scholarly journals An outbreak of Salmonella Saintpaul in a Scottish childcare facility: the influence of parental under-reporting

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rachel M. Thomson ◽  
Hazel J. Henderson ◽  
Alison Smith-Palmer
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Gastrointestinal Symptoms ◽  
Control Measures ◽  
Incident Management ◽  
Reference Laboratory ◽  
Public Health Department ◽  
Water Tank ◽  
Stool Samples ◽  
Childcare Facility

Abstract Background Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features. Methods Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak. Results There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility. Conclusions This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.

scholarly journals Translating genomics into practice for real-time surveillance and response to carbapenemase-producing Enterobacteriaceae: evidence from a complex multi-institutional KPC outbreak

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4210 ◽  
Author(s):  
Jason C. Kwong ◽  
Courtney R. Lane ◽  
Finn Romanes ◽  
Anders Gonçalves da Silva ◽  
Marion Easton ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Real Time ◽  
The State ◽  
Control Measures ◽  
Reference Laboratory ◽  
Epidemiological Investigation ◽  
Transmission Networks ◽  
Healthcare Facilities ◽  
Incident Cases

BackgroundUntil recently,Klebsiella pneumoniaecarbapenemase (KPC)-producing Enterobacteriaceae were rarely identified in Australia. Following an increase in the number of incident cases across the state of Victoria, we undertook a real-time combined genomic and epidemiological investigation. The scope of this study included identifying risk factors and routes of transmission, and investigating the utility of genomics to enhance traditional field epidemiology for informing management of established widespread outbreaks.MethodsAll KPC-producing Enterobacteriaceae isolates referred to the state reference laboratory from 2012 onwards were included. Whole-genome sequencing was performed in parallel with a detailed descriptive epidemiological investigation of each case, using Illumina sequencing on each isolate. This was complemented with PacBio long-read sequencing on selected isolates to establish high-quality reference sequences and interrogate characteristics of KPC-encoding plasmids.ResultsInitial investigations indicated that the outbreak was widespread, with 86 KPC-producing Enterobacteriaceae isolates (K. pneumoniae92%) identified from 35 different locations across metropolitan and rural Victoria between 2012 and 2015. Initial combined analyses of the epidemiological and genomic data resolved the outbreak into distinct nosocomial transmission networks, and identified healthcare facilities at the epicentre of KPC transmission. New cases were assigned to transmission networks in real-time, allowing focussed infection control efforts. PacBio sequencing confirmed a secondary transmission network arising from inter-species plasmid transmission. Insights from Bayesian transmission inference and analyses of within-host diversity informed the development of state-wide public health and infection control guidelines, including interventions such as an intensive approach to screening contacts following new case detection to minimise unrecognised colonisation.ConclusionA real-time combined epidemiological and genomic investigation proved critical to identifying and defining multiple transmission networks of KPC Enterobacteriaceae, while data from either investigation alone were inconclusive. The investigation was fundamental to informing infection control measures in real-time and the development of state-wide public health guidelines on carbapenemase-producing Enterobacteriaceae surveillance and management.

scholarly journals Real-time genomic and epidemiological investigation of a multi-institution outbreak of KPC-producing Enterobacteriaceae: a translational study

2017 ◽  
Author(s):  
JC Kwong ◽  
C Lane ◽  
F Romanes ◽  
A Gonçalves da Silva ◽  
M Easton ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Real Time ◽  
The State ◽  
Control Measures ◽  
Reference Laboratory ◽  
Epidemiological Investigation ◽  
Transmission Networks ◽  
Translational Study ◽  
Incident Cases

ABSTRACTBackgroundUntil recently, KPC-producing Enterobacteriaceae were rarely identified in Australia. Following an increase in the number of incident cases across the state of Victoria, we undertook a real-time combined genomic and epidemiological investigation. The scope of this study included identifying risk factors and routes of transmission, and investigating the utility of genomics to enhance traditional field epidemiology for informing management of established widespread outbreaks.Methods and FindingsAll KPC-producing Enterobacteriaceae isolates referred to the state reference laboratory from 2012 onwards were included. Whole-genome sequencing (WGS) was performed in parallel with a detailed descriptive epidemiological investigation of each case, using Illumina sequencing on each isolate. This was complemented with PacBio long-read sequencing on selected isolates to establish high-quality reference sequences and interrogate characteristics of KPC-encoding plasmids. Initial investigations indicated the outbreak was widespread, with 86 KPC-producing Enterobacteriaceae isolates (K. pneumoniae92%) identified from 35 different locations across metropolitan and rural Victoria between 2012-2015. Initial combined analyses of the epidemiological and genomic data resolved the outbreak into distinct nosocomial transmission networks, and identified healthcare facilities at the epicentre of KPC transmission. New cases were assigned to transmission networks in real-time, allowing focussed infection control efforts. PacBio sequencing confirmed a secondary transmission network arising from inter-species plasmid transmission. Insights from Bayesian transmission inference and analyses of within-host diversity informed the development of state-wide public health and infection control guidelines, including interventions such as an intensive approach to screening contacts following new case detection to minimise unrecognised colonisation.ConclusionsA real-time combined epidemiological and genomic investigation proved critical to identifying and defining multiple transmission networks of KPC Enterobacteriaceae, while data from either investigation alone were inconclusive. The investigation was fundamental to informing infection control measures in real-time and the development of state-wide public health guidelines on carbapenemase producing Enterobacteriaceae management.

