Nursing Home Outbreak of Invasive Group A Streptococcal Infections Caused by 2 Distinct Strains

2007 ◽  
Vol 28 (1) ◽  
pp. 68-74 ◽  
Author(s):  
Michael C. Thigpen ◽  
D. Michael Thomas ◽  
David Gloss ◽  
Sarah Y. Park ◽  
Amy J. Khan ◽  
...  
Keyword(s):  
Nursing Home ◽  
Infection Control ◽  
Group A Streptococcus ◽  
Respiratory Illness ◽  
Control Measures ◽  
Unknown Etiology ◽  
Susceptible Population ◽  
Invasive Group ◽  
Infection Control Measures ◽  
Group A

Objective.To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases.Design.Outbreak investigation.Setting.A 146-bed nursing home facility in northern Nevada.Methods.We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices.Results.Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts.Conclusions.Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.

Successive outbreaks of Group A streptococcus (GAS) in care of the elderly settings; lessons learned

2011 ◽  
Vol 13 (2) ◽  
pp. 38-43 ◽  
Author(s):  
T Inkster ◽  
P Wright ◽  
H Kane ◽  
E Paterson ◽  
S Dodd ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Infection Control ◽  
Healthcare Workers ◽  
Group A Streptococcus ◽  
The Elderly ◽  
Rapid Identification ◽  
Lessons Learned ◽  
Control Measures ◽  
Infection Control Measures ◽  
Group A

Group A streptococcal (GAS) outbreaks in care of the elderly settings are rare. We describe two successive outbreaks involving care of the elderly patients. The first outbreak involved 18 patients and the second involved six patients and two healthcare workers. We describe the difficulties encountered controlling GAS outbreaks in care of the elderly settings and how the lessons learned from the first outbreak influenced management of the second incident. Stringent infection control measures including isolation until completion of treatment and re-screening for evidence of eradication were required to bring outbreak one under control. These measures were adopted early in outbreak two and we suspect that these measures and the rapid identification of carriers brought this second outbreak under control quickly.

scholarly journals Group A Streptococcal Endometritis: Report of an Outbreak and Review of the Literature

1994 ◽  
Vol 5 (6) ◽  
pp. 276-281 ◽  
Author(s):  
Ziad A Memish ◽  
Denise Gravel-Tropper ◽  
Catherine Oxley ◽  
Baldwin Toye ◽  
Gary E Garber
Keyword(s):  
Infection Control ◽  
Group A Streptococcus ◽  
Invasive Procedure ◽  
Restriction Endonuclease Analysis ◽  
Skin Lesions ◽  
Control Measures ◽  
Direct Patient Care ◽  
Infection Control Measures ◽  
History Of ◽  
Group A

Two cases of group A streptococcus (gas) postpartum endometritis were diagnosed within 24 h following uncomplicated vaginal delivery. Investigation by the infection control service identified all 10 obstetric personnel who performed any invasive procedure on both cases. These personnel were questioned about a recent history of sore throat, skin lesions, vaginal or rectal symptoms. Throat and rectal cultures were obtained forgasfrom all 10 personnel. A carrier was identified among the personnel screened. This nurse was removed from direct patient care and treated with a two-week course of oral clindamycin and rifampin with documentation of carrier eradication ofgasat the end of therapy, 30 days, 60 days and six months post-treatment. All three isolated strains were identical by restriction endonuclease analysis and by M and T typing. Rapid implementation of infection control measures were successful in arresting this outbreak, with no further cases ofgasoccurring in the subsequent year.

scholarly journals 1891. Invasive Group A Streptococcus Infections Among Residents of Multiple Nursing Homes—Denver, Colorado, 2017–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S55-S56
Author(s):  
Osatohamwen Idubor ◽  
Nisha B Alden ◽  
Srinivas Nanduri ◽  
Abimbola Ogundimu ◽  
Sukarma S S Tanwar ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Infection Control ◽  
Group A Streptococcus ◽  
Multiple Infection ◽  
Invasive Group ◽  
Increased Risk ◽  
Group A ◽  
Sterile Site ◽  
Colorado Department ◽  
Emm Type

Abstract Background Older adults residing in nursing homes (NH) are at increased risk for invasive group A Streptococcus (GAS) infections due to advanced age, presence of wounds, and comorbidities; approximately one-third of infected patients die. Beginning in 2015, increasing numbers of GAS infections in NH residents and several NH clusters were reported from the Denver metropolitan area. Colorado Department of Public Health and Environment (CDPHE) and CDC investigated to characterize cases and assess if outbreaks resulted from interfacility transmission. Methods We reviewed data from Active Bacterial Core surveillance (ABCs) in the 5-county Denver area from January 2017 to June 2018. We defined a case as isolation of GAS from a normally sterile site in an NH resident. GAS isolates underwent whole-genome sequencing (WGS) at CDC’s Streptococcus Laboratory to determine emm types for genotyping. Among isolates with the same emm type, pairwise single-nucleotide polymorphism (SNP) distances were calculated using Nucmer software. In October 2018, a CDPHE-CDC team assessed infection control at NHs with cases of the most common emm type. Results Over 18 months, among >100 NHs in the Denver area, ≥1 GAS case was identified in 29 NHs, with 6 having ≥3 cases. During this period, 68 cases in NH residents were identified. WGS identified 17 emm types among isolates from these cases; most common was emm11.10 (34%, n = 22), a rare subtype in ABCs. All emm11.10 isolates had nearly identical genomes (average pairwise SNP distance: 3.2), and were isolated from 10 NHs, with 2 NHs having ≥ 4 cases. Multiple infection control lapses were noted during site visits to 8 NHs. Conclusion Multiple outbreaks due to GAS were noted in 5-county Denver area NHs in 2017–2018. WGS of surveillance isolates identified a rarely seen emm subtype 11.10 from multiple facilities with temporal and genomic clustering suggesting interfacility GAS transmission. Disclosures All Authors: No reported Disclosures.

Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home

2000 ◽  
Vol 21 (11) ◽  
pp. 700-704 ◽  
Author(s):  
Christine Lee ◽  
Mark Loeb ◽  
Anne Phillips ◽  
Judy Nesbitt ◽  
Karen Smith ◽  
...  
Keyword(s):  
Nursing Home ◽  
Influenza A ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Respiratory Illness ◽  
The Elderly ◽  
Control Measures ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures

AbstractObjective:To describe the use of zanamivir during an influenza A outbreak.Population:Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.Outbreak:When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.Intervention:Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.Results:There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.Conclusion:A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.

scholarly journals COVID-19 and ophthalmology- Challenges and mitigation of disease

2021 ◽  
Vol 7 (2) ◽  
pp. 284-288
Author(s):  
Pravin M Bhat ◽  
Sunil S Kewat
Keyword(s):  
Infection Control ◽  
Respiratory Illness ◽  
Control Measures ◽  
Protective Equipment ◽  
Health Crisis ◽  
Surface Disinfection ◽  
Infection Control Measures ◽  
Contagious Nature ◽  
The World ◽  
Respiratory Hygiene

The SARS-CoV-2 infection has become a global health crisis with an uprising trend of infection and death in the world. Considering the contagious nature and the human to human transmission of the disease, it is utmost important to follow the infection control measures in the ophthalmic practice. The pink eye or conjunctivitis is the associated symptom reported along with the respiratory illness and fever in patients of COVID-19. So the triage policy, using noncontact procedures, understanding the risk factors of the disease, postponement of routine ophthalmic patient’s visit, following respiratory hygiene, hand hygiene, using personal protective equipment (PPE) are some of the measures to keep the infection in control are explained in this article. The surface disinfection, equipment disinfection are also important considering the environmental contamination nature of the disease. So in order to minimize the infection every ophthalmologist should work as per the guidelines and measures and work with the local designated infection control authorities.

Screening High-Risk Patients for Methicillin-ResistantStaphylococcus Aureuson Admission to the Hospital Is It Cost Effective?

1999 ◽  
Vol 20 (7) ◽  
pp. 473-477 ◽  
Author(s):  
Giuseppe Papia ◽  
Marie Louie ◽  
Arnold Tralla ◽  
Claudette Johnson ◽  
Veronica Collins ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Infection Control ◽  
Control Measures ◽  
Care Hospital ◽  
High Risk Patients ◽  
Infection Control Measures ◽  
Risk Patients ◽  
Nursing Costs ◽  
Mrsa Colonization

Objectives:To determine the cost-effectiveness of a policy of screening high-risk patients for methicillin-resistantStaphylococcus aureus(MRSA) colonization on admission to hospital.Setting:980-bed university-affiliated tertiary-care hospital.Patients:Between June 1996 and May 1997, patients directly transferred from another hospital or nursing home, or who had been hospitalized in the previous 3 months, were screened for MRSA within 72 hours of hospital admission.Design:Nasal, perineal, and wound swabs were obtained for MRSA screening using standard laboratory methods. Laboratory and nursing costs associated with screening patients for MRSA on admission to hospital were calculated. The costs associated with the implementation of recommended infection control measures for patients with MRSA also were determined.Results:3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), representing 36% of the 64 patients with MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4;P=.04) or to have had a previous history of MRSA colonization (OR, 13.1;P=.05). Laboratory and nursing costs were found to be $8.34 per specimen, for a total cost of $30,632 during the year. The average cost of implementing recommended infection control measures for patients colonized with MRSA was approximately $5,235 per patient.Conclusion:If early identification of MRSA in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.

scholarly journals Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes

2021 ◽  
Vol 18 (11) ◽  
pp. 5805
Author(s):  
Ryuichi Ohta ◽  
Yoshinori Ryu ◽  
Chiaki Sano
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Statistical Power ◽  
Control Period ◽  
Control Measures ◽  
Secondary Outcome ◽  
Rural Nursing ◽  
Infection Control Measures ◽  
Number Of Visits

