scholarly journals Contamination of Healthcare Worker Personal Protective Equipment with MRSA Outside the Intensive Care Unit Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s27-s28
Author(s):  
Gita Nadimpalli ◽  
Lisa Pineles ◽  
Karly Lebherz ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Care ◽  
Direct Patient Care ◽  
Care Group ◽  
Surveillance Culture ◽  
Care Hospital ◽  
Contact Precautions ◽  
Patient Interactions ◽  
The Right

Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.Funding: NoneDisclosures: None

scholarly journals Patient to healthcare personnel transmission of MRSA in the non–intensive care unit setting

2020 ◽  
Vol 41 (5) ◽  
pp. 601-603
Author(s):  
Gita Nadimpalli ◽  
Lyndsay M. O’Hara ◽  
Lisa Pineles ◽  
Karly Lebherz ◽  
J. Kristie Johnson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Patient Care ◽  
Transmission Rate ◽  
Intensive Care Unit Setting ◽  
Healthcare Personnel ◽  
Direct Patient Care ◽  
Methicillin Resistant ◽  
Contact Precautions

AbstractThe transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.

scholarly journals Assistência de enfermagem humanizada ao paciente em UTI

2013 ◽  
pp. 17
Author(s):  
Claudir Aparecido Vieira ◽  
Luiz Faustino dos Santos Maia
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Analysis ◽  
Continuing Education ◽  
Patient Care ◽  
Nursing Care ◽  
Nursing Staff ◽  
Analysis Data ◽  
Terapia Intensiva ◽  
The Right

Hoje em dia a humanização é ponto de pauta nos encontros nacionais e internacionais da área da saúde. Assim, cada vez mais enfermeiros nas unidades de terapia intensiva tem se preocupado com a sua prática. O presente estudo foi desenvolvido com o objetivo de compreender, reconhecer e entender como o comportamento humanizado reflete ao paciente e identificar a percepção da equipe de enfermagem sobre o processo de humanização. Trata-se de uma pesquisa de revisão bibliográfica descritiva com análise qualitativa, os dados foram coletados nas Bases de Dados de Enfermagem (BDENF) da Biblioteca Virtual de Saúde (BVS) e livros publicados no período de 2009 a 2012. O ambiente de cuidados em UTI precisa ser acolhedor, integrador e estimulador para todos os envolvidos no processo de cuidado e/ou sob o cuidado. A humanização não tem data e nem momento certo para acontecer, devendo estar presente em todas as ações dos profissionais no cuidado ao paciente, a despeito das barreiras encontradas. A educação permanente é uma importante aliada que pode contribuir de forma positiva para assistência humanizada.Descritores: Enfermagem, Humanização, Unidade de Terapia Intensiva. Humanized nursing care to the patient in ICUAbstract: Today, the humanization is point to agenda in national and international meetings in the field of health. Thus, more and more, nurses in intensive care units were been concerned with its practice. The present study was aimed to understand, recognize how the behavior humanized reflects in the patient and identify the perception of the nursing staff on the process of humanization. This is a bibliographic survey with descriptive and qualitative analysis data were collected in the Basis of Data of Nursing (BDENF) of the Virtual Health Library (BVS) and books published between 2009 and 2012. The environment of care in the ICU needs to be welcoming, inclusive and stimulating for all involved in the care and/or under the care. Humanization is undated and not the right time to happen, and should be present in all the actions of the professionals in patient care, despite the barriers encountered. Continuing education is an important tool that can contribute positively to the humanized.Descriptors: Nursing, Humanization, Intensive Care Unit. Asistencia de enfermería humanizada para el paciente en la UCIResumen: Hoy es el orden del día el punto humanización en reuniones nacionales e internacionales en el campo de la salud. Por lo tanto, más y más enfermeras en las unidades de cuidados intensivos se ha preocupado con su practica. El presente estudio tuvo como objetivo comprender, reconocer y entender cómo el comportamiento humanizado refleja el paciente e identificar la percepción del personal de enfermería en el proceso de humanización. Se trata de un estudio de analisis cualitativo descriptivo bibliográfica, se recogieron datos sobre la Base de Datos de Enfermería (BDENF) de la Biblioteca Virtual en Salud (BVS) y los libros publicados entre 2009-2012. El entorno de los cuidados en la UCI debe ser acogedor, integrador y estimulante para todos los involucrados en el cuidado y/o bajo el cuidado. La humanización no tiene fecha y no el momento adecuado para pasar, y debe estar presente en todas las acciones de los profesionales en la atención al paciente, a pesar de los obstáculos encontrados. La educación continua es una herramienta importante que puede contribuir positivamente a humanizado.Descriptores: Enfermería, Humanización, Unidad de Cuidados Intensivos.

