scholarly journals Use of Adherence Monitors as Part of a Team Approach to Control Clonal Spread of Multidrug-ResistantAcinetobacter baumanniiin a Research Hospital

2011 ◽  
Vol 32 (12) ◽  
pp. 1166-1172 ◽  
Author(s):  
Tara N. Palmore ◽  
Angela V. Michelin ◽  
MaryAnn Bordner ◽  
Robin T. Odom ◽  
Frida Stock ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
National Institutes Of Health ◽  
Temporal Association ◽  
Team Approach ◽  
Environmental Cleaning ◽  
Clinical Center ◽  
Clonal Spread ◽  
Adherence Monitoring ◽  
Hygiene Violations

Background.Multidrug-resistantAcinetobacter baumannii(MDRAB) is difficult to treat and eradicate. Several reports describe isolation and environmental cleaning strategies that controlled hospital MDRAB outbreaks. Such interventions were insufficient to interrupt MDRAB transmission in 2 intensive care unit-based outbreaks in our hospital. We describe strategies that were associated with termination of MDRAB outbreaks at the National Institutes of Health Clinical Center.Methods.In response to MDRAB outbreaks in 2007 and 2009, we implemented multiple interventions, including stakeholder meetings, enhanced isolation precautions, active microbial surveillance, cohorting, and extensive environmental cleaning. We conducted a case-control study to analyze risk factors for acquiring MDRAB. In each outbreak, infection control adherence monitors were placed in MDRAB cohort areas to observe and correct staff infection control behavior.Results.Between May 2007 and December 2009, 63 patients acquired nosocomial MDRAB; 57 (90%) acquired 1 or more of 4 outbreak strains. Of 347 environmental cultures, only 2 grew outbreak strains of MDRAB from areas other than MDRAB patient rooms. Adherence monitors recorded 1,330 isolation room entries in 2007, of which 8% required interventions. In 2009, around-the-clock monitors recorded 4,892 staff observations, including 127 (2.6%) instances of nonadherence with precautions, requiring 68 interventions (1.4%). Physicians were responsible for more violations than other staff (58% of hand hygiene violations and 37% of violations relating to gown and glove use). Each outbreak terminated in temporal association with initiation of adherence monitoring.Conclusions.Although labor intensive, adherence monitoring may be useful as part of a multifaceted strategy to limit nosocomial transmission of MDRAB.

scholarly journals VIM-CRPA in West Texas: Developing a Regional Multidrug-Resistant Organism Containment Strategy for a Novel Bug

2020 ◽  
Vol 41 (S1) ◽  
pp. s432-s432
Author(s):  
Gillian Blackwell ◽  
Thi Dang ◽  
Abby Hoffman ◽  
Mary McConnell ◽  
Katherine Wells ◽  
...  
Keyword(s):  
Infection Control ◽  
Health Department ◽  
Multidrug Resistant ◽  
Local Health Department ◽  
Local Health ◽  
Health Departments ◽  
Environmental Cleaning ◽  
Healthcare Facilities ◽  
Multidrug Resistant Organisms ◽  
Containment Strategy

Background: The Texas Department of State Health Services Healthcare Safety (HCS) Investigation Team began investigating a cluster of positive carbapenem-resistant Pseudomonas aeruginosa (CRPA) results in August 2017. These CRPA isolates contained the novel carbapenemase Verona integron-encoded metallo-β-lactamase (VIM). This cluster became an outbreak that spanned >2 years and involved multiple healthcare facilities in and around northern Texas. In response to positive results, infection control assessments were conducted, which exposed common infection control gaps including inadequate hand hygiene performance, environmental cleaning issues, and poor communication during interfacility patient transfers. As part of the ongoing investigation efforts, a regional containment strategy was developed to prevent the spread of multidrug-resistant organisms. Methods: Beginning in October 2018, the HCS Investigation Team made site visits to participating facilities every 6 months to provide targeted infection control support and hand hygiene performance and environmental cleaning observations. An initial kick-off meeting was held in February 2019 for facilities to begin collaboration on the containment strategy. This strategy became known as BOOT, an acronym meaning: Being prompt in response to positive cases, Obtaining isolates for testing, Optimizing infection prevention, and Transferring patients using a designated form. An interfacility transfer form to reduce the risk of transmission of multidrug-resistant organisms when patients are transferred between healthcare facilities was developed by a work group that consisted of the local health department, the Public Health Region healthcare-associated infections epidemiologist, and multiple healthcare facilities. Results: Facilities have increased communication with other facilities and with the health departments since the implementation of the BOOT strategy. The local health department is contacted when facilities do not receive a transfer form, and follow-up is initiated to ensure appropriate understanding and compliance. Facility handwashing rates and environmental cleaning results have improved with each visit, and access to alcohol-based hand sanitizing dispensers has increased in select facilities. Conclusions: The regional containment strategy is dynamic and ongoing, and changes are implemented as obstacles are encountered. Implementation has resulted in a successful decrease of positive VIM results in the local area by ∼50% since the first half of 2019. This program has led to greater collaboration among healthcare facilities, health departments, and a neighboring state. This investigation and its products have been used as a model for the implementation of containment strategies in other regions of Texas. The HCS Investigation Team hopes to create and implement an interfacility transfer form that can be used in healthcare facilities statewide.Funding: NoneDisclosures: None

scholarly journals Challenges to Infection Control Team during COVID-19 Pandemic in a Quaternary Medical Center in Saudi Arabia

