  
Baseline Period ◽  
Intervention Period ◽  
Support Tool ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

OBJECTIVETo reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model.DESIGNBefore-after trial with a 44-week baseline period and 24-week intervention period.SETTINGMedical intensive care unit of a tertiary care teaching hospital.PARTICIPANTSAll patients admitted to the unit.METHODSWe developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted.RESULTSThe goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0–2.1).CONCLUSIONSThe simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention.Infect Control Hosp Epidemiol2016;1–8

scholarly journals 1192. A Visual Family Empowerment Tool Is Associated with Increased Healthcare Worker Hand Hygiene in a Pediatric Intensive Care Unit in Vietnam

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S427-S428
Author(s):  
Jeffrey I Campbell ◽  
Pham Thanh Thuy ◽  
Le Trang ◽  
Dang Thi Thu Huong ◽  
Celeste Chandonnet ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Outcome Data ◽  
World Health ◽  
Intervention Period ◽  
Family Empowerment ◽  
Visual Tool

Abstract Background Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections. The World Health Organization (WHO) recommends empowering patients and families to remind healthcare workers (HCWs) to perform HH. The effectiveness of patient and family empowerment tools in Southeast Asia is unknown. Methods We performed a prospective intervention study in an intensive care unit of a pediatric referral hospital in Vietnam. Using family and HCW input, we created a visual tool for families to use to remind HCWs to perform HH. For 2 weeks pre-intervention, we collected baseline data on HH performance, method (hand rub or soap and water), adequacy, HCW type (e.g., physician, nurse), and WHO 5 moments of HH using direct, unobtrusive observation. During a subsequent 3-week intervention period, consenting families were provided the visual tool and educated on its use to prompt HCW HH. Prospective collection of outcome data continued during the intervention period. The primary outcome was change in HCW HH between baseline and intervention periods. Multivariable logistic regression models were used to identify independent predictors of HH. Results A total of 2,014 pre-intervention and 2,498 intervention period HH opportunities were observed. During the intervention period, 73 families received visual reminder tools and education. Overall HCW HH was 46% pre-intervention, which increased to 73% in the intervention period (P < 0.001). Lowest HH adherence in both periods occurred after HCW contact with patient surroundings (WHO Moment 5; 16% pre-intervention and 24% intervention). In multivariable analyses, the odds of HCW HH during the intervention period were significantly higher than pre-intervention (OR 2.94 [95% CI 2.54 – 3.41], P < 0.001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs. evening/weekend), and HH moment. Among completed HH opportunities, HH adequacy was >90% in both periods. Conclusion Introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese pediatric intensive care unit. More research is needed to explore acceptability and barriers to the use of such tools in other low- and middle-income settings. Disclosures All authors: No reported disclosures.

scholarly journals Criteria for referral of pediatric SARS-CoV-2 infection: a real-life experience in the pandemic era

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Carlotta Montagnani ◽  
Elisabetta Venturini ◽  
Manuela L’Erario ◽  
Chiara Tersigni ◽  
Barbara Bortone ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Experience ◽  
Tertiary Care ◽  
Real Life ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Children At Risk ◽  
Referral Criteria ◽  
Practical Guidance

AbstractA practical guidance on the management of children with COVID-19 to insure homogeneous criteria for referral to a higher-level facility, according to the disease severity, is pivotal in the pandemic era. A panel of experts in pediatric infectious diseases and intensive care at the tertiary-care Meyer Children’s University Hospital, Florence, Italy, issued a practical document shared with Tuscany hospitals. The rationale was to target the referral for those children at risk of requiring an intensive support, since the above mentioned hospital has the pediatric intensive care unit. Overall, 378 patients between 0 and 19 years of age were diagnosed with COVID-19 infection in the Tuscany region with 24 (6.3%) hospitalizations. Only three children were centralized to Meyer Children’s University Hospital according to reported criteria. Considering that appropriate referral criteria have been associated with reduced mortality in other conditions, our document might be useful to improve outcomes of children with COVID-19.

scholarly journals Efficacy of active rapid molecular screening and IPC interventions to reduce carbapenem-resistant  Enterobacteriaceae infections in emergency intensive care unit – a prospective, multi-stage study