Rate of Healthcare Worker–Patient Interaction and Hand Hygiene Opportunities in an Acute Care Setting

2014 ◽  
Vol 35 (3) ◽  
pp. 225-230 ◽  
Author(s):  
Laura Goodliffe ◽  
Kelsey Ragan ◽  
Michael Larocque ◽  
Emily Borgundvaag ◽  
Sophia Khan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Healthcare Worker ◽  
Acute Care ◽  
Healthcare Workers ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Factors Affecting ◽  
Patient Interactions

Objective.Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.Design.Prospective observational study.Setting.Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.Participants.Healthcare workers.Methods.One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the “Four Moments for Hand Hygiene.” Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.Results.During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions.Conclusions.Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.

scholarly journals Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Gaud Catho ◽  
R. Martischang ◽  
F. Boroli ◽  
M. N. Chraïti ◽  
Y. Martin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Patient Care ◽  
Control Strategies ◽  
Tertiary Care ◽  
Mitigation Strategies ◽  
Care Hospital ◽  
Adult Intensive Care Unit ◽  
Vim Carbapenemase

Abstract Background Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually failed to eradicate environmental sources of Pseudomonas aeruginosa. Methods We report the investigation and termination of an outbreak of P. aeruginosa producing VIM carbapenemase (PA-VIM) in the adult intensive care unit (ICU) of a Swiss tertiary care hospital with active case finding, environmental sampling and whole genome sequencing (WGS) of patient and environmental strains. We also describe the implemented control strategies and their effectiveness on eradication of the environmental reservoir. Results Between April 2018 and September 2020, 21 patients became either infected or colonized with a PA-VIM strain. For 16 of them, an acquisition in the ICU was suspected. Among 131 environmental samples collected in the ICU, 13 grew PA-VIM in sink traps and drains. WGS confirmed the epidemiological link between clinical and environmental strains and the monoclonal pattern of the outbreak. After removing sinks from patient rooms and implementation of waterless patient care, no new acquisition was detected in the ICU within 8 months after the intervention. Discussion Implementation of waterless patient care with removal of the sinks in patient rooms was successful for termination of a PA-VIM ICU outbreak linked to multiple environmental water sources. WGS provides highly discriminatory accuracy to investigate environment-related outbreaks.

Increasing Prevalence of Gastrointestinal Colonization With Ceftazidime-Resistant Gram-Negative Bacteria Among Intensive Care Unit Patients

2007 ◽  
Vol 28 (11) ◽  
pp. 1240-1246 ◽  
Author(s):  
Kerri A. Thom ◽  
Judith A. Johnson ◽  
Sandra M. Strauss ◽  
Jon P. Furuno ◽  
Eli N. Perencevich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Surveillance Culture ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Clinical Culture ◽  
Gastrointestinal Colonization ◽  
Culture Positive

