scholarly journals Detection of Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci on the Gowns and Gloves of Healthcare Workers

2008 ◽  
Vol 29 (7) ◽  
pp. 583-589 ◽  
Author(s):  
Graham M. Snyder ◽  
Kerri A. Thorn ◽  
Jon P. Furuno ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Routine Care ◽  
Inpatient Setting ◽  
Jejunostomy Tube ◽  
Endoscopic Gastrostomy ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant

Objective.To assess the rate of and the risk factors for the detection of methicillin-resistantS. aureus(MRSA) and vancomycin-resistant enterococci (VRE) on the protective gowns and gloves of healthcare workers (HCWs).Methods.We observed the interactions between HCWs and patients during routine clinical activities in a 29-bed medical intensive care unit at the University of Maryland Medical Center, an urban tertiary care academic hospital. Samples for culture were obtained from HCWs' hands prior to their entering a patient's room, from HCWs' disposable gowns and gloves after they completed patient care activities, and from HCWs' hands immediately after they removed their protective gowns and gloves.Results.Of 137 HCWs caring for patients colonized or infected with MRSA and/or VRE, 24 (17.5%; 95% confidence interval, 11.6%–24.4%) acquired the organism on their gloves, gown, or both. HCW contact with the endotracheal tube or tracheostomy site of a patient (P< .05), HCW contact with the head and/or neck of a patient (P< .05), and HCW presence in the room of a patient with a percutaneous endoscopic gastrostomy and/or jejunostomy tube (P< .05) were associated with an increased risk of acquiring these organisms.Conclusions.The gloves and gowns of HCWs frequently become contaminated with MRSA and VRE during the routine care of patients, and particularly during care of the patient's respiratory tract and any associated indwelling devices. As part of a larger infection control strategy, including high-compliance hand disinfection, they likely provide a useful barrier to transmitting antibiotic-resistant organisms among patients in an inpatient setting.

Risk of Hand or Glove Contamination After Contact With Patients Colonized With Vancomycin-ResistantEnterococcusor the Colonized Patients' Environment

2008 ◽  
Vol 29 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Mary K. Hayden ◽  
Donald W. Blom ◽  
Elizabeth A. Lyle ◽  
Charity G. Moore ◽  
Robert A. Weinstein
Keyword(s):  
Healthcare Workers ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Routine Care ◽  
Intact Skin ◽  
Vancomycin Resistant Enterococci ◽  
After Care ◽  
Before And After ◽  
Medical Intensive Care ◽  
Vancomycin Resistant

Objective.To estimate the level of hand or glove contamination with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) who touch a patient colonized with VRE and/or the colonized patient's environment during routine care.Design.Structured observational study.Setting.Medical intensive care unit of a 700-bed, tertiary-care teaching hospital.Participants.VRE-colonized patients and their caregivers.Methods.We obtained samples from sites on the intact skin of 22 patients colonized with VRE and samples from sites in the patients' rooms, before and after routine care, during 27 monitoring episodes. A total of 98 unique HCWs were observed during 131 HCW observations. Observers recorded the sites touched by HCWs. Culture samples were obtained from HCWs' hands and gloves before and after care.Results.VRE were isolated from a mean (±SD) of 55% ± 24% of patient sites (n= 256) and 17% ± 12% of environmental sites (n= 1,572). Most HCWs (131 [56%]) touched both the patient and the patient's environment; no HCW touched only the patient. Of 103 HCWs whose hand samples were negative for VRE when they entered the room, 52% contaminated their hands or gloves after touching the environment, and 70% contaminated their hands or gloves after touching the patient and the environment (P= .101). In a univariate logistic regression model, the risk of hand or glove contamination was associated with the number of contacts made (odds ratio, 1.1 [95% confidence interval, 1.01-1.19). In a multivariate model, the effect of the number of contacts could not be distinguished from the effect of type of contact (ie, touching the environment alone or touching both the patient and the environment). Overall, 37% of HCWs who did not wear gloves contaminated their hands, and 5% of HCWs who wore gloves did so (an 86% difference).Conclusion.HCWs were nearly as likely to have contaminated their hands or gloves after touching the environment in a room occupied by a patient colonized by VRE as after touching the colonized patient and the patient's environment. Gloves were highly protective with respect to hand contamination.

scholarly journals Association between Vancomycin-Resistant Enterococci Bacteremia and Ceftriaxone Usage

2012 ◽  
Vol 33 (7) ◽  
pp. 718-724 ◽  
Author(s):  
James A. McKinnell ◽  
Danielle F. Kunz ◽  
Eric Chamot ◽  
Mukesh Patel ◽  
Rhett M. Shirley ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Medical Center ◽  
Tertiary Care ◽  
Health Concern ◽  
Care Hospital ◽  
Antimicrobial Usage ◽  
Vancomycin Resistant Enterococci ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Vancomycin Resistant

