scholarly journals Effectiveness of ultraviolet disinfection in reducing hospital-acquired Clostridium difficile and vancomycin-resistant Enterococcus on a bone marrow transplant unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1301-1306 ◽  
Author(s):  
Jennifer Brite ◽  
Tracy McMillen ◽  
Elizabeth Robilotti ◽  
Janet Sun ◽  
Hoi Yan Chow ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Active Surveillance ◽  
Tertiary Care ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant ◽  
Hospital Acquired

AbstractObjectiveTo determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.DesignUsing active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.SettingBone marrow transplant unit at a tertiary-care cancer center.ParticipantsStem cell transplant (SCT) recipients.InterventionTerminal disinfection of all rooms with UV regardless of isolation status of patients.ResultsDuring the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.ConclusionsUtilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.

scholarly journals Screening for Asymptomatic Clostridium difficile Among Bone Marrow Transplant Patients: A Mixed-Methods Study of Intervention Effectiveness and Feasibility

2018 ◽  
Vol 39 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Anna K. Barker ◽  
Benjamin Krasity ◽  
Jackson Musuuza ◽  
Nasia Safdar
Keyword(s):  
Bone Marrow ◽  
Mixed Methods ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Systems Engineering ◽  
Tertiary Care ◽  
Marrow Transplant ◽  
Mixed Methods Study ◽  
Organizational Level ◽  
Positive Polymerase Chain Reaction

OBJECTIVETo identify facilitators and barriers to implementation of a Clostridium difficile screening intervention among bone marrow transplant (BMT) patients and to evaluate the clinical effectiveness of the intervention on the rate of hospital-onset C. difficile infection (HO-CDI).DESIGNBefore-and-after trialSETTINGA 505-bed tertiary-care medical centerPARTICIPANTSAll 5,357 patients admitted to the BMT and general medicine wards from January 2014 to February 2017 were included in the study. Interview participants included 3 physicians, 4 nurses, and 4 administrators.INTERVENTIONAll BMT patients were screened within 48 hours of admission. Colonized patients, as defined by a C. difficile–positive polymerase chain reaction (PCR) stool result, were placed under contact precautions for the duration of their hospital stay.METHODSInterview responses were coded according to the Systems Engineering Initiative for Patient Safety conceptual framework. We compared pre- and postintervention HO-CDI rates on BMT and general internal medicine units using time-series analysis.RESULTSStakeholder engagement, at both the person and organizational level, facilitates standardization and optimization of intervention protocols. While the screening intervention was generally well received, tools and technology were sources of concern. The mean incidence of HO-CDI decreased on the BMT service postintervention (P<.0001). However, the effect of the change in the trend postintervention was not significantly different on BMT compared to the control wards (P=.93).CONCLUSIONSWe report the first mixed-methods study to evaluate a C. difficile screening intervention among the BMT population. The positive nature by which the intervention was received by front-line clinical staff, laboratory staff, and administrators is promising for future implementation studies.Infect Control Hosp Epidemiol 2018;39:177–185

scholarly journals Admission Screening for Clostridium difficile Infection (CDI) in Bone Marrow Transplant Populations

2020 ◽  
Vol 41 (S1) ◽  
pp. s113-s113
Author(s):  
Jessica Tarabay ◽  
Marie Ayers ◽  
Tanushree Soni ◽  
Amelia Langston ◽  
Emily Bracewell ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Early Identification ◽  
Infection Prevention ◽  
Marrow Transplant ◽  
Cell Transplant ◽  
Admission Screening ◽  
Screening Protocol ◽  
Toxin Assay