This study aimed to clarify the effect of coronavirus disease (hereafter, COVID-19) control on patients’ health conditions and staff’s working conditions in rural nursing homes. An interventional study including all staff and patients in a rural nursing home was performed from 1 April 2019 to 31 March 2021. Infection control measures against COVID-19 were initiated on 1 April 2020. The primary outcome was the frequency of patients’ medical care visits to the outpatient and emergency departments. The secondary outcome was the number of days-off taken by staff. Each group (pre- and post-COVID-19 control groups) had 48 participants. The number of visits to the outpatient department reduced from the pre-COVID-19 to post-COVID-19 control period the difference in number of visits to the emergency department was not significant, due to the low statistical power. The number of days-off taken by the staff was increased from the pre-COVID-19 to post-COVID-19 control period. This is the first study investigating COVID-19 control measures in a rural nursing home. It may help reduce the number of patient visits to medical facilities without increasing the risk of emergencies. A strict health check of the staff can allow staff to take more days off in rural contexts.

Tightly Clustered Outbreak of Group A Streptococcal Disease at a Long-Term Care Facility

2006 ◽  
Vol 27 (12) ◽  
pp. 1377-1384 ◽  
Author(s):  
Kathryn E. Arnold ◽  
Jody L. Schweitzer ◽  
Barbara Wallace ◽  
Monique Salter ◽  
Ruth Neeman ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Care Facility ◽  
Control Measures ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Infection Control Measures ◽  
Group A

Objective.To describe investigation of a tightly clustered outbreak of invasive group A streptococcal (GAS) disease associated with a high mortality rate in a long-term care facility (LTCF).Design.Cross-sectional carriage survey and epidemiologic investigation of LTCF resident and employee cohorts.Setting.A 104-bed community LTCF between March 1 and April 7, 2004.Patients.A cohort of LTCF residents with assigned beds at the time of the outbreak.Interventions.Reinforcement of standard infection control measures and receipt of chemoprophylaxis by GAS carriers.Results.Four confirmed and 2 probable GAS cases occurred between March 16 and April 1, 2004. Four case patients died. The final case occurred during the investigation, before the patient was determined to be a GAS carrier. No case occurred during the 6 months after the intervention. Disease was caused by typeemm3GAS; 16.5% of residents and 2.4% of employees carried the outbreak strain. Disease was clustered in 1 quadrant of the LTCF and associated with nonintact skin. GAS disease or carriage was associated with having frequent personal visitors.Conclusions.Widespread carriage of a virulent GAS strain likely resulted from inadequate infection control measures. Enhanced infection control and targeted prophylaxis for GAS carriers appeared to end the outbreak. In addition to employees, regular visitors to LTCFs should be trained in hand hygiene and infection control because of the potential for extended relationships over time, leading to interaction with multiple residents, and disease transmission in such residential settings. Specific attention to prevention of skin breaks and proper wound care may prevent disease. The occurrence of a sixth case during the investigation suggests urgency in addressing severe, large, or tightly clustered outbreaks of GAS infection in LTCFs.

scholarly journals Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care

2020 ◽  
Author(s):  
Patricia Rios ◽  
Amruta Radhakrishnan ◽  
Sonia M. Thomas ◽  
Nazia Darvesh ◽  
Sharon E. Straus ◽  
...  
Keyword(s):  
Infection Control ◽  
Long Term Care ◽  
Respiratory Infections ◽  
Respiratory Illness ◽  
Control Measures ◽  
Term Care ◽  
Infection Control Measures ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

ABSTRACTBackgroundThe overall objective of this rapid review was to identify infection protection and control recommendations from published clinical practice guidelines (CPGs) for adults aged 60 years and older in long-term care settingsMethodsComprehensive searches in MEDLINE, EMBASE, the Cochrane Library, and relevant CPG publishers/repositories were carried out in early March 2020. Title/abstract and full-text screening, data abstraction, and quality appraisal (AGREE-II) were carried out by single reviewers.ResultsA total of 17 relevant CPGs were identified, published in the USA (n=8), Canada (n=6), Australia (n=2), and the United Kingdom (n=1). All of the CPGs dealt with infection control in long-term care facilities (LTCF) and addressed various types of viral respiratory infections (e.g., influenza, COVID-19, severe acute respiratory syndrome). Ten or more CPGs recommended the following infection control measures in LTCF: hand hygiene (n=13), wearing personal protective equipment (n=13), social distancing or isolation (n=13), disinfecting surfaces (n=12), droplet precautions (n=12), surveillance and evaluation (n=11), and using diagnostic testing to confirm illness (n=10). While only two or more CPGs recommended these infection control measures: policies and procedures for visitors, staff and/or residents (n=9), respiratory hygiene/cough etiquette (n=9), providing supplies (n=9), staff and/or residents education (n=8), increasing communication (n=6), consulting or notifying health professionals (n=6), appropriate ventilation practices (n=2), and cohorting equipment (n=2). Ten CPGs also addressed management of viral respiratory infections in LTCF and recommended antiviral chemoprophylaxis (n=10) and one CPG recommended early mobilization of residents.ConclusionThe recommendations from current guidelines overall seem to support environmental measures for infection prevention and antiviral chemoprophylaxis for infection management as the most appropriate first-line response to viral respiratory illness in long-term care.

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