Background.The occurrence of nosocomial infections due to third-generation cephalosporin–resistant gram-negative bacteria is increasing. Gastrointestinal colonization is an important reservoir for antibiotic-resistant bacteria, and it often precedes clinical infection.Objective.To estimate the prevalence of gastrointestinal colonization with ceftazidime-resistant gram-negative bacteria among intensive care unit (ICU) patients at a university-affiliated tertiary-care hospital during 2 distinct periods and to assess whether, at any time during the index hospitalization, colonized patients had a clinical culture positive for the same organism that was recovered from surveillance culture.Setting.Two ICUs at the University of Maryland Medical Center, a 656-bed tertiary-care hospital located in Baltimore, Maryland. Both ICUs provide care to adult patients.Methods.We performed a cross-sectional study of adult patients admitted to the medical ICU or the surgical ICU from June 14 to July 14, 2003, and from June 14 to July 14, 2006. Perirectal swab samples were obtained for surveillance culture on admission to the intensive care unit, weekly thereafter, and at discharge. Each culture sample was plated onto MacConkey agar supplemented with ceftazidime.Results.In 2003, a total of 33 (18.8%) of 176 patients were colonized with ceftazidime-resistant gram-negative bacilli; in 2006, 60 (31.4%) of 191 patients were (P<.01). This increase was largely driven by an increase in ceftazidime-resistantKlebsiellaisolates (which accounted for 6.4% of isolates in 2003 and for 22.8% in 2006;P<.01). In 2003, a total of 16 (48.5%) of 33 colonized patients had a clinical culture positive for the same organism that was recovered from the perirectal surveillance culture, compared with 22 (36.6%) of 60 colonized patients in 2006 (P= .28).Conclusion.Our data suggest that gastrointestinal colonization with ceftazidime-resistant gram-negative bacilli is common, that its prevalence is increasing, and that colonization may result in clinical cultures positive for these bacilli.

scholarly journals Outbreak of Pseudomonas Aeruginosa Producing VIM Carbapenemase in an Intensive Care Unit and its termination by implementation of waterless patient care

2021 ◽  
Author(s):  
Gaud Catho ◽  
R. Martischang ◽  
F. Boroli ◽  
M.N. Chraïti ◽  
Y. Martin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Patient Care ◽  
Control Strategies ◽  
Tertiary Care ◽  
Mitigation Strategies ◽  
Care Hospital ◽  
Adult Intensive Care Unit ◽  
Vim Carbapenemase

Abstract Background: Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually failed to eradicate environmental sources of Pseudomonas aeruginosa.Methods: We report the investigation and termination of an outbreak of P. aeruginosa producing VIM carbapenemase (PA-VIM) in the adult intensive care unit (ICU) of a Swiss tertiary care hospital with active case finding, environmental sampling and whole genome sequencing (WGS) of patient and environmental strains. We also describe the implemented control strategies and their effectiveness on eradication of the environmental reservoir.Results: Between April 2018 and September 2020, 21 patients became either infected or colonized with a PA-VIM strain. For 16 of them, an acquisition in the ICU was suspected. Among 131 environmental samples collected in the ICU, 13 grew PA-VIM in sink traps and drains. WGS confirmed the epidemiological link between clinical and environmental strains and the monoclonal pattern of the outbreak. After removing sinks from patient rooms and implementation of waterless patient care, no new acquisition was detected in the ICU within 6 months after the intervention.Discussion: Implementation of waterless patient care with removal of the sinks in patient rooms was successful for termination of a PA-VIM ICU outbreak linked to multiple environmental water sources. WGS provides highly discriminatory accuracy to investigate environment-related outbreaks.

scholarly journals Assistência de enfermagem humanizada ao paciente em UTI

2013 ◽  
Vol 3 (9) ◽  
pp. 17
Author(s):  
Claudir Aparecido Vieira ◽  
Luiz Faustino dos Santos Maia
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Qualitative Analysis ◽  
Continuing Education ◽  
Patient Care ◽  
Nursing Care ◽  
Nursing Staff ◽  
Analysis Data ◽  
Terapia Intensiva ◽  
The Right

