scholarly journals Risk Estimate of Duodenoscope-Associated Infections in The Netherlands

2020 ◽  
Vol 41 (S1) ◽  
pp. s436-s437
Author(s):  
M. Vos ◽  
Judith Kwakman ◽  
Marco Bruno
Keyword(s):  
The Netherlands ◽  
Multidrug Resistant ◽  
National Database ◽  
Clinical Infection ◽  
Minimum Risk ◽  
Medical Practitioners ◽  
Healthcare Facilities ◽  
Calculated Risk ◽  
Original Calculation ◽  
Bare Minimum

Background: The likelihood of endoscopy-associated infections (EAIs) is often referenced from a paper published in 1993 by Kimmery et al1 in which a risk of 1 exogenous infection for every 1.8 million endoscopies (0.00006%) is proclaimed. Even though Ofstead et al2 pointed out in 2013 that this was at least an underestimation by 6-fold because of erroneous assumptions and mathematical errors, the original calculation is still often referred to. In the past decade, multiple outbreaks of multidrug-resistant microorganisms (MDROs) related to contaminated duodenoscopes have been reported worldwide. This leads to the assumption that the former risk calculation is indeed incorrect. Objective: We calculated the duodenoscope-associated infection (DAI) risk for the Dutch ERCP practice. Methods: We searched and consolidated all Dutch patients reported in the literature to have suffered from a clinical infection linked to a contaminated duodenoscope between 2008 and 2018. From a national database, the number of ERCPs performed per year in The Netherlands were retrieved. Actual numbers were available from 2012 to 2018. Numbers from 2008 to 2011 were estimated and assumed to be equal to 2012. Results: In 2008–2018, 3 MDRO outbreaks in Dutch hospitals were reported in the literature, with 21 patients suffering from a clinical infection based on a microorganism proven to be transmitted by a duodenoscope. In that period, ∼203,500 ERCP procedures were performed. Hence, for every 9,690 procedures, 1 patient developed a clinically relevant infection (DAI risk, 0.010%). Conclusions: The risk of developing a DAI is at least 30–180 times higher than the risks that were previously reported for all types of endoscopy-associated infections. Importantly, the current calculated risk of 0.010% constitutes a bare minimum risk of DAI because endoscope-related infections are underreported. Apart from DAI risk, a patient is also at risk of becoming colonized with a microorganism through contaminated endoscopes but without developing symptoms of clinical infection. These data call for consorted action of medical practitioners, industry, and government agencies to minimize and ultimately eliminate the risk of exogenous endoscope-associated infections and contamination. As a first step, the FDA recently recommended that healthcare facilities and manufacturers begin transitioning to duodenoscopes with disposable components.3Funding: NoneDisclosures: None

Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: a systematic review

Endoscopy ◽  
2021 ◽  
Author(s):  
Judith A. Kwakman ◽  
Nicole S. Erler ◽  
Margreet C. Vos ◽  
Marco J. Bruno
Keyword(s):  
The Netherlands ◽  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Endoscopic Retrograde ◽  
Minimum Risk ◽  
Actual Risk ◽  
Molecular Matching ◽  
Estimated Risk ◽  
Technical Solutions ◽  
Risk Ratios

Abstract Background The risk of exogenous infections from endoscopic procedures is often cited as almost negligible (1 infection in 1.8 million procedures); however, this risk is based on older literature and does not seem to match the number of infectious outbreaks due to contaminated duodenoscopes reported after endoscopic retrograde cholangiopancreatography (ERCP). Using Dutch data, we aimed to estimate the minimum risk of duodenoscope-associated infection (DAI) and colonization (DAC) in patients undergoing ERCP. Methods A systematic literature search identified all DAI outbreaks in the Netherlands reported between 2008 and 2019. Included cases were confirmed by molecular matching of patient and duodenoscope cultures. Risk ratios were calculated based on the total number of ERCPs performed during the study period. Results Three outbreaks were reported and published between 2008 and 2018, including 21 confirmed DAI cases and 52 confirmed DAC cases. The estimated number of ERCPs performed during the same period was 181 209–227 006. The calculated minimum estimated DAI risk was approximately 0.01 % and the minimum estimated DAC risk was 0.023 %–0.029 %. Conclusions The estimated risk of DAI in Dutch ERCP practice was at least 180 times higher than previously published risk estimates. The actual risk is likely to be (much) higher due to underreporting of infections caused by multidrug-resistant organisms and sensitive bacteria. Greater awareness by healthcare personnel involved in endoscopy and endoscope cleaning is required, as well as innovative technical solutions to contain and ultimately eliminate DAIs.