scholarly journals Aggressive Colonization Screening and Infection Control Measures in Containment of NDM-5 Carbapenemase-Producing CRE

2020 ◽  
Vol 41 (S1) ◽  
pp. s458-s459
Author(s):  
Ishrat Kamal-Ahmed ◽  
Kate Tyner ◽  
Teresa Fitzgerald ◽  
Heather Adele Moulton-Meissner ◽  
Gillian McAllister ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
The United States ◽  
Control Measures ◽  
Care Hospital ◽  
Clinical Culture ◽  
Medical Histories ◽  
Asymptomatic Case

Background: In April 2019, Nebraska Public Health Laboratory identified an NDM-producing Enterobacter cloacae from a urine sample from a rehabilitation inpatient who had recently received care in a specialized unit (unit A) of an acute-care hospital (ACH-A). After additional infections occurred at ACH-A, we conducted a public health investigation to contain spread. Methods: A case was defined as isolation of NDM-producing carbapenem-resistant Enterobacteriaceae (CRE) from a patient with history of admission to ACH-A in 2019. We conducted clinical culture surveillance, and we offered colonization screening for carbapenemase-producing organisms to all patients admitted to unit A since February 2019. We assessed healthcare facility infection control practices in ACH-A and epidemiologically linked facilities by visits from the ICAP (Infection Control Assessment and Promotion) Program. The recent medical histories of case patients were reviewed. Isolates were evaluated by whole-genome sequencing (WGS). Results: Through June 2019, 7 cases were identified from 6 case patients: 4 from clinical cultures and 3 from 258 colonization screens including 1 prior unit A patient detected as an outpatient (Fig. 1). Organisms isolated were Klebsiella pneumoniae (n = 5), E. cloacae (n = 1), and Citrobacter freundii (n = 1); 1 patient had both NDM-producing K. pneumoniae and C. freundii. Also, 5 case patients had overlapping stays in unit A during February–May 2019 (Fig. 2); common exposures in unit A included rooms in close proximity, inhabiting the same room at different times and shared caregivers. One case-patient was not admitted to unit A but shared caregivers, equipment, and devices (including a colonoscope) with other case patients while admitted to other ACH-A units. No case patients reported travel outside the United States. Screening at epidemiologically linked facilities and clinical culture surveillance showed no evidence of transmission beyond ACH-A. Infection control assessments at ACH-A revealed deficiencies in hand hygiene, contact precautions adherence, and incomplete cleaning of shared equipment within and used to transport to/from a treatment room in unit A. Following implementation of recommended infection control interventions, no further cases were identified. Finally, 5 K. pneumoniae of ST-273 were related by WGS including carriage of NDM-5 and IncX3 plasmid supporting transmission of this strain. Further analysis is required to relate IncX3 plasmid carriage and potential transmission to other organisms and sequence types identified in this study. Conclusions: We identified a multiorganism outbreak of NDM-5–producing CRE in an ACH specialty care unit. Transmission was controlled through improved infection control practices and extensive colonization screening to identify asymptomatic case-patients. Multiple species with NDM-5 were identified, highlighting the potential role of genotype-based surveillance.Funding: NoneDisclosures: Muhammad Salman Ashraf reports that he is the principal investigator for a study funded by an investigator-initiated research grant.

scholarly journals Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine

2020 ◽  
Vol 99 (5) ◽  
pp. 481-487 ◽  
Author(s):  
L. Meng ◽  
F. Hua ◽  
Z. Bian
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Control Measures ◽  
World Health ◽  
Infection Control Measures ◽  
Dental Practitioners ◽  
The World ◽  
Essential Knowledge ◽  
Novel Coronavirus ◽  
Health Organization

The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.

scholarly journals Content Analysis of the Free COVID-19 Telephone Consultations Available during the First Wave of the Pandemic in Japan