Objective.Vancomycin-resistant enterococci (VRE) have become a public health concern with implications for patient mortality and costs. Hospital antibiotic usage may impact VRE incidence, but the relationship is poorly understood. Animal investigations suggest that ceftriaxone may be associated with VRE proliferation. We measured antimicrobial usage and VRE bloodstream infection (VRE-BSI) incidence to test our hypothesis that increased ceftriaxone usage would be associated with a higher incidence of VRE-BSI.Design.Retrospective cohort study.Setting.University of Alabama at Birmingham Medical Center, a 900-bed urban tertiary care hospital.Participants.All patients admitted during the study period contributed data.Methods.We conducted a retrospective analysis of antimicrobial usage and VRE-BSI from 2005 to 2008 (43 months). Antimicrobial usage was quantified as days of therapy (DOTs) per 1,000 patient-days. VRE-BSI incidence was calculated as cases per 1,000 patient-days. Negative binomial regression with adjustment for correlation between consecutive observations was used to measure the association between antimicrobial usage and VRE-BSI incidence at the hospital- and care-unit levels.Results.VRE-BSI incidence increased from 0.06 to 0.17 infections per 1,000 patient-days. Hospital VRE-BSI incidence was associated with prior-month ceftriaxone DOTs (incidence rate ratio, 1.38 per 10 DOTs; P = .005). After controlling for ceftriaxone, prior-month cephalosporin usage (class) was not predictive of VRE-BSI (P = .70). Similarly, prior-month usage of piperacillin-tazobactam, ceftazidime, cefepime, cefazolin, or vancomycin was not predictive of VRE-BSI when considered individually (P ≥ .4 for all comparisons). The final model suggests that type of intensive care unit was related to VRE-BSI incidence.Conclusions.Ceftriaxone usage in the prior month, but not cephalosporin (class) or vancomycin usage, was related to VRE-BSI incidence. These findings suggest that an antimicrobial stewardship program that limits ceftriaxone may reduce nosocomial VRE-BSI incidence.

Stool Colonization With Vancomycin-Resistant Enterococci in Healthcare Workers and Their Households

2002 ◽  
Vol 23 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Joseph Baran ◽  
Jambunathan Ramanathan ◽  
Kathleen M. Riederer ◽  
Riad Khatib
Keyword(s):  
Healthcare Workers ◽  
Tertiary Care ◽  
Pfge Analysis ◽  
Hospital Employees ◽  
Vancomycin Resistant Enterococci ◽  
Prospective Assessment ◽  
Stool Specimens ◽  
Household Members ◽  
Vancomycin Resistant ◽  
Age Range

AbstractObjective:To determine the prevalence of stool colonization with vancomycin-resistant enterococci (VRE) among healthcare workers (HCWs) and their families.Design:Prospective assessment of fecal colonization with VRE.Setting:A 603-bed, tertiary-care teaching hospital.Participants:Healthy volunteers recruited from hospital employees and their households were screened to exclude pregnancy, diabetes mellitus, immunosuppressive disorders, and recent use of antimicrobials.Intervention:Self-obtained stool swabs were used to obtain cultures. Isolated enterococci were screened for vancomycin resistance and species were identified. Intra-household isolates were genotyped using pulsed-field gel electrophoresis (PFGE).Results:The participants (n = 228; age range, 28 days to 80 years) were from 137 households with and 91 without employees who had contact with patients.Enterococcusspecies were isolated from 127 stool specimens (55.7%). VRE were detected in 12 individuals, representing 6E. casseliflavus, 5E. faecium, and 1E. gallinarum. VRE were more commonly isolated in employees who had contact with patients (5 of 52 vs 0 of 40; relative risk [RR], 1.9; 95% confidence interval [CI95], 1.5 to 2.2;P= .07) and their household members (10 of 137 vs 2 of 91; RR, 3.3; CI95, 0.7 to 14.8;P= .13). In 2 households (2 adults in a physician's household and an adult plus a child in a nurse's household) PFGE analysis demonstrated identical intra-household strains of vancomycin-resistantE. faecium.Conclusions:VRE colonization was found in 5.3% of screened stools and was more prevalent in HCWs who had contact with patients and their households. Identical PFGE patterns between 2 employees who had contact with patients and their household members demonstrated probable intra-household spread. Although the mode of acquisition was uncertain, the association with employees who had contact with patients suggests possible occupational sources. These findings demonstrate the spread of VRE within the household and implicate occupational risk for its acquisition.

