scholarly journals A Single Negative Result for van Quantitative PCR on Enrichment Broth Can Replace Five Rectal Swab Cultures in Screening for Vancomycin-Resistant Enterococci

2017 ◽  
Vol 55 (7) ◽  
pp. 2261-2267 ◽  
Author(s):  
J. M. Fonville ◽  
C. M. C. van Herk ◽  
P. H. A. C. Das ◽  
J. H. B. van de Bovenkamp ◽  
L. van Dommelen
Keyword(s):  
Quantitative Pcr ◽  
Rectal Swab ◽  
Agar Plate ◽  
Improve Patient Care ◽  
Blood Agar Plate ◽  
Enrichment Broth ◽  
Content Type ◽  
Chromogenic Agar ◽  
Vancomycin Resistant ◽  
Improve Patient

ABSTRACT The increased incidence of infections by vancomycin-resistant Enterococcus (VRE) causes an accumulation of patients who are either colonized with VRE or flagged as potentially colonized with VRE. Since such patients require precautionary isolation upon admission to a hospital, rapid methods to establish VRE colonization status would improve patient care and optimize hospital operation. We evaluated van quantitative PCR (qPCR) on one enrichment broth as a VRE-screening approach. We obtained 255 sets of five rectal specimens from 243 patients. The specimens were cultured using an amoxicillin-containing enrichment broth. Subsequently, a chromogenic agar was incubated and suspect colonies were inoculated on a blood agar plate and characterized by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF), followed by a vancomycin Etest in cases in which Enterococcus spp. were detected. The culturing results were compared with the outcome of van qPCR on all enrichment broths of the first rectal swab. The van qPCR was positive for 43% of the sample sets ( vanA , n = 5; vanB , n = 101; vanA and vanB , n = 3). Based on culture data, 20 (7.8%) of the sets were VRE positive in at least one of five samples. The negative predictive value of van qPCR on the first enrichment broth was 99.3%. With a cutoff quantification cycle ( C q ) value of >35 to discriminate negative and positive samples, 87% of the negative patients can be identified within a day after obtaining the sample, compared to 7 days in the culturing approach. VRE screening using qPCR on one enrichment broth can quickly identify non-VRE-colonized patients and therefore decrease costs and limit unnecessary isolation restrictions.

scholarly journals Automatic Digital Analysis of Chromogenic Media for Vancomycin-Resistant-Enterococcus Screens Using Copan WASPLab

2016 ◽  
Vol 54 (10) ◽  
pp. 2464-2469 ◽  
Author(s):  
Matthew L. Faron ◽  
Blake W. Buchan ◽  
Christopher Coon ◽  
Theo Liebregts ◽  
Anita van Bree ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Images ◽  
Package Insert ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Labor Cost ◽  
High Definition ◽  
Content Type ◽  
Chromogenic Agar ◽  
Vancomycin Resistant

Vancomycin-resistant enterococci (VRE) are an important cause of health care-acquired infections (HAIs). Studies have shown that active surveillance of high-risk patients for VRE colonization can aid in reducing HAIs; however, these screens generate a significant cost to the laboratory and health care system. Digital imaging capable of differentiating negative and “nonnegative” chromogenic agar can reduce the labor cost of these screens and potentially improve patient care. In this study, we evaluated the performance of the WASPLab Chromogenic Detection Module (CDM) (Copan, Brescia, Italy) software to analyze VRE chromogenic agar and compared the results to technologist plate reading. Specimens collected at 3 laboratories were cultured using the WASPLab CDM and plated to each site's standard-of-care chromogenic media, which included Colorex VRE (BioMed Diagnostics, White City, OR) or Oxoid VRE (Oxoid, Basingstoke, United Kingdom). Digital images were scored using the CDM software after 24 or 40 h of growth, and all manual reading was performed using digital images on a high-definition (HD) monitor. In total, 104,730 specimens were enrolled and automation agreed with manual analysis for 90.1% of all specimens tested, with sensitivity and specificity of 100% and 89.5%, respectively. Automation results were discordant for 10,348 specimens, and all discordant images were reviewed by a laboratory supervisor or director. After a second review, 499 specimens were identified as representing missed positive cultures falsely called negative by the technologist, 1,616 were identified as containing borderline color results (negative result but with no package insert color visible), and 8,234 specimens were identified as containing colorimetric pigmentation due to residual matrix from the specimen or yeast (Candida). Overall, the CDM was accurate at identifying negative VRE plates, which comprised 84% (87,973) of the specimens in this study.