scholarly journals Bacteremia Among Febrile Patients Attending Selected Healthcare Facilities in Ibadan, Nigeria

2019 ◽  
Vol 69 (Supplement_6) ◽  
pp. S466-S473 ◽  
Author(s):  
Oluwafemi Popoola ◽  
Aderemi Kehinde ◽  
Veronica Ogunleye ◽  
Oluwafemi J Adewusi ◽  
Trevor Toy ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Bacterial Infections ◽  
Common Species ◽  
Epidemiological Studies ◽  
Multidrug Resistant ◽  
African Countries ◽  
Healthcare Facilities ◽  
Relative Contribution ◽  
Polymerase Chain ◽  
Ibadan Nigeria

Abstract Background The relative contribution of bacterial infections to febrile disease is poorly understood in many African countries due to diagnostic limitations. This study screened pediatric and adult patients attending 4 healthcare facilities in Ibadan, Nigeria, for bacteremia and malaria parasitemia. Methods Febrile patients underwent clinical diagnosis, malaria parasite testing, and blood culture. Bacteria from positive blood cultures were isolated and speciated using biochemical and serological methods, and Salmonella subtyping was performed by polymerase chain reaction. Antimicrobial susceptibility was tested by disk diffusion. Results A total of 682 patients were recruited between 16 June and 16 October 2017; 467 (68.5%) were <18 years of age. Bacterial pathogens were cultured from the blood of 117 (17.2%) patients, with Staphylococcus aureus (69 [59.0%]) and Salmonella enterica (34 [29.1%]) being the most common species recovered. Twenty-seven (79.4%) of the Salmonella isolates were serovar Typhi and the other 7 belonged to nontyphoidal Salmonella serovarieties. Thirty-four individuals were found to be coinfected with Plasmodium falciparum and bacteria. Five (14.7%) of these coinfections were with Salmonella, all in children aged <5 years. Antimicrobial susceptibility testing revealed that most of the Salmonella and Staphylococcus isolates were multidrug resistant. Conclusions The study demonstrates that bacteria were commonly recovered from febrile patients with or without malaria in this location. Focused and extended epidemiological studies are needed for the introduction of typhoid conjugate vaccines that have the potential to prevent a major cause of severe community-acquired febrile diseases in our locality.

scholarly journals Registration of Blood Exposure Accidents in the Netherlands by a Nationally Operating Call Center

2012 ◽  
Vol 33 (10) ◽  
pp. 1017-1023
Author(s):  
Peter M. Schneeberger ◽  
Annemarie E. Meiberg ◽  
Janet Warmelts ◽  
Sander C. A. P. Leenders ◽  
Paul T. L. van Wijk
Keyword(s):  
The Netherlands ◽  
Call Center ◽  
Preventive Measures ◽  
Healthcare Providers ◽  
Mental Healthcare ◽  
Incidence Rates ◽  
Hepatitis B Vaccination ◽  
Occupational Health Services ◽  
Healthcare Facilities ◽  
Call Center Employees