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1593
Author(s):  
Kyoko Yoshioka-Maeda ◽  
Yuka Sumikawa ◽  
Noriha Tanaka ◽  
Chikako Honda ◽  
Riho Iwasaki-Motegi ◽  
...  
Keyword(s):  
Public Health ◽  
Content Analysis ◽  
Infection Control ◽  
Qualitative Content Analysis ◽  
Cross Sectional Study ◽  
Control Measures ◽  
Cross Sectional ◽  
Telephone Consultation ◽  
Infection Control Measures ◽  
Consultation Services

This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed a total of 207 calls in which the purpose of the call was unclassified into pre-set categories. PHNs transcribed the exact text of the consultation conversations recorded from 25 March to 20 April 2020 in City A. Approximately half of the calls were from residents. Seven categories were extracted through a qualitative content analysis. The most common topic was infection control measures, where the presence of COVID-19 infection was assumed (n = 62); the second most common was extreme anxiety and fear of infection (n = 50). Questions about the COVID-19 response system (n = 30), discrimination and misunderstandings about COVID-19 (n = 24), and response measures for COVID-19 outbreaks within organizations (n = 18) were also included. The unclassified consultations included various topics, several of which required the expertise of a PHN. Each local government should consider sharing and task-shifting telephone consultation services among PHNs and other staff to reduce their burden and allow them to concentrate on conducting infection control more effectively.

scholarly journals The interplay of SARS-CoV-2 and Clostridioides difficile infection

2021 ◽  
Vol 16 (6) ◽  
pp. 439-443
Author(s):  
Sahil Khanna ◽  
Colleen S Kraft
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Gastrointestinal Symptoms ◽  
Control Measures ◽  
Antibiotic Exposure ◽  
Hospital Acquired Infections ◽  
Infection Control Measures ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Hospital Acquired

The COVID-19 pandemic has changed the way we practice medicine and lead our lives. In addition to pulmonary symptoms; COVID-19 as a syndrome has multisystemic involvement including frequent gastrointestinal symptoms such as diarrhea. Due to microbiome alterations with COVID-19 and frequent antibiotic exposure, COVID-19 can be complicated by Clostridioides difficile infection. Co-infection with these two can be associated with a high risk of complications. Infection control measures in hospitals is enhanced due to the COVID-19 pandemic which in turn appears to reduce the incidence of hospital-acquired infections such as C. difficile infection. Another implication of COVID-19 and its potential transmissibility by stool is microbiome-based therapies. Potential stool donors should be screened COVID-19 symptoms and be tested for COVID-19.

Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden

2011 ◽  
Vol 139 (12) ◽  
pp. 1928-1935 ◽  
Author(s):  
M. RIERA-MONTES ◽  
K. BRUS SJÖLANDER ◽  
G. ALLESTAM ◽  
E. HALLIN ◽  
K.-O. HEDLUND ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Supply ◽  
Gastrointestinal Symptoms ◽  
Control Measures ◽  
Drinking Water Supply ◽  
Water Network ◽  
Public Network ◽  
The Public ◽  
Increased Risk ◽  
Stool Samples

SUMMARYDuring Easter 2009, almost 200 people resident in a small Swedish village fell ill with gastrointestinal symptoms. We conducted a retrospective cohort study and a molecular investigation in order to identify the source of the outbreak. Residents living in households connected to the public water network were at an increased risk of developing disease (relative risk 4·80, 95% confidence interval 1·68–13·73) compared to those with no connection to the public network. Norovirus genotype GI.3 was identified in stool samples from six patients and in a sample from the public water network. Contamination of one of the wells supplying the public water network was thought to be the source of the outbreak. This is a description of a norovirus outbreak linked to a municipal drinking-water supply in Sweden. Information from epidemiological and molecular investigations is of utmost importance to guide outbreak control measures and to prevent future outbreaks.

scholarly journals Expanding the Use of Noninvasive Ventilation During an Epidemic

2014 ◽  
Vol 8 (4) ◽  
pp. 310-314 ◽  
Author(s):  
Jasminka Kopić ◽  
Maja Tomić Paradžik
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Noninvasive Ventilation ◽  
Therapeutic Option ◽  
Control Measures ◽  
Invasive Ventilation ◽  
Preparedness Planning ◽  
Infection Control Measures ◽  
Effective Therapeutic Option ◽  
Infection Control Guidelines

ABSTRACTNoninvasive ventilation (NIV) is a proved and effective therapeutic option for some patients with respiratory failure. During an epidemic, NIV can free up respirators and other intensive care unit equipment for patients with respiratory insufficiency whose survival depends exclusively on invasive ventilation. Some guidelines have indicated that NIV is potentially hazardous and should not be recommended for use during epidemics, given the perceived potential risk of transmission from aerosolized pathogen dispersion to other patients or medical staff. Conversely, some reports of previous epidemics describe NIV as a very efficient and safe modality of respiratory support, if strict infection control measures are implemented.We discuss NIV use during epidemics and indicate the need for prospective randomized clinical studies on the efficacy of NIV in epidemic conditions to provide important information to the current body of literature. Meanwhile, the use of NIV under strict infection control guidelines should be incorporated into epidemic preparedness planning. (Disaster Med Public Health Preparedness. 2014;8:1-5)

scholarly journals Cross-border investigation of a Shigella sonnei outbreak in a group of Norwegian tourists after a trip to Russia

