Carbapenem-ResistantEnterobacteriaceae: A Strategic Roadmap for Infection Control

2017 ◽  
Vol 38 (5) ◽  
pp. 580-594 ◽  
Author(s):  
N. Deborah Friedman ◽  
Yehuda Carmeli ◽  
Aaron Lea Walton ◽  
Mitchell James Schwaber
Keyword(s):  
Infection Control ◽  
Medical Problem ◽  
Control Measures ◽  
Global Public Health ◽  
Regional Variability ◽  
Preparedness Plan ◽  
Healthcare Settings ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Crude Mortality

The incidence of carbapenem-resistantEnterobacteriaceae(CRE) has increased worldwide with great regional variability. Infections caused by these organisms are associated with crude mortality rates of up to 70%. The spread of CRE in healthcare settings is both an important medical problem and a major global public health threat. All countries are at risk of falling victim to the emergence of CRE; therefore, a preparedness plan is required to avoid the catastrophic natural course of this epidemic. Proactive and adequate preventive measures locally, regionally, and nationally are required to contain the spread of these bacteria. The keys to success in preventing the establishment of CRE endemicity in a region are early detection through targeted laboratory protocols and containment of spread through comprehensive infection control measures. This guideline provides a strategic roadmap for infection control measures based on the best available evidence and expert opinion, to enable preparation of a multifaceted preparedness plan to abort epidemics of CRE.Infect Control Hosp Epidemiol2017;38:580–594

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

2021 ◽  
pp. 1-7
Author(s):  
Katharina R. Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl M. Froilan ◽  
Ellen C. Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Skilled Nursing ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Resident Care ◽  
Semistructured Interviews ◽  
Self Protection

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.

scholarly journals ANTIMICROBIAL SUSCEPTIBILITY AND DETECTION METHODS FOR THE EXTENDED‑SPECTRUM β-LACTAMASES PRODUCING ENTEROBACTERIACEAE FROM CLINICAL SAMPLES

2018 ◽  
Vol 11 (5) ◽  
pp. 139
Author(s):  
Kaviyarasan G ◽  
Rajamanikandan Kcp ◽  
Sabarimuthu M ◽  
Ramya S ◽  
Arvind Prasanth D
Keyword(s):  
Infection Control ◽  
Bacterial Infections ◽  
Control Measures ◽  
Detection Methods ◽  
Clinical Samples ◽  
Healthcare Settings ◽  
Infection Control Measures ◽  
Extended Spectrum ◽  
Drug Choice ◽  
Synergy Test

Objectives: Detection of extended-spectrum β-lactamases (ESBLs) is crucial for the infection control and antibiotic choice in healthcare settings. The aim of this study is to develop a standardized, inexpensive, and simple approach that is able to detect ESBL-producing Enterobacteriaceae isolates.Methods: Isolates those were resistant to at least one of the three indicator cephalosporins (cefotaxime, cefpodoxime, and ceftazidime) were tested for ESBL production using the double disc synergy test (DDST), combined disc synergy test (CDST) test and genotypic detection of the responsible gene for the ESBL.Result: From 64 isolates, 28 were resistant to cephalosporins. In 28 isolates, 23 were positive in CDST but in the DDST 18 were showing ESBL positive. 10 were positive in both CDST and DDST.Conclusion: Resistance to cephalosporins, which are the drug choice to treat mixed bacterial infections by the Enterobacteriaceae of which disseminate rapidly being plasmid mediated. Hence, it is necessary that rapid detection of ESBL should be done and immediate infection control measures should be implemented to prevent their dissemination.

Rethinking creative research methods in response to COVID-19: Creating a remote research kit

2021 ◽  
Vol 12 (3) ◽  
pp. 271-288 ◽  
Author(s):  
Rebecka Fleetwood-Smith
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Infection Control ◽  
Public Engagement ◽  
Control Measures ◽  
Arts Organizations ◽  
Healthcare Settings ◽  
Infection Control Measures ◽  
Hospital Environments ◽  
Creative Research

The ‘Sensing Spaces of Healthcare: Rethinking the NHS Hospital’ project involves working with National Health Service (NHS) staff, patients and visitors to explore their experiences of hospital environments. Over the course of the project, creative approaches centred on art-based and design-led practices are employed to research people’s experiences. Such approaches often involve working closely with participants during sessions. As COVID-19 infection control measures have affected in-person research, it has been necessary to develop and adopt alternative low-contact approaches. This article presents the development of a remote creative research kit designed to be used without a researcher/practitioner present. The kit has been developed through work with creative practitioners, hospital arts organizations, patient and public contributors and learning from public engagement events. The remote creative research kit has led to rethinking and reimagining the ways in which such approaches may be of benefit more broadly in healthcare settings.