Hoje em dia a humanização é ponto de pauta nos encontros nacionais e internacionais da área da saúde. Assim, cada vez mais enfermeiros nas unidades de terapia intensiva tem se preocupado com a sua prática. O presente estudo foi desenvolvido com o objetivo de compreender, reconhecer e entender como o comportamento humanizado reflete ao paciente e identificar a percepção da equipe de enfermagem sobre o processo de humanização. Trata-se de uma pesquisa de revisão bibliográfica descritiva com análise qualitativa, os dados foram coletados nas Bases de Dados de Enfermagem (BDENF) da Biblioteca Virtual de Saúde (BVS) e livros publicados no período de 2009 a 2012. O ambiente de cuidados em UTI precisa ser acolhedor, integrador e estimulador para todos os envolvidos no processo de cuidado e/ou sob o cuidado. A humanização não tem data e nem momento certo para acontecer, devendo estar presente em todas as ações dos profissionais no cuidado ao paciente, a despeito das barreiras encontradas. A educação permanente é uma importante aliada que pode contribuir de forma positiva para assistência humanizada.Descritores: Enfermagem, Humanização, Unidade de Terapia Intensiva. Humanized nursing care to the patient in ICUAbstract: Today, the humanization is point to agenda in national and international meetings in the field of health. Thus, more and more, nurses in intensive care units were been concerned with its practice. The present study was aimed to understand, recognize how the behavior humanized reflects in the patient and identify the perception of the nursing staff on the process of humanization. This is a bibliographic survey with descriptive and qualitative analysis data were collected in the Basis of Data of Nursing (BDENF) of the Virtual Health Library (BVS) and books published between 2009 and 2012. The environment of care in the ICU needs to be welcoming, inclusive and stimulating for all involved in the care and/or under the care. Humanization is undated and not the right time to happen, and should be present in all the actions of the professionals in patient care, despite the barriers encountered. Continuing education is an important tool that can contribute positively to the humanized.Descriptors: Nursing, Humanization, Intensive Care Unit. Asistencia de enfermería humanizada para el paciente en la UCIResumen: Hoy es el orden del día el punto humanización en reuniones nacionales e internacionales en el campo de la salud. Por lo tanto, más y más enfermeras en las unidades de cuidados intensivos se ha preocupado con su practica. El presente estudio tuvo como objetivo comprender, reconocer y entender cómo el comportamiento humanizado refleja el paciente e identificar la percepción del personal de enfermería en el proceso de humanización. Se trata de un estudio de analisis cualitativo descriptivo bibliográfica, se recogieron datos sobre la Base de Datos de Enfermería (BDENF) de la Biblioteca Virtual en Salud (BVS) y los libros publicados entre 2009-2012. El entorno de los cuidados en la UCI debe ser acogedor, integrador y estimulante para todos los involucrados en el cuidado y/o bajo el cuidado. La humanización no tiene fecha y no el momento adecuado para pasar, y debe estar presente en todas las acciones de los profesionales en la atención al paciente, a pesar de los obstáculos encontrados. La educación continua es una herramienta importante que puede contribuir positivamente a humanizado.Descriptores: Enfermería, Humanización, Unidad de Cuidados Intensivos.

Transition from an Open Bay to a Private Room Neonatal Intensive Care Unit Design — A Human Factors Evaluation

2005 ◽  
Vol 49 (11) ◽  
pp. 974-978 ◽  
Author(s):  
Thomas J. Smith ◽  
Sandra Clayton ◽  
Kathleen Schoenbeck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Human Factors ◽  
Neonatal Intensive Care Unit ◽  
Patient Care ◽  
Neonatal Intensive Care ◽  
Patient Care Team ◽  
Care Staff ◽  
Care Technology

This report summarizes findings from a human factors evaluation of a change in the design of a neonatal intensive care unit (NICU) from an open bay (OBNICU) to a private room (PRNICU) patient care environment. The objective was to compare and contrast effects of this design change on the perceptions and performance of NICU patient care staff. Results indicate that, relative to work on the OBNICU, staff perceived that work on the PRNICU resulted in notable improvements in the quality of physical environmental conditions, their jobs, patient care and patient safety, interaction with parents of NICU patients, interaction with patient care technology and their life off-the-job. In contrast, staff perceived that the quality of interaction among different members of the NICU patient care team worsened substantially after the move to the PRNICU. The latter finding prompted the recommendation that a virtual open bay environment be implemented in the PRNICU.

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