Molecular Epidemiology of Vancomycin-Resistant Enterococci: A 2-Year Perspective

1999 ◽  
Vol 20 (10) ◽  
pp. 653-659 ◽  
Author(s):  
Valentina Stosor ◽  
Julie Kruszynski ◽  
Terra Suriano ◽  
Gary A. Noskin ◽  
Lance R. Peterson
Keyword(s):  
Molecular Epidemiology ◽  
Medical Center ◽  
Tertiary Care ◽  
Control Program ◽  
Restriction Endonuclease Analysis ◽  
Nosocomial Transmission ◽  
Care Hospital ◽  
Infection Control Program ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

AbstractObjective:To determine the molecular epidemiology of vancomycin-resistant enterococci (VRE) at our medical center in order to identify the extent of strain clonality and possible transmission patterns of this pathogen.Design:An important facet of our infection control program includes molecular typing of all clinical and surveillance isolates of VRE to determine transmission patterns in the hospital. Molecular strain typing is performed by restriction endonuclease analysis (REA) of genomic DNA. REA patterns are visually compared to categorize VRE strains into type and subtype designations.Setting:A 588-bed, university-affiliated, tertiary-care hospital and a neighboring 155-bed rehabilitation facility.Results:From January 1995 through December 1996, 379 VRE isolates were collected from 197 patients. Thirty-three genotypes were determined by REA typing; 15 genotypes were implicated in 29 instances of potential nosocomial transmission. Three major clusters of VRE involving patients on multiple nursing units and two adjacent hospitals were identified. The remaining instances of nosocomial transmission occurred in small patient clusters.Conclusions:In conclusion, the VRE epidemic at this medical center is polyclonal. VRE transmission patterns are complex, and, while large clusters do occur, the usual pattern of nosocomial acquisition of this pathogen occurs in the setting of “mini-clusters”.

Prevalence of Vancomycin Resistant Enterococci in Various Clinical Specimens in Tertiary Care Hospital in North Delhi

2012 ◽  
Vol 3 (3) ◽  
pp. 141-144
Author(s):  
Swati Chaudhary ◽  
◽  
Swastika Aggarwal ◽  
Pawan Kumar ◽  
SK Aggarwal SK Aggarwal ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals Vancomycin-Resistant Enterococci and Extended-Spectrum β-Lactamase-Producing Bacterial Colonization of the Cervix after Emergency Cerclage: Is It Safe?

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 933
Author(s):  
Won-Kyu Jang ◽  
Jin-Gon Bae
Keyword(s):  
Early Onset ◽  
Neonatal Death ◽  
Medical Center ◽  
Bacterial Colonization ◽  
Control Group ◽  
Vancomycin Resistant Enterococci ◽  
Extended Spectrum ◽  
Early Onset Sepsis ◽  
Cervical Surgery ◽  
Vancomycin Resistant

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

scholarly journals A Japanese traditional medicine Hochuekkito promotes negative conversion of vancomycin-resistant Enterococci

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Junko Kohno ◽  
Tsuyoshi Kawamura ◽  
Akiko Kikuchi ◽  
Tetsuya Akaishi ◽  
Shin Takayama ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Tertiary Care ◽  
Albumin Level ◽  
Kampo Medicine ◽  
Care Hospital ◽  
Intestinal Immunity ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Japanese Traditional Medicine ◽  
Negative Conversion

AbstractVancomycin-resistant enterococci (VRE) are prominent causes of nosocomial infections. Japanese traditional (Kampo) medicine promotes intestinal immunity and protects against bacterial infections. We assessed potential differences in the clinical course of VRE-positive patients, based on their characteristics and treatment with Kampo medicines. This retrospective observational study collected data from VRE-positive patients from August 2018 to July 2019 at a tertiary-care hospital in Japan. The data of 122 consecutive VRE-positive inpatients were analyzed. Sixty-nine patients were treated with probiotics, among whom, 18 were further treated with Kampo medicines. Twenty-six of the 122 patients subsequently died. In univariate analyses, subsequent VRE negative conversion significantly reduced the mortality of VRE-detected patients (p = .0003). Administration of probiotics (p = .0065) and Kampo medicines with probiotics (p = .0002), especially of the Kampo medicine hochuekkito (p = .0014), and a higher serum albumin level positively contributed to the subsequent VRE negative conversion. Multivariate analyses demonstrated that Kampo medicines and body mass index contributed to VRE negative conversion. Hochuekkito shortened the time needed for VRE negative conversion (p = 0.0485). Administration of Kampo medicines, especially of hochuekkito, in addition to probiotics in VRE patients may promote VRE negative conversion.

Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

2009 ◽  
Vol 30 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Sang Hoon Han ◽  
Bum Sik Chin ◽  
Han Sung Lee ◽  
Su Jin Jeong ◽  
Hee Kyung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Multivariate Logistic Regression Analysis ◽  
University Hospital ◽  
Cell Contact ◽  
Patient Risk ◽  
Clinical Specimens ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

scholarly journals A descriptive study of vancomycin resistant enterococci in Tertiary Care Hospital of Western India

2020 ◽  
Vol 7 (3) ◽  
pp. 230-236
Author(s):  
Ridhdhi B Patel ◽  
◽  
Geeta M Vaghela ◽  
Manali Shah ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Western India ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

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