scholarly journals High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

mBio ◽  
2019 ◽  
Vol 10 (6) ◽  
Author(s):  
Andreu Coello Pelegrin ◽  
Yulia Rosa Saharman ◽  
Aurélien Griffon ◽  
Mattia Palmieri ◽  
Caroline Mirande ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Intensive Care Units ◽  
Clinical Data ◽  
Prevention Measures ◽  
Content Type ◽  
Control Intervention ◽  
The Impact

ABSTRACT Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541). IMPORTANCE In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hattie Catherine Ann Moyes ◽  
Lana MacNaboe ◽  
Kate Townsend
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Substance Misuse ◽  
Well Being ◽  
Training Programme ◽  
Content Type ◽  
National Quality ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

scholarly journals High-Quality Complete Genome Sequences of Three Pseudomonas aeruginosa Isolates Retrieved from Patients Hospitalized in Intensive Care Units

2019 ◽  
Vol 8 (9) ◽  
Author(s):  
Bárbara Magalhães ◽  
Laurence Senn ◽  
Dominique S. Blanc
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Genome Sequences ◽  
High Quality ◽  
Gram Negative ◽  
Content Type ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
High Quality Genome

Pseudomonas aeruginosa is one of the major Gram-negative pathogens responsible for hospital-acquired infections. Here, we present high-quality genome sequences of isolates from three P. aeruginosa genotypes retrieved from patients hospitalized in intensive care units.

scholarly journals Motivation of infection control in nurses' viewpoint

2020 ◽  
Vol 85 ◽  
pp. 02001
Author(s):  
Diana Platace ◽  
Kristine Puzirevska ◽  
Amanda Kreile ◽  
Inga Millere
Keyword(s):  
Internal Medicine ◽  
Intensive Care ◽  
Infection Control ◽  
Intensive Care Units ◽  
Therapy Resistance ◽  
Underlying Disease ◽  
Hospital Infections ◽  
Motivating Factors ◽  
Prevention Measures ◽  
Control And Prevention

The spread of hospital infections in high-risk units remains even though infection control and prevention measures are being improved annually. It is associated with factors such as age, severity of the underlying disease, duration of hospitalization, antibacterial therapy, resistance to microorganisms, and the number of invasive procedures. The human resources and the financial distribution in medicine play the key role in controlling infections. Intensive care nurses supervising and taking care of the patients 24 hours a day have an invaluable role in controlling infections and reducing hospital infections. The aim of the study is to find out the nurses' opinions about the factors motivating infection control in the intensive care units and in the department of internal medicine. The study used a quantitative study method-survey (n = 160). The questionnaire included questions about the factors influencing infection control and the factors motivating the nurse. Questionnaires involved nurses in the intensive care units and in the department of internal medicine, who care for patients in Latvian multifunctional regional hospitals. The study suggests that nurses are motivated by both material and non-material motivating factors. The material motivating factors in nurses' viewpoint are maintenance of workplace, the premium of work quality, the premium for night work and overtime, premium for work on holidays, possibility to attend courses and training, vacation pay, as well as environment of work. The non-material motivating factors in nurses' viewpoint are the attitude of the supervisor, being respectful of their workplace, the relations with colleagues, acknowledgment for the work done, the responsibility at work, the pride and respect for the work to be done, the challenges, interesting job and variety in work tasks, as well as the growth and development in the workplace.

Improving Influenza Immunization Rates Among Healthcare Workers Caring for High-Risk Pediatric Patients

2004 ◽  
Vol 25 (11) ◽  
pp. 912-917 ◽  
Author(s):  
Kristina A. Bryant ◽  
Beth Stover ◽  
Linda Cain ◽  
Gail L. Levine ◽  
Jane Siegel ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Intensive Care Units ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Pediatric Intensive Care ◽  
Vaccination Rates ◽  
Influenza Immunization ◽  
Immunization Rates

