scholarly journals 2464. Partnerships in the Field: Using Real-time Sequencing to Enhance Epidemiologic Investigation and Response to a Norovirus Outbreak

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S853-S853
Author(s):  
Handy K Lori ◽  
Erin H Graf ◽  
Linda Brostowski ◽  
Lindsay Cunnigham ◽  
Caitlin Dougherty ◽  
...  
Keyword(s):  
Real Time ◽  
Epidemiologic Methods ◽  
Infection Prevention ◽  
Control Measures ◽  
Prevention Measures ◽  
Epidemic Curve ◽  
Epidemiologic Surveillance ◽  
Infectious Gastroenteritis ◽  
Prevention Interventions ◽  
Stool Samples

Abstract Background Norovirus is a common cause of infectious gastroenteritis and frequently leads to hospital-based outbreaks of gastrointestinal (GI) illness. We utilized hospital-wide surveillance to detect outbreaks of GI illness among patients and healthcare workers (HCW). Real-time norovirus sequencing was applied to establish conclusive links between patient cases. Methods Patient cases of healthcare-associated GI illness were detected through house-wide microbiologic surveillance. HCW cases were defined as acute episodes of vomiting and/or diarrhea that began within 48 hours of the last shift. Outbreak procedures were implemented on a unit when 3 or more cases were identified within 48 hours. Traditional epidemiologic methods were used, including an epidemic curve and line listing, while instituting local control measures. De-identified clinical stool samples positive for norovirus from any hospital unit during the defined outbreak time period were analyzed. Sanger sequencing was performed using primer sets targeting the norovirus VP1 capsid and polymerase regions. Capillary electrophoresis was implemented on a 3500 Genetic Analyzer (Applied Biosystems) and analysis was performed via MEGA7. Results Epidemiologic surveillance identified a norovirus outbreak involving 11 patients on a single unit. Sequencing was performed on 20 norovirus positive stool samples, of which 13 shared 100% identity across both the VP1 and polymerase regions. Of these 13, 10 specimens were from patients epidemiologically linked to the outbreak; 3 specimens were from patients located on 2 geographically separate floors, not epidemiologically linked to the outbreak. Identification of cases outside of the outbreak unit prompted additional hospital-wide infection prevention interventions, including increased education and messaging, changes in hand hygiene practice, and prohibition of shared food for staff. Conclusion Real-time sequencing confirmed epidemiologically linked cases of norovirus during an outbreak and identified additional transmission events not detected by conventional epidemiologic methods. Partnership between hospital epidemiology and the laboratory identified the need for hospital-wide infection prevention measures to halt ongoing transmission. Disclosures All authors: No reported disclosures.

scholarly journals Results of screening for emergent highly resistant bacteria in Tunisian intensive care units

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Ben Rejeb ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
M Kahloul ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Early Identification ◽  
Infection Prevention ◽  
Screening Program ◽  
Control Measures ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Resistant Bacteria ◽  
Prevention Interventions

Abstract Background The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes. Methods Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018. Results During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%). Conclusions Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital. Key messages eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.

scholarly journals Universal Masking to Control Healthcare-Associated Transmission of SARS-CoV-2

2021 ◽  
pp. 1-24
Author(s):  
Eliza R. Thompson ◽  
Faith S. Williams ◽  
Pat A. Giacin ◽  
Shay Drummond ◽  
Eric Brown ◽  
...  
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
Index Patient ◽  
Field Investigation ◽  
Point Prevalence ◽  
Control Measures ◽  
Prevention Measures ◽  
Infection Control Measures ◽  
Va Health Care System ◽  
Healthcare Associated

Abstract Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.

scholarly journals A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1127
Author(s):  
Estefanía Cano-Martín ◽  
Inés Portillo-Calderón ◽  
Patricia Pérez-Palacios ◽  
José María Navarro-Marí ◽  
María Amelia Fernández-Sierra ◽  
...  
Keyword(s):  
Real Time ◽  
Bacterial Resistance ◽  
Control Measures ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Major Advance ◽  
Prevention Measures ◽  
Cross Sectional ◽  
Effective Manner ◽  
Major Increase

Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsed-field gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner.

scholarly journals Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

2020 ◽  
Author(s):  
Benedikt Marche ◽  
Meike Neuwirth ◽  
Christiane Kugler ◽  
Bertil Bouillon ◽  
Frauke Mattner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Infection Prevention ◽  
Literature Search ◽  
Trauma Surgery ◽  
Implementation Strategies ◽  
Surgical Site Infections ◽  
Control Measures ◽  
Successful Implementation ◽  
Prevention Measures ◽  
Outcome Parameters

Abstract Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology.

scholarly journals Nosocomial Outbreak of SARS-CoV-2 in a Non-COVID Zone of a Tertiary Care Hospital of North India: Need to Upgrade Infection Control Practices

2021 ◽  
Vol 12 ◽  
pp. 215013272110507
Author(s):  
Kirtan Rana ◽  
Bhawna Sharma ◽  
Pinnaka Venkata Maha Lakshmi ◽  
ManharPreet Kaur ◽  
Mini P. Singh ◽  
...  
Keyword(s):  
Infection Control ◽  
Infection Prevention ◽  
Tertiary Care Hospital ◽  
Ventilation System ◽  
Tertiary Care ◽  
Control Measures ◽  
North India ◽  
Care Hospital ◽  
Prevention Measures ◽  
Infection Control Measures