Objective.Healthcare providers and other employees, especially those who do not work in a hospital, may not easily find help after the occurrence of a blood exposure accident. In 2006, a national call center was established in the Netherlands to fill this gap.Methods.All occupational blood exposure accidents reported to the 24-hours-per-day, 7-days-per-week call center from 2007, 2008, and 2009 were analyzed retrospectively for incidence rates, risk assessment, handling, and preventive measures taken.Results.A total of 2,927 accidents were reported. The highest incidence rates were reported for private clinics and hospitals (68.5 and 54.3 accidents per 1,000 person-years, respectively). Dental practices started reporting incidents frequently after the arrangement of a collective financial agreement with the call center. Employees of ambulance services, midwife practices, and private clinics reported mostly high-risk accidents, whereas penitentiaries frequently reported low-risk accidents. Employees in mental healthcare facilities, private clinics, and midwife practices reported accidents relatively late. The extent of hepatitis B vaccination in mental healthcare facilities, penitentiaries, occupational health services, and cleaning services was low (<70%).Conclusions.The national call center successfully organized the national registration and handling of blood exposure accidents. The risk of blood exposure accidents could be estimated on the basis of this information for several occupational branches. Targeted preventive measures for healthcare providers and other employees at risk can next be developed.Infect Control Hosp Epidemiol 2012;33(10):1017-1023

scholarly journals 1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S576-S577
Author(s):  
Brittany O’Brien ◽  
Sudha Chaturvedi ◽  
Vishnu Chaturvedi
Keyword(s):  
New York ◽  
Diagnostic System ◽  
Multidrug Resistant ◽  
Drug Combinations ◽  
Antifungal Drugs ◽  
Drug Resistant ◽  
Candida Auris ◽  
Current Case ◽  
Healthcare Facilities ◽  
Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

scholarly journals 1225. How Frequently Should Sink Drains Be Disinfected?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S440-S440
Author(s):  
Jorge A Ramos-Castaneda ◽  
Matthew L Faron ◽  
Joshua Hyke ◽  
Blake W Buchan ◽  
Rahul Nanchal ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Group ◽  
Care Hospital ◽  
Bacterial Reduction ◽  
Post Intervention ◽  
Bacterial Colony ◽  
Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 Patient Detection Based on Fusion of Transfer Learning and Fuzzy Ensemble Models Using CXR Images

2021 ◽  
Vol 11 (23) ◽  
pp. 11423
Author(s):  
Chandrakanta Mahanty ◽  
Raghvendra Kumar ◽  
Panagiotis G. Asteris ◽  
Amir H. Gandomi
Keyword(s):  
Transfer Learning ◽  
Ensemble Methods ◽  
Cost Effective ◽  
Majority Voting ◽  
Learning Models ◽  
Medical Practitioners ◽  
Healthcare Facilities ◽  
Ensemble Techniques ◽  
Effective Manner ◽  
Detection Strategies

The COVID-19 pandemic has claimed the lives of millions of people and put a significant strain on healthcare facilities. To combat this disease, it is necessary to monitor affected patients in a timely and cost-effective manner. In this work, CXR images were used to identify COVID-19 patients. We compiled a CXR dataset with equal number of 2313 COVID positive, pneumonia and normal CXR images and utilized various transfer learning models as base classifiers, including VGG16, GoogleNet, and Xception. The proposed methodology combines fuzzy ensemble techniques, such as Majority Voting, Sugeno Integral, and Choquet Fuzzy, and adaptively combines the decision scores of the transfer learning models to identify coronavirus infection from CXR images. The proposed fuzzy ensemble methods outperformed each individual transfer learning technique and several state-of-the-art ensemble techniques in terms of accuracy and prediction. Specifically, VGG16 + Choquet Fuzzy, GoogleNet + Choquet Fuzzy, and Xception + Choquet Fuzzy achieved accuracies of 97.04%, 98.48%, and 99.57%, respectively. The results of this work are intended to help medical practitioners achieve an earlier detection of coronavirus compared to other detection strategies, which can further save millions of lives and advantageously influence society.

scholarly journals How prepared are we for cross-border outbreaks? An exploratory analysis of cross-border response networks for outbreaks of multidrug resistant microorganisms in the Netherlands and Germany

PLoS ONE ◽  
2019 ◽  
Vol 14 (7) ◽  
pp. e0219548
Author(s):  
Jacklien H. J. Maessen ◽  
Jörg Raab ◽  
Manon Haverkate ◽  
Martin Smollich ◽  
Henriëtte L. G. ter Waarbeek ◽  
...  
Keyword(s):  
The Netherlands ◽  
Multidrug Resistant ◽  
Exploratory Analysis ◽  
Cross Border
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