scholarly journals Diagnostic Performance of Various Methodologies for Group B Streptococcus Screening in Pregnant Woman in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Kankan Gao ◽  
Qiulian Deng ◽  
Lianfen Huang ◽  
Chien-Yi Chang ◽  
Huamin Zhong ◽  
...  
Keyword(s):  
Group B Streptococcus ◽  
Agar Plate ◽  
Reference Method ◽  
Antigen Detection ◽  
The Other ◽  
Blood Agar ◽  
Blood Agar Plate ◽  
Chromogenic Agar ◽  
Group B ◽  
Detection Reagent

Maternal vaginal/rectal colonization of group B streptococcus (GBS) is a main risk for neonatal invasive infection. Efficient determination of GBS colonization in pregnant women is crucial. This study aimed to investigate the prevalence of GBS carriage and evaluate the diagnostic performance of six methodologies for GBS screening conducted in China, including blood agar plate, liquid chromogenic medium, and loop-mediated isothermal amplification (LAMP) without pre-enrichment, chromogenic agar plate with pre-enrichment, and GBS antigen detection without and with pre-enrichment in comparison with the standard reference method (Lim broth-enriched subculture with plating on 5% sheep blood agar). Vaginal/rectal swabs were collected from 1,281 pregnant women at 35–37 weeks of gestation. Of them, 309 were taken in triplicate, one for Lim broth-enriched subculture, one for blood agar plate, and the third for GBS antigen detection (Reagent W); 177 were acquired in duplicate, one for Lim broth-enriched subculture and the other for GBS antigen detection (Reagent H); 502 were obtained in duplicate, one for Lim broth-enriched subculture and the other for liquid chromogenic medium; 158 were collected in duplicate, one for Lim broth-enriched subculture and the other for LAMP; and 135 were inoculated in Lim broth-enriched for GBS antigen detection (Reagent W) and subculture with chromogenic agar plate and 5% blood agar plate. The overall prevalence of GBS carriage was 10.1% (130/1,281, 95% CI: 8.5–12.1%) according to the standard reference method. Compared with the standard reference method, the LAMP had excellent performance of sensitivity (100%, 95%CI: 83.4–100%), specificity (94%, 95%CI: 88.1–97.1%), and Yoden index (0.940); as well as the blood agar plate with sensitivity (81.5%, 95%CI: 61.3–93.0%), specificity (100%, 95%CI: 98.3–100.0%), and Yoden index (0.815). The other four methods were not sufficient to reach the threshold in terms of sensitivity or specificity compared to the standard reference method. Furthermore, for LAMP, results can be obtained within 0.5–1 h, while for blood agar plate, which needed 24–48 h, and further identification was required. Our data suggested that the performance of LAMP was highly comparable to the standard Lim broth-enriched subculture and LAMP is considered as an alternative for fast and accurate GBS screening.

scholarly journals Impact of consultant obstetric presence on serious incidents

2019 ◽  
Vol 24 (3) ◽  
pp. 187-193
Author(s):  
Sherif Shawer ◽  
Shirley Rowbotham ◽  
Alexander Heazell ◽  
Teresa Kelly ◽  
Sarah Vause
Keyword(s):  
Negative Impact ◽  
Positive Impact ◽  
Care Delivery ◽  
A Priori ◽  
Improve Patient Care ◽  
Positive Influence ◽  
Content Type ◽  
Uk National Health Service ◽  
The Impact ◽  
Improve Patient