2021 ◽  
pp. 1-20
Author(s):  
Hala A Amer ◽  
Ibrahim A Alowidah ◽  
Chasteffi Bugtai ◽  
Barbara M. Soule ◽  
Ziad A Memish
Keyword(s):  
Saudi Arabia ◽  
Infection Control ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Task Force ◽  
Care Center ◽  
Capital City ◽  
Infection Prevention And Control ◽  
Team Approach ◽  
And Control

Abstract Background: King Saud Medical City (KSMC) is a quaternary care center based in the center of the capital city, Riyadh, Kingdom of Saudi Arabia (KSA) and is one of the key Ministry of Health (MoH) facilities dedicated to the care of COVID-19 patients in the central region. Methods: A comprehensive surge plan was promptly launched in mid-March 2020 to address the pandemic and then expanded in a phase-wise approach. Supporting the capacity of the infection prevention and control department (IPCD) was one of the main pillars of KSMC surge plan. Task force Infection Control teams have been formulated to tackle the different aspects of pandemic containment processes. The challenges and measures undertaken by the IPC team have been described. Conclusion: Realizing the more prominent role of infection prevention and control staff as frontline responders to public health emergencies like COVID-19, a solid infection prevention and control system at the healthcare setting supported by qualified and sufficient manpower, a well-developed multidisciplinary team approach, electronic infrastructure and efficient supply utilization is required for effective crisis management.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

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.

Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

2005 ◽  
Vol 26 (1) ◽  
pp. 13-20 ◽  
Author(s):  
François L'Hériteau ◽  
Corinne Alberti ◽  
Yves Cohen ◽  
Gilles Troché ◽  
Pierre Moine ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Multiple Correspondence Analysis ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Central Venous ◽  
Venous Catheterization ◽  
Structural Variables ◽  
Tract Infections

AbstractObjectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

scholarly journals A Comprehensive, Intensive Patient Surveillance Program for Carbapenemase-Producing Bacteria at the National Institutes of Health Clinical Center

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Robin T. Odom ◽  
Amanda M. Ramsburg ◽  
Anna F. Lau ◽  
John P. Dekker ◽  
Angela V. Michelin ◽  
...  
Keyword(s):  
National Institutes Of Health ◽  
Surveillance Program ◽  
Clinical Center

scholarly journals Animal and Human Multidrug-Resistant, Cephalosporin-ResistantSalmonella Isolates Expressing a Plasmid-Mediated CMY-2 AmpC β-Lactamase

2000 ◽  
Vol 44 (10) ◽  
pp. 2777-2783 ◽  
Author(s):  
P. L. Winokur ◽  
A. Brueggemann ◽  
D. L. DeSalvo ◽  
L. Hoffmann ◽  
M. D. Apley ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Plasmid Dna ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Geographic Region ◽  
Chromosomal Dna ◽  
Important Food ◽  
Food Borne ◽  
Clonal Spread ◽  
Resistance Rates

ABSTRACT Salmonella spp. are important food-borne pathogens that are demonstrating increasing antimicrobial resistance rates in isolates obtained from food animals and humans. In this study, 10 multidrug-resistant, cephalosporin-resistant Salmonellaisolates from bovine, porcine, and human sources from a single geographic region were identified. All isolates demonstrated resistance to cephamycins and extended-spectrum cephalosporins as well as tetracycline, chloramphenicol, streptomycin, and sulfisoxazole. Molecular epidemiological analyses revealed eight distinct chromosomal DNA patterns, suggesting that clonal spread could not entirely explain the distribution of this antimicrobial resistance phenotype. However, all isolates encoded an AmpC-like β-lactamase, CMY-2. Eight isolates contained a large nonconjugative plasmid that could transformEscherichia coli. Transformants coexpressed cephalosporin, tetracycline, chloramphenicol, streptomycin, and sulfisoxazole resistances. Plasmid DNA revealed highly related restriction fragments though plasmids appeared to have undergone some evolution over time. Multidrug-resistant, cephalosporin-resistant Salmonellaspp. present significant therapeutic problems in animal and human health care and raise further questions about the association between antimicrobial resistance, antibiotic use in animals, and transfer of multidrug-resistant Salmonella spp. between animals and man.

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