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

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.

scholarly journals Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

2020 ◽  
Vol 9 (9) ◽  
pp. 2744 ◽  
Author(s):  
Beatrice Tiri ◽  
Emanuela Sensi ◽  
Viola Marsiliani ◽  
Mizar Cantarini ◽  
Giulia Priante ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Prone Position ◽  
Antimicrobial Stewardship ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Prolonged Contact

The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.

scholarly journals Economic Impact of Outbreaks of Norovirus Infection in Hospitals

2011 ◽  
Vol 32 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Bruce Y. Lee ◽  
Sarah M. McGlone ◽  
Rachel R. Bailey ◽  
Zachary S. Wettstein ◽  
Craig A. Umscheid ◽  
...  
Keyword(s):  
Infection Control ◽  
Economic Impact ◽  
Control Measures ◽  
Johns Hopkins Hospital ◽  
Computer Simulation Model ◽  
Hospital Administrators ◽  
Healthcare Settings ◽  
Infection Control Measures ◽  
Hospital Stays ◽  
And Control

Norovirus is highly infectious and can spread rapidly in healthcare settings, consuming resources and resulting in longer hospital stays. Although the economic impact of specific past outbreaks has been reported (eg, a 2007 outbreak of norovirus infection at Johns Hopkins Hospital cost an estimated $650,000), these costs may not be generalizable. We developed an economic computer simulation model to assist policy makers, hospital administrators, infection control professionals, and other healthcare workers in determining how much to invest in norovirus prevention and control interventions above and beyond existing infection control measures.

scholarly journals Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1537
Author(s):  
Yoshiro Sakai ◽  
Kenji Gotoh ◽  
Ryuichi Nakano ◽  
Jun Iwahashi ◽  
Miho Miura ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Service ◽  
Control Measures ◽  
Infection Control Team ◽  
Partial Closure ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Emergency Medical ◽  
Lactamase Gene ◽  
Carbapenem Resistant Enterobacteriaceae

Background: A carbapenem-resistant Enterobacteriaceae (CRE) outbreak occurred in an advanced emergency medical service center [hereafter referred to as the intensive care unit (ICU)] between 2016 and 2017. Aim: Our objective was to evaluate the infection control measures for CRE outbreaks. Methods: CRE strains were detected in 16 inpatients located at multiple sites. Environmental cultures were performed and CRE strains were detected in 3 of 38 sites tested. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and detection of β-lactamase genes were performed against 25 CRE strains. Findings: Molecular typing showed the PFGE patterns of two of four Klebsiella pneumoniae strains were closely related and the same MLST (ST2388), and four of five Enterobacter cloacae strains were closely related and same MLST (ST252). Twenty-three of 25 CRE strains harbored the IMP-1 β-lactamase gene and 15 of 23 CRE strains possessed IncFIIA replicon regions. Despite interventions by the infection control team, new inpatients with the CRE strain continued to appear. Therefore, the ICU was partially closed and the inpatients with CRE were isolated, and the ICU staff was divided into two groups between inpatients with CRE and non-CRE strains to avoid cross-contamination. Although the occurrence of new cases dissipated quickly after the partial closure, a few months were required to eradicate the CRE outbreak. Conclusion: Our data suggest that the various and combined measures that were used for infection control were essential in stopping this CRE outbreak. In particular, partial closure to isolate the ICU and division of the ICU staff were effective.

scholarly journals Knowledge and awareness on usage of mouth masks among dental fraternity during this pandemic COVID-19: A cross-sectional study

2020 ◽  
Vol 11 (6) ◽  
pp. 9-14
Author(s):  
Ravichandra Ravi ◽  
Srividya Athkuri ◽  
Charishma Chowdary Ponugubati ◽  
Roopesh Borugadda ◽  
Sahithi Pamidimukkala ◽  
...  
Keyword(s):  
Infection Control ◽  
Cross Sectional Study ◽  
Control Measures ◽  
World Health ◽  
Global Public Health ◽  
Cross Sectional ◽  
Infection Control Measures ◽  
Significant Difference ◽  
Novel Coronavirus ◽  
Health Organization

Background: The pandemic caused by novel coronavirus (SARS-CoV-2) in Wuhan, China, in December 2019 is a highly infectious disease. The World Health Organization (WHO) has declared the outbreak of Corona Virus Diseases (COVID 19) as a global public health emergency. Currently, research on novel coronaviruses is still in the primary stage. Aims and Objective: The aim of this study is to assess knowledge and awareness on the usage of mouth masks among dental fraternity during this pandemic COVID-19. Materials and Methods: A total of 507 dentists from the Andhra Pradesh (India) region completed a questionnaire-based survey on knowledge, awareness, and infection control measures, such as usage of mouth masks during the pandemic COVID -19. The questionnaire was tailored from the guidance and the information provided for healthcare workers issued by the US Centres for Disease Control and Prevention (CDC). A suitable sampling method was used for the collection of data, and the distribution of responses was presented as percentages. Explanatory statistics were performed for all groups based on the percentage of correct responses. Results: A total of 530 participated in the survey, out of which 507 dentists completely answered the survey, and the response rate was 95.6%. Among the respondents, general practitioners and postgraduates accounted for 58.8% and 41.2%, respectively. There was a statistically significant difference for all the questions solicited among the respondents. General or private practitioners seem to be more aware than postgraduates, as they have answered correctly (>65%) for almost all the questions. Conclusion: The inputs from the study help us to throw some light and fill up space where required. There is a specific and strong need to implement periodic educational programmes and training sessions on infection control practices for COVID-19 among dentists in particular.

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