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 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

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 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

scholarly journals High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands

PLoS ONE ◽  
2019 ◽  
Vol 14 (9) ◽  
pp. e0222200 ◽  
Author(s):  
Eline van Dulm ◽  
Aletta T. R. Tholen ◽  
Annika Pettersson ◽  
Martijn S. van Rooijen ◽  
Ina Willemsen ◽  
...  
Keyword(s):  
The Netherlands ◽  
Long Term Care ◽  
Multidrug Resistant ◽  
Term Care ◽  
High Prevalence ◽  
Care Facilities

scholarly journals Methicillin-Resistant Staphylococcus aureus Diabetic Foot Crossed Infection: A Case Report

Pathogens ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. 549 ◽  
Author(s):  
María Reina-Bueno ◽  
Inmaculada C. Palomo-Toucedo ◽  
Aurora Castro-Méndez ◽  
Gabriel Domínguez-Maldonado ◽  
María del Carmen Vázquez-Bautista
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Immunological Response ◽  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Diabetic Patients ◽  
Methicillin Resistant ◽  
Specific Protocol ◽  
Hygiene Measures ◽  
Patients With Diabetes

This work presents a protocol to prevent the transmission of multidrug-resistant infections. We focus on the Diabetic Foot Unit Podiatry Clinic Area attached to the University of Seville in particular. The most common complication for patients with diabetes is leg ulcers. Together with neuropathy, vasculopathy, and immunological response disorder, these individuals have a high predisposition to developing infections. Staphylococcus aureus is a highly prevalent microorganism in humans which, at times, may act as a pathogen. Due mainly to indiscriminate abuse of antibiotics, the methicillin-resistant strain known by its initials as MRSA is the most extended nosocomial infection globally and is a severe community and hospital healthcare problem. This paper describes compliance with new general recommendations on cleaning, hygiene, and decontamination, in addition to implementation of this specific protocol, after detection of cross infection (healthcare-related infection) in the studied unit in two patients with MRSA-infected ulcers. After an in-depth bibliographical review, strict hand hygiene measures and use of non-sterile gloves were used when treating all patients with a diabetic foot. Finally, we reflect on the need to educate healthcare personnel to guarantee correct prescription of selected antibiotics. The role of the podiatrist in the multidisciplinary team is highlighted not only in terms of management and treatment of lesions in diabetic patients, but also as a healthcare agent for the detection and prevention of MRSA together with other multidrug-resistant infections.

Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands

1999 ◽  
Vol 42 (3) ◽  
pp. 185-192 ◽  
Author(s):  
B.E.de Galan ◽  
P.M.B.van Tilburg ◽  
M Sluijter ◽  
S.J.M Mol ◽  
R.de Groot ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
The Netherlands ◽  
Multidrug Resistant

scholarly journals Characterization and whole genome sequencing of closely related multidrug-resistant Salmonella enterica serovar Heidelberg isolates from imported poultry meat in the Netherlands

PLoS ONE ◽  
2019 ◽  
Vol 14 (7) ◽  
pp. e0219795 ◽  
Author(s):  
Redmar R. van den Berg ◽  
Serge Dissel ◽  
Michel L. B. A. Rapallini ◽  
Coen C. van der Weijden ◽  
Ben Wit ◽  
...  
Keyword(s):  
The Netherlands ◽  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Salmonella Enterica ◽  
Multidrug Resistant ◽  
Poultry Meat ◽  
Whole Genome

scholarly journals Hospital Policies Related to Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA)

2020 ◽  
Vol 41 (S1) ◽  
pp. s252-s253
Author(s):  
Lindsey Lesher Erickson ◽  
Toben Nelson ◽  
J. Michael Oakes
Keyword(s):  
Hand Hygiene ◽  
Influenza Vaccination ◽  
Traffic Safety ◽  
Multidrug Resistant ◽  
Healthcare Personnel ◽  
Resistant Organism ◽  
Training And Education ◽  
Hospital Policies ◽  
Corrective Actions ◽  
Organizational Rules

Background: MRSA continues to spread in hospitals, despite modest recent success. Gaps exist regarding how hospital policies impact MRSA transmission in hospitals. Characterization of the policy environment has been useful in approaching other public health issues including control of alcohol, firearms, tobacco, and traffic safety. Objective: Our goal was to describe measurable and modifiable policy components designed to prevent MRSA in hospital settings. Methods: We examined 4 types of hospital policies from 5 metropolitan hospitals in Minnesota: hand hygiene, multidrug-resistant organism (MDRO) and isolation, healthcare personnel influenza vaccination, and whistleblower (corporate compliance). We developed a tool to systematically evaluate policies for each topic that included 19–23 instructional and implementation elements guided by regulatory and clinical practice guidelines: purpose, expectations, education and training, monitoring, enforcement, corrective actions, responsibilities, and corrective actions. Each policy element was evaluated for its presence (yes or no) and thoroughness (nonexistent = 0, cursory = 1, thorough = 2). Results: All hospitals had hand hygiene and MDRO and isolation policies; 3 of 5 had influenza and whistleblower policies. The policies varied in comprehensiveness and thoroughness across hospitals and topics. Most policies included purpose and policy statements with a statement of organizational rules (14 of 16 and 16 of 16, respectively) with mean thoroughness scores of 1.04 and 1.20, respectively. Most policies lacked consequences for noncompliance (6 of 16), accountability (6 of 16), and monitoring and enforcement of policy expectations (5 of 16). When included, the policy components scored low for thoroughness, and 50% of policies (8 of 16; range, 20% for hand hygiene and 100% for influenza vaccination) specified expectations for educating staff about the policy topic, with a mean thoroughness score of 0.75. Responsibilities for policy expectations were lacking: responsibilities for product needs and availability (3 of 13), training and education (1 of 16); and monitoring compliance with skills and techniques (4 of 16). Of the 4 policy types, influenza vaccination was the most complete. All influenza policies had 50% of categories completed versus hand hygiene (26%), MDRO (17%), and whistleblower (26%). The hand hygiene policies scored highest for thoroughness; 48% of policy elements scored >1.0 versus MDRO (22%), influenza (25%), and whistleblower (11%). Conclusions: We developed a systematic method to quantitatively evaluate hospital policies. Our review of hospital policies most commonly contained thorough instructional elements such as organizational requirements and protocols and procedures. Policies often lacked implementation elements such as expectations for monitoring, enforcement, responsibilities, accountabilities, and staff training and education. As we begin to characterize policy, endogenous in nature, as a potential exposure, it is important that we develop rigorous measurement. We have provided a first step in developing such an approach.Funding: NoneDisclosures: None

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