2007 ◽  
Vol 12 (4) ◽  
pp. 9-10 ◽  
Author(s):  
B Schimmer ◽  
H Meldal ◽  
N G Perederij ◽  
L Vold ◽  
M A Petukhova ◽  
...  
Keyword(s):  
Public Health ◽  
Gastrointestinal Symptoms ◽  
Food Samples ◽  
Shigella Sonnei ◽  
Epidemiological Surveillance ◽  
Cross Border ◽  
Cured Meat ◽  
Food And Beverage ◽  
Stool Samples ◽  
E Mail

In early September 2006, the Norwegian Institute of Public Health was alerted to an outbreak of Shigella sonnei infections (shigellosis) among 23 Norwegian passengers who had taken a bus tour from Kirkenes, Norway to Murmansk, Russia. The trip lasted from 27 to 31 August, and the group stayed in various hotels and visited several restaurants in both Kirkenes and Murmansk during this period. Stool samples from three ill passengers yielded S. sonnei; an additional 10 passengers had gastrointestinal symptoms with diarrhoea or loose stools with abdominal pain. An investigation was initiated in collaboration with the department of epidemiological surveillance in Murmansk. We sent a questionnaire to the work e-mail addresses of all passengers asking about symptoms and exposures. Two restaurants and a hotel visited by the Norwegian tourists in Murmansk were inspected and sampled. Of all the food and beverage items mentioned in the questionnaire, only cured meat consumed in restaurant A in Murmansk on 28 August was associated with the risk of developing illness. Inspections of the restaurants in Murmansk identified some hygienic shortcomings and inadequate routines. However, S. sonnei could not be isolated from food samples or the personnel. Improved routines were implemented.

scholarly journals Community Pharmacy Response to Infection Control during COVID-19. A Cross-Sectional Survey.

2020 ◽  
Author(s):  
Zachary Sum ◽  
Charmane Ow
Keyword(s):  
Public Health ◽  
Infection Control ◽  
Community Pharmacy ◽  
Pharmacy Practice ◽  
Control Measures ◽  
Public Healthcare ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Crisis ◽  
Infection Control Measures

Background: Australia received its first case of coronavirus on 25 January 2020. Since then the demands of COVID-19 has presented unparalleled levels of strain on the public healthcare systems in the country. In this time of crisis, pharmacists and community pharmacy staff have modified work strategies according to the rapidly changing environment. With a delayed dissemination of resources and guidelines, pharmacist and pharmacies are practicing innovative infection control methods across Australia to protect their staff, patients and the community. This article seeks to explore the current activities undertaken by pharmacists in various community pharmacy settings across Australia in relation to the safety of the workplace environments for staff and patients. Information collected can help inform future decisions in pandemic preparation for pharmacies in response to similar health crisis now and in the future. Methods: An online cross-sectional survey study was conducted in Australia during the COVID-19 outbreak from 1st to 30th April 2020. The questionnaire addressed community pharmacist’s awareness and response to infection and sanitation control. Results: A total of 137 pharmacists took part in the survey, with almost half (45.26%) belonging to the age group of 25 to 34 years. Community pharmacy formed the bulk (89.05%) of the respondent’s primary place of practice. There was a good uptake of safety measures by pharmacists and their pharmacies to protect staff and patients. However the task of reassigning high health risk staff was not heavily practiced (34.31%). Regular cleaning took place in the pharmacy, but the use of gloves while cleaning was not practiced in 48.18% of respondents. In addition, only 46.72% of respondents reported observing script baskets being cleaned and disinfected. About one-third (37.96%) of pharmacists were aware of the two-step cleaning and disinfecting process, but only 18.98% of pharmacists reported observing or performing this sanitation procedure. More than half of surveyed pharmacists reported having difficulty keeping up with infection control changes and pharmacy practice guidelines during the pandemic. Conclusion: This study demonstrates that the majority of pharmacists are not fully aware of the infection control measures needed in a community pharmacy setting. The influx of coronavirus updates has made it difficult for pharmacists to implement accurate procedures on some aspects of workplace hygiene, which may have led to some gaps in infection control measures. Pharmacists must aim to uphold their public health ambassador role and aim to keep up-to-date with professional guidance to provide the necessary infection control measures to ensure staff, patient and public health safety.

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