Background Hospital acquired infections are preventable cause for morbidity and mortality worldwide. In the current pandemic era proper implementation of infection control measures can prevent the spread of such infections including SARS-CoV 2. The study was done to identified the source and reason for spread of COVID-19 infection and devise recommendations to halt the progress of infection in a non-COVID area. Methods An outbreak in a non-COVID area of a tertiary care hospital was investigated by the infection control team along with the epidemiologist when they were notified about the rising cases of COVID-19 from Advanced Trauma Center’s (ATC) disaster ward. The time, place and person distribution of the cases were studied. Recommendations based on gaps identified were developed onsite and implemented to control the outbreak. Results The outbreak lasted from 19th December 2020 to 12th January 2021, affecting 34 people (25 patients and 9 health care workers). The attack rate was 9.2%. We identified the causes of current outbreak as compromises in infection prevention measures, high bed patient ratio, irregularities in the ventilation system, overcrowding by patient attendants and communication gaps between nursing officers and doctors. Measures required to control the outbreak were implemented and no cases were reported for 2 weeks following the last positive case. Conclusion Non-COVID areas of hospitals are also at risk of nosocomial outbreaks of SARS-CoV 2 and therefore strict infection prevention measures those designated to COVID areas should be followed in non-COVID zones also to prevent such outbreaks.

scholarly journals Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

2021 ◽  
Author(s):  
Hitomu Kotani ◽  
Mari Tamura ◽  
Susumu Nejima
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
Early Stage ◽  
Close Contact ◽  
Physical Distance ◽  
Control Measures ◽  
Religious Communities ◽  
Prevention Measures ◽  
Religious Activities ◽  
Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

scholarly journals Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

2021 ◽  
Author(s):  
Hitomu Kotani ◽  
Mari Tamura ◽  
Susumu Nejima
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
Early Stage ◽  
Close Contact ◽  
Physical Distance ◽  
Control Measures ◽  
Religious Communities ◽  
Prevention Measures ◽  
Religious Activities ◽  
Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past natural disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected qualitative information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

scholarly journals Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

2021 ◽  
Author(s):  
Hitomu Kotani ◽  
Mari Tamura ◽  
Susumu Nejima
Keyword(s):  
Large Scale ◽  
Infection Prevention ◽  
Early Stage ◽  
Close Contact ◽  
Physical Distance ◽  
Control Measures ◽  
Religious Communities ◽  
Prevention Measures ◽  
Religious Activities ◽  
Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

scholarly journals Development and Delivery of a Real-time Hospital-onset COVID-19 Surveillance System Using Network Analysis

2020 ◽  
Author(s):  
James Richard Price ◽  
Siddharth Mookerjee ◽  
Eleonora Dyakova ◽  
Ashleigh Myall ◽  
Wendy Leung ◽  
...  
Keyword(s):  
Network Analysis ◽  
Real Time ◽  
Surveillance System ◽  
Healthcare Setting ◽  
Prevention Measures ◽  
Patient Pathways ◽  
Prevention Interventions ◽  
Target Prevention ◽  
Trends Over Time ◽  
Over Time

Abstract Background Understanding nosocomial acquisition, outbreaks, and transmission chains in real time will be fundamental to ensuring infection-prevention measures are effective in controlling coronavirus disease 2019 (COVID-19) in healthcare. We report the design and implementation of a hospital-onset COVID-19 infection (HOCI) surveillance system for an acute healthcare setting to target prevention interventions. Methods The study took place in a large teaching hospital group in London, United Kingdom. All patients tested for SARS-CoV-2 between 4 March and 14 April 2020 were included. Utilizing data routinely collected through electronic healthcare systems we developed a novel surveillance system for determining and reporting HOCI incidence and providing real-time network analysis. We provided daily reports on incidence and trends over time to support HOCI investigation and generated geotemporal reports using network analysis to interrogate admission pathways for common epidemiological links to infer transmission chains. By working with stakeholders the reports were co-designed for end users. Results Real-time surveillance reports revealed changing rates of HOCI throughout the course of the COVID-19 epidemic, key wards fueling probable transmission events, HOCIs overrepresented in particular specialties managing high-risk patients, the importance of integrating analysis of individual prior pathways, and the value of co-design in producing data visualization. Our surveillance system can effectively support national surveillance. Conclusions Through early analysis of the novel surveillance system we have provided a description of HOCI rates and trends over time using real-time shifting denominator data. We demonstrate the importance of including the analysis of patient pathways and networks in characterizing risk of transmission and targeting infection-control interventions.

scholarly journals The rapid identification ofClostridium perfringensas the possible aetiology of a diarrhoeal outbreak using PCR

2007 ◽  
Vol 136 (8) ◽  
pp. 1142-1146 ◽  
Author(s):  
J. P. LOH ◽  
Y. C. LIU ◽  
S. W. CHEW ◽  
E. S. ONG ◽  
J. M. FAM ◽  
...  
Keyword(s):  
Real Time ◽  
Clinical Symptoms ◽  
Food Contamination ◽  
Rapid Identification ◽  
Control Measures ◽  
Pcr Analysis ◽  
Military Camp ◽  
Stool Samples ◽  
Laboratory Investigations ◽  
And Control

SUMMARYA gastroenteritis outbreak occurred in a military camp where a laboratory and epidemiological investigation was carried out. The early onset of symptoms indicated probable food contamination withClostridium perfringens. Stool samples collected from affected patients were tested within 4 h via real-time polymerase chain reaction (PCR) for the presence of theC. perfringens plcgene. Ten out of the 12 stool samples were positive. Confirmation of the molecular test results was carried out by enumeration ofC. perfringensin stool by culture and shown to be in excess of 106spores/g stool. The isolates obtained from culture were further analysed by PCR for the presence of the chromosomal enterotoxin (cpe) gene. Based on the clinical symptoms, epidemiological and laboratory investigations,C. perfringenswas implicated as the aetiological agent. The ability to conduct real-time PCR analysis greatly shortens the time to diagnosis and allows for preventive and control measures to be effected quickly.

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