AbstractObjective:To assess influenza vaccination rates of healthcare workers (HCWs) in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and oncology units in Pediatric Prevention Network (PPN) hospitals.Participants:Infection control practitioners and HCWs in NICUs, PICUs, and oncology units.Methods:In November 2000, posters, electronic copies of a slide presentation, and an influenza fact sheet were distributed to 32 of 76 PPN hospitals. In January 2001, a survey was distributed to PPN hospital participants to obtain information about the immunization campaigns. On February 7, 2001, a survey of influenza immunization was conducted among HCWs in NICU, PICU, and oncology units at participating hospitals.Results:Infection control practitioners from 19 (25%) of the 76 PPN hospitals completed the surveys. The median influenza immunization rate was 43% (range, 12% to 63%), with 7 hospitals exceeding 50%. HCWs (n = 1,123) at 15 PPN hospitals completed a survey; 53% of HCWs reported receiving influenza immunization. Immunization rates varied by work site: 52% in NICUs and PICUs compared with 60% in oncology units. Mobile carts and PPN educational fact cards were associated with higher rates among these subpopulations (P < .001) (361 [63%] of 575 vs 236 [44%] of 541 for mobile carts; 378 [60%] of 633 vs 219 [45%] of 483 for fact cards).Conclusion:Despite delayed distribution of influenza vaccine during the 2000–2001 season, immunization rates at 7 hospitals and among HCWs in high-risk units exceeded the National Association of Children's Hospitals and Related Institutions goal of 50%.

scholarly journals Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait

2018 ◽  
Vol 19 (4) ◽  
pp. 168-176 ◽  
Author(s):  
Haifaa Hassan Al-Mousa ◽  
Abeer Aly Omar ◽  
Víctor Daniel Rosenthal ◽  
Mona Foda Salama ◽  
Nasser Yehia Aly ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Intensive Care Units ◽  
Density Ratio ◽  
Incidence Density ◽  
Ventilator Associated Pneumonia ◽  
Multidimensional Approach ◽  
The Impact

Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015. Design: A prospective, before–after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences. Logistic regression analysis was performed to estimate the effect of the intervention on VAP, controlling for potential bias. Results: During baseline, 1990 mechanical ventilator (MV)-days and 14 VAPs were recorded, accounting for 7.0 VAPs per 1000 MV-days. During intervention, 9786 MV-days and 35 VAPs were recorded, accounting for 3.0 VAPs per 1000 MV-days. The VAP rate was reduced by 57.1% (incidence-density ratio = 0.51; 95% CI = 0.28–0.93; p = 0.042). Logistic regression showed a significant reduction in VAP rate during the intervention phase (OR = 0.39, 95% CI = 0.18–0.83), with 61% effectiveness. Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the VAP rate in Kuwait ICUs.

The epidemic burden on prisons in Lombardy (Italy) during the first wave of the COVID-19 pandemic: the transmission and measures of prevention in detention facilities

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ruggero Giuliani ◽  
Sara Mazzilli ◽  
Teresa Sebastiani ◽  
Giorgia Cocca ◽  
Raffaella Bortolotti ◽  
...  
Keyword(s):  
High Risk ◽  
Prevention And Control ◽  
Control Measures ◽  
Prevention Measures ◽  
Content Type ◽  
Lombardy Region ◽  
Prevention And Control Measures ◽  
And Control ◽  
The Impact ◽  
Detention Facilities

Purpose Early on in the COVID-19 pandemic, the scientific community highlighted a potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released, and containment measures were quickly implemented in prisons. This paper aims to describe the spread of COVID-19 in detention facilities within the Lombardy region of Italy during March to July 2020, and the impact of the prevention and control measures implemented. Design/methodology/approach A descriptive retrospective analysis of case distribution was performed for all COVID-19 cases identified among people in detention (PiD) and prison officers (POs). A comparison of the epidemic burden affecting different populations and a correlation analysis between the number of cases that occurred and prevention measures implemented were also carried out. Findings From this study, it emerged that POs were at a high risk of contracting COVID-19. This study observed a delay in the occurrence of cases among PiD and substantial heterogeneity in the size of outbreaks across different prisons. Correlation between reported cases among PiD and registered sick leave taken by POs suggested the latter contributed to introducing the infection into prison settings. Finally, number of cases among PiD inversely correlated with the capacity of each prison to identify and set up dedicated areas for medical isolation. Originality/value Prevention and control measures when adopted in a timely manner were effective in protecting PiD. According to the findings, POs are a population at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the critical importance of including prison settings within emergency preparedness plans.