Purpose Many organisations, including the Royal College of Obstetricians and Gynaecologists, have recommended increasing the number of hours of consultant obstetric presence in UK National Health Service maternity units to improve patient care. St Mary’s Hospital, Manchester implemented 24-7 consultant presence in September 2014. The paper aims to discuss these issues. Design/methodology/approach To assess the impact of 24-7 consultant presence upon women and babies, a retrospective review of all serious clinical intrapartum incidents occurring between September 2011 and September 2017 was carried out by two independent reviewers; disagreements in classification were reviewed by a senior Obstetrician. The impact of consultant presence was classified in a structure agreed a priori. Findings A total of 72 incidents were reviewed. Consultants were directly involved in the care of 75.6 per cent of cases before 24-7 consultant presence compared to 96.8 per cent afterwards. Negative impact due to a lack of consultant presence fell from 22 per cent of the incidents before 24-7 consultant presence to 9.7 per cent after implementation. In contrast, positive impact of consultant presence increased from 14.6 to 32.3 per cent following the introduction of 24-7 consultant presence. Practical implications Introduction of 24-7 consultant presence reduced the negative impact caused by a lack of, or delay in, consultant presence as identified by serious untoward incident (SUI) reviews. Consultant presence was more likely to have a positive influence on care delivery. Originality/value This is the first assessment of the impact of 24-7 consultant presence on the SUIs in obstetrics.

Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017?

2020 ◽  
Vol 34 (7) ◽  
pp. 775-788
Author(s):  
Robin Gauld ◽  
Simon Horsburgh
Keyword(s):  
New Zealand ◽  
Patient Care ◽  
Health Professionals ◽  
Online Survey ◽  
Improve Patient Care ◽  
Public Hospitals ◽  
Quality And Safety ◽  
District Health ◽  
Content Type ◽  
Improve Patient

PurposeThe work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017.Design/methodology/approachThree questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived.FindingsIn 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics.Practical implicationsWith no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon.Originality/valueThis study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.

National early warning score (NEWS) – evaluation in surgery

2015 ◽  
Vol 28 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Peter M Neary ◽  
Mark Regan ◽  
Myles J Joyce ◽  
Oliver J McAnena ◽  
Ian Callanan
Keyword(s):  
Patient Outcome ◽  
Improve Patient Care ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Content Type ◽  
Response Team ◽  
National Early Warning Score ◽  
The Impact ◽  
Improve Patient

Purpose – The purpose of this paper is to evaluate staff opinion on the impact of the National Early Warning Score (NEWS) system on surgical wards. In 2012, the NEWS system was introduced to Irish hospitals on a phased basis as part of a national clinical programme in acute care. Design/methodology/approach – A modified established questionnaire was given to surgical nursing staff, surgical registrars, surgical senior house officers and surgical interns for completion six months following the introduction of the NEWS system into an Irish university hospital. Findings – Amongst the registrars, 89 per cent were unsure if the NEWS system would improve patient care. Less than half of staff felt consultants and surgical registrars supported the NEWS system. Staff felt the NEWS did not correlate well clinically with patients within the first 24 hours (Day zero) post-operatively. Furthermore, 78-85 per cent of nurses and registrars felt a rapid response team should be part of the escalation protocol. Research limitations/implications – Senior medical staff were not convinced that the NEWS system may improve patient care. Appropriate audit proving a beneficial impact of the NEWS system on patient outcome may be essential in gaining support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward. Originality/value – Appropriate audit of the impact of the NEWS system on patient outcome may be pertinent to obtain the support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward.