2019 ◽  
Author(s):  
Wenjuan Wu ◽  
Simin Yang ◽  
Lihua He ◽  
Ke Li ◽  
Xiaoyu Yu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Laboratory ◽  
Health Workers ◽  
Experimental Period ◽  
Infection Prevention And Control ◽  
Molecular Screening ◽  
Active Screening ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background: To investigate whether molecular rapid active screening and infection-prevention and control（IPC）interventions can reduce the colonization and infection of carbapenem-resistant Enterobacteriaceae (CRE) in a general emergency intensive care unit (EICU). Methods: The study was designed as a before-and-after quasi-experiment. It was conducted in 3 stages. During stage 1, April 2018, the environment was prepared and the staff in EICU was trained. Stage 2 was the main experimental stage from May 2018 to January 2019. The active screening was tested by semi-nested real-time fluorescent PCR (polymerase chain reaction) detection with rectal swabs from all the patients on admission to EICU and the results would be feedback in 1 hour and other IPC interventions were conducted in strict supervision in this stage. In the last stage (stage 3), February 2019-April 2019, only active screening was strictly executed. Other IPC interventions were carried out by health workers without supervision. In the meantime, the atient information and culture results from clinical laboratory from January 2017-April 2019 were collected. Results: In this 1-year study, a total of 217 patients were enrolled. There were 23.04% of the patients were initially colonized or infected with CRE as tested by active molecular screening. The clinical culture detection rate of CRE colonization/infection was 3.37% during the baseline stage (before this study was carried out), from January 2017-March 2018. The rate decreased significantly to 1.20% (p<0.05) during the main experimental period in which active screening and IPC intervention were executed strictly. However, the rate increased again to 6 .12% in stage 3 in which only active screening were carried out in supervision. Based on the clinical characteristics of the EICU patients, we found there's a higher probability that the patients had invasive devices or skin-barrier damage on admission or had antibiotic use before admission were colonized or infected with CRE (p<0.05). Conclusions : Rapid active screening by molecular detection and other IPC interventions conducted in supervision showed a significant reduction of CRE in nosocomial infection. The key to reduce the spread of CRE in the EICU is that all medical staff and healthcare workers execute IPC interventions strictly.

scholarly journals Cefiderocol for Severe Carbapenem-Resistant A. baumannii Pneumonia: Towards the Comprehension of Its Place in Therapy

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 3
Author(s):  
Emanuele Rando ◽  
Francesco Vladimiro Segala ◽  
Joel Vargas ◽  
Cristina Seguiti ◽  
Gennaro De Pascale ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Success Rate ◽  
Real Life ◽  
General Ward ◽  
Polymicrobial Infection ◽  
Ventilator Associated Pneumonia ◽  
Future Studies ◽  
Carbapenem Resistant

Cefiderocol use in A. baumannii pneumonia still represents an important matter of debate. The aim of this study is to describe 13 cases of carbapenem-resistant A. baumannii (CRAB) pneumonia treated with cefiderocol in real-life practice. We retrospectively included patients with CRAB pneumonia hospitalized at Fondazione Policlinico Universitario Agostino Gemelli Hospital treated with cefiderocol either in the general ward or the intensive care unit. A total of 11 patients out of 13 had ventilator-associated pneumonia caused by CRAB, and 12/13 patients had polymicrobial infection. We found a 30-day success rate of 54%. Cefiderocol may have a role when facing severe XDR A. baumannii pneumonia. Future studies are warranted to better define its place in therapy in CRAB infections.

scholarly journals 495. Risk Factors of Carbapenem-Resistant Enterobacteriaceae (CRE) Infections Among Intensive Care Unit (ICU) Patients in a Tertiary Hospital in the Philippines

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S241-S242
Author(s):  
Roderick Oreal Torio ◽  
Danielle Nicole T Paras ◽  
Cybele Lara R Abad
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Philippines ◽  
Common Site ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The threat of Carbapenem-Resistant Enterobacteriaceae (CRE) is increasing worldwide, and the epidemiology, risk factors, and outcomes of CRE in the Philippines is unknown. Methods We performed a retrospective case–control study of 128 CRE cases and Carbapenem-Susceptible Enterobacteriaceae (CSE) controls matched 1:1 based on site of infection and date of admission among all adult patients in the Intensive Care Unit (ICU) between January 2014 and May 2018 at The Medical City. Predictors of CRE infection among matched cases and controls were determined through multiple conditional logistic regression analysis. In-hospital mortality was analyzed using z-test of two proportions and length of stay among patients with CRE and CSE were compared. Results The mean age in both groups was similar at 65.8 (range 23–92) and 64.3 (range 23–98) years, respectively. There were more males among cases than controls [(76/128, 59%) vs. 62/128 (48%)]. Those with CRE were more likely to have a co-morbid illness and an invasive device. Pneumonia was the most common site of CRE infection (40%) followed by the urinary tract (27%). Enterobacter cloacae (54.68%) was the most common organism, followed by Klebsiella pneumoniae (30.46%). On univariate analysis, the use of piperacillin–tazobactam, third or fourth-generation cephalosporins and carbapenems, mechanical ventilation, and acute kidney injury (AKI) increased the risk of developing CRE infections by an OR of 7.5 (CI 1.88–29.95, P = 0.004), 9.32 (CI 1.48–58.59, P = 0.017), and 10.76 (CI 1.69–68.53, P = 0.012), respectively. Those with CRE had a higher in-hospital mortality than the CSE group [(49/79, 38.3%) vs. (33/95, 25.8%); P = 0.032]. Length of hospital stay among CRE cases was also longer with a mean of 43.9 vs. 28 days compared with controls. Conclusion In our cohort, older patients w/ comorbidities developed CRE with pneumonia being the most common site of infection. Prior use of broad-spectrum antimicrobials, mechanical ventilation and AKI appeared to increase the risk of CRE infection in the ICU. CRE infection also increased patient mortality and length of hospital stay. Interventions that target these risk factors should be undertaken to help prevent CRE infection. Disclosures All authors: No reported disclosures.

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