Background:Clostridium difficile infection (CDI) is the most common healthcare-associated infection (HAI) and is often associated with increased medical costs and longer lengths of hospital stay. Previous studies have highlighted that hematopoietic stem cell transplant (HSCT) recipients are at an increased risk for CDI of up to 33% from other hospitalized patients. Studies have also supported the prevalence of asymptomatic colonization with C. difficile among HSCT patients. Asymptomatic colonization with C. difficile is a significant risk factor for transmission of infection to other patients developing hospital onset (HO-CDI). Therefore, targeted infection prevention efforts, such as early identification of patients with community-onset (CO-CDI) and patients with asymptomatic colonization with CDI in HSCT patients, may be effective in reducing the occurrence of HO-CDI. We discuss the CDI admission screening protocol in Emory University Hospital’s (EUH) bone marrow transplant (BMT) unit. Methods: As part of an infection prevention initiative, a CDI screening protocol was implemented in December 2018 for all patients that admitted to the EUH inpatient BMT unit. Upon admission, patients were screened for CO-CDI symptoms, specifically loose or unformed stools. A C. difficile toxin assay PCR would be collected within the first 3 calendar days of admission for all patients screened. Patients with symptoms were placed on isolation precautions pending results of the C. difficile toxin assay. If a patient had a positive C. difficile toxin assay result, isolation precautions would be maintained for the duration of hospitalization regardless of symptoms. Patients who are were unable to produce a stool specimen on the first 3 days of admission were excluded from the screening protocol. Patients with positive C. difficile toxin assay PCRs were classified as CO-CDI and were treated. Results: Since implementation of the CDI screening protocol, 109 CDI events were identified from January 2019 to October 2019. Moreover, 79% of positive C. difficile toxin assays were collected within the first 3 calendar days of admission. HO-CDI has decreased from 78% in 2018 to 21% during the designated time frame. Conclusions: CDI screening upon admission of BMT populations has shown a decrease among HO-CDI by early identification of CO-CDI and CO asymptomatic colonization with C. difficile. This early identification has allowed rapid implementation of infection preventions precautions, thus reducing risk of unit-based transmission.Funding: NoneDisclosures: None

Identification of an unusual VanA element in glycopeptide-resistantEnterococcus faeciumin Brazil following international transfer of a bone marrow transplant patient

2004 ◽  
Vol 50 (9) ◽  
pp. 767-770 ◽  
Author(s):  
I L.B.C Camargo ◽  
P F Del Peloso ◽  
C F Da Costa Leite ◽  
G H Goldman ◽  
A L.C Darini
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Transplant Patient ◽  
Marrow Transplant ◽  
Vana Gene ◽  
The Usa ◽  
History Of ◽  
Previously Treated ◽  
Vancomycin Resistant ◽  
Mic Minimum Inhibitory Concentration

A vancomycin-resistant Enterococcus (VRE) was isolated from a blood culture of a patient in a Brazilian hospital who had a treatment history of a bone marrow transplant in the USA. The organism was identified as Enterococcus faecium, which exhibited an MIC (minimum inhibitory concentration) ≥ 256 µg/mL for vancomycin. This was confirmed by E-test and the vanA gene was detected by PCR. Overlapping PCR revealed a left IR deletion and an additional 1.5 kb fragment between vanSH genes. DdeI digestion of vanRSHAX genes showed the determinant to be a T type variant, and the element was cloned and sequenced. These results revealed an IS1251 downstream of nucleotide 5820 of the VanA element. Insertions like this have not been reported previously in Brazil, but have been detected in the USA. The genotype and association with a patient previously treated in the USA suggest that this VRE was introduced from abroad, probably through inter-hospital strain spread.Key words: vancomycin-resistant enterococci, IS1251, inter-hospital spread.

Investigation of a Clostridium difficile cluster by multilocus sequence typing in a bone marrow transplant unit

2014 ◽  
Vol 42 (6) ◽  
pp. 691-693 ◽  
Author(s):  
Carol Hu ◽  
Richard Sunday ◽  
Jackrapong Bruminhent ◽  
Brent Bobik ◽  
John Wagner ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clostridium Difficile ◽  
Bone Marrow Transplant ◽  
Multilocus Sequence Typing ◽  
Marrow Transplant
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