Improvements in neonatal care; using experience-based co-design

2014 ◽  
Vol 27 (5) ◽  
pp. 427-438 ◽  
Author(s):  
Susanne Maria Kristina Gustavsson
Keyword(s):  
Patient Care ◽  
Design Methodology ◽  
Healthcare Professionals ◽  
Improve Patient Care ◽  
Quality Improvements ◽  
Healthcare Staff ◽  
Content Type ◽  
Care Processes ◽  
Improve Patient ◽  
Practical Implications

Purpose – The purpose of this paper is to identify and improve patient care processes by collaborating patients, relatives and healthcare professionals. Design/methodology/approach – To identify and improve patient care processes by collaborating patients, relatives and healthcare professionals. Findings – Healthcare problems captured from collaboration between patients and healthcare professionals fall into simple, complicated and complex problems. Healthcare staff and patient experiences with patient processes differ, and a collaborative approach is needed to capture all areas needing improvement. Research limitations/implications – The conclusions are drawn from a project with few participants in a context that probably influenced the results. In contrast, other studies in the same area confirm the results. Practical implications – The study outcomes have direct implications for healthcare professionals who can learn from patients involved in quality improvements such as this experience-based co-design (EBCD) project. Originality/value – The paper contributes to limited studies on EBCD involving patients in healthcare quality improvements.

scholarly journals An initial survey on the prevalence of group B Streptococcus (GBS) among Yemeni pregnant women.

2021 ◽  
Author(s):  
Ibrahim Hasan AL-Subol ◽  
Maha Abdul-Aziz ◽  
Abdullah A. Almikhlafy ◽  
Talal Y Alqahtani
Keyword(s):  
Pregnant Women ◽  
Antibiotic Susceptibility ◽  
Group B Streptococcus ◽  
Agar Plate ◽  
Blood Agar Plate ◽  
Diffusion Method ◽  
Enrichment Broth ◽  
Antibiotic Susceptibility Test ◽  
Study Results ◽  
Group B

Abstract Background: Neonatal infection with group B Streptococcus (GBS) is still a threat to the life of fetus and mother, especially in developing countries that do not adopt a prenatal screening test policy such as Yemen. Objective: This study aimed to determine the vaginal colonization rates and antibiotic susceptibility pattern of group B Streptococcus among pregnant Yemeni women. Methods: We conducted a cross-sectional study over a four-month period involved 210 pregnant women who visited Gaza medical center (a primary health center in Sana’a city, Yemen) at the 35th to 39th gestational weeks. A vaginal swab from each pregnant woman was inoculated in Todd-Hewitt enrichment broth and after 24h incubation; the subculture on a 5% human blood agar plate was performed from inoculated Todd-Hewitt enrichment broth. All positive cultures identified as group B streptococcus were subjected to antibiotic susceptibility test using the disk-diffusion method. Results: Out of 210 recruited pregnant women, 23 (10.95%) were GBS vaginal carriers. All isolates showed no resistance to penicillin, ampicillin, levofloxacin, cefotaxime, and vancomycin. However, we observed decreased sensitivity to clindamycin (82.8%) and tetracycline (30.5%). Conclusion: Based on the study results; approximately eleven out of every 100 pregnant women were vaginal colonized by GBS in Sana'a governorate. Beta-lactam antibiotics remain the drug of choice for treatment and prophylaxis of GBS infections. Therefore, we recommend implementing a screening policy to detect GBS in Yemeni pregnant women.

scholarly journals Rapid Detection of KPC, NDM, and OXA-48-Like Carbapenemases by Real-Time PCR from Rectal Swab Surveillance Samples

2015 ◽  
Vol 53 (8) ◽  
pp. 2731-2733 ◽  
Author(s):  
Tracy D. Lee ◽  
Kathleen Adie ◽  
Alan McNabb ◽  
Dale Purych ◽  
Kulvinder Mannan ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Rapid Detection ◽  
Rectal Swab ◽  
Bacterial Culture ◽  
New Delhi ◽  
Pcr Assay ◽  
Enrichment Broth ◽  
Content Type ◽  
Sample Enrichment

We describe a multiplex real-time PCR assay for use on the ABI 7500 Fast TaqMan platform to detect all currently described Klebsiella pneumoniae carbapenemases (KPC), New Delhi metallo-β-lactamases (NDM), and the OXA-48-like family of carbapenemases from bacterial culture lysates or sample enrichment broth lysates.

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