Impact of the International Nosocomial Infection Control Consortium (INICC)’s Multidimensional Approach on Rates of Central Line-Associated Bloodstream Infection in 14 Intensive Care Units in 11 Hospitals of 5 Cities in Argentina

2018 ◽  
Vol 39 (4) ◽  
pp. 445-451 ◽  
Author(s):  
Victor Daniel Rosenthal ◽  
Javier Desse ◽  
Diego Marcelo Maurizi ◽  
Gustavo Jorge Chaparro ◽  
Pablo Wenceslao Orellano ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Intensive Care Units ◽  
Central Line ◽  
Incidence Density ◽  
Multidimensional Approach ◽  
The Impact ◽  
Clabsi Rate

OBJECTIVETo analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.DESIGNThis prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.RESULTSDuring the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).CONCLUSIONSImplementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.Infect Control Hosp Epidemiol 2018;39:445–451

Underestimating the Impact of Ventilator-Associated Pneumonia by Use of Surveillance Data

2010 ◽  
Vol 31 (6) ◽  
pp. 650-652 ◽  
Author(s):  
Marci Drees ◽  
Sherry Hausman ◽  
Andrea Rogers ◽  
Leslie Freeman ◽  
Karen Frosh ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Administrative Data ◽  
Clinical Data ◽  
Surveillance Data ◽  
Ventilator Associated Pneumonia ◽  
Clinical Documentation ◽  
The Impact

We calculated rates of ventilator-associated pneumonia (VAP) by using surveillance data, clinical data, and coding data. Compared with the VAP rates calculated on the basis of surveillance data, the VAP rates calculated on the basis of coding data were significantly overestimated in 4 of 5 intensive, care units. Efforts to improve coding and clinical documentation will address much but not all of this discrepancy between surveillance and administrative data.

scholarly journals Exogenous Alginate Protects Staphylococcus aureus from Killing by Pseudomonas aeruginosa

2019 ◽  
Vol 202 (8) ◽  
Author(s):  
Courtney E. Price ◽  
Dustin G. Brown ◽  
Dominique H. Limoli ◽  
Vanessa V. Phelan ◽  
George A. O’Toole
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Physical Space ◽  
Late Time ◽  
Protective Effects ◽  
Content Type ◽  
Alginate Production ◽  
The Impact

ABSTRACT Cystic fibrosis (CF) patients chronically infected with both Pseudomonas aeruginosa and Staphylococcus aureus have worse health outcomes than patients who are monoinfected with either P. aeruginosa or S. aureus. We showed previously that mucoid strains of P. aeruginosa can coexist with S. aureus in vitro due to the transcriptional downregulation of several toxic exoproducts typically produced by P. aeruginosa, including siderophores, rhamnolipids, and HQNO (2-heptyl-4-hydroxyquinoline N-oxide). Here, we demonstrate that exogenous alginate protects S. aureus from P. aeruginosa in both planktonic and biofilm coculture models under a variety of nutritional conditions. S. aureus protection in the presence of exogenous alginate is due to the transcriptional downregulation of pvdA, a gene required for the production of the iron-scavenging siderophore pyoverdine as well as the downregulation of the PQS (Pseudomonas quinolone signal) (2-heptyl-3,4-dihydroxyquinoline) quorum sensing system. The impact of exogenous alginate is independent of endogenous alginate production. We further demonstrate that coculture of mucoid P. aeruginosa with nonmucoid P. aeruginosa strains can mitigate the killing of S. aureus by the nonmucoid strain of P. aeruginosa, indicating that the mechanism that we describe here may function in vivo in the context of mixed infections. Finally, we investigated a panel of mucoid clinical isolates that retain the ability to kill S. aureus at late time points and show that each strain has a unique expression profile, indicating that mucoid isolates can overcome the S. aureus-protective effects of mucoidy in a strain-specific manner. IMPORTANCE CF patients are chronically infected by polymicrobial communities. The two dominant bacterial pathogens that infect the lungs of CF patients are P. aeruginosa and S. aureus, with ∼30% of patients coinfected by both species. Such coinfected individuals have worse outcomes than monoinfected patients, and both species persist within the same physical space. A variety of host and environmental factors have been demonstrated to promote P. aeruginosa-S. aureus coexistence, despite evidence that P. aeruginosa kills S. aureus when these organisms are cocultured in vitro. Thus, a better understanding of P. aeruginosa-S. aureus interactions, particularly mechanisms by which these microorganisms are able to coexist in proximal physical space, will lead to better-informed treatments for chronic polymicrobial infections.

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