Implementation of an automated cluster alert system into the routine work of infection control and hospital epidemiology: experiences from a tertiary care university hospital

Abstract Background Early detection of clusters of pathogens is crucial for infection prevention and control (IPC) in hospitals. Conventional manual cluster detection is usually restricted to certain areas of the hospital and multidrug resistant organisms. Automation can increase the comprehensiveness of cluster surveillance without depleting human resources. We aimed to describe the application of an automated cluster alert system (CLAR) in the routine IPC work in a hospital. Additionally, we aimed to provide information on the clusters detected and their properties. Methods CLAR was continuously utilized during the year 2019 at Charité university hospital. CLAR analyzed microbiological and patient-related data to calculate a pathogen-baseline for every ward. Daily, this baseline was compared to data of the previous 14 days. If the baseline was exceeded, a cluster alert was generated and sent to the IPC team. From July 2019 onwards, alerts were systematically categorized as relevant or non-relevant at the discretion of the IPC physician in charge. Results In one year, CLAR detected 1,714 clusters. The median number of isolates per cluster was two. The most common cluster pathogens were Enterococcus faecium (n = 326, 19 %), Escherichia coli (n = 274, 16 %) and Enterococcus faecalis (n = 250, 15 %). The majority of clusters (n = 1,360, 79 %) comprised of susceptible organisms. For 906 alerts relevance assessment was performed, with 317 (35 %) alerts being classified as relevant. Conclusions CLAR demonstrated the capability of detecting small clusters and clusters of susceptible organisms. Future improvements must aim to reduce the number of non-relevant alerts without impeding detection of relevant clusters. Digital solutions to IPC represent a considerable potential for improved patient care. Systems such as CLAR could be adapted to other hospitals and healthcare settings, and thereby serve as a means to fulfill these potentials.

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Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1017 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s382-s383

Author(s):

Souad Belkebir ◽

Alaa Kanaan ◽

Rawan Jeetawi

Keyword(s):

Bacterial Colonization ◽

Tertiary Care ◽

Multidrug Resistant ◽

University Hospital ◽

Diffusion Method ◽

Infection Prevention And Control ◽

Isolation And Identification ◽

Active Screening ◽

Multidrug Resistant Organisms ◽

Positive Results

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.Funding: NoneDisclosures: None

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4700 ◽

2015 ◽

Vol 9 (03) ◽

pp. 309-312 ◽

Cited By ~ 5

Author(s):

Aysegul Ulu-Kilic ◽

Emine Alp ◽

Dilek Altun ◽

Fatma Cevahir ◽

Gamze Kalın ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Tertiary Care ◽

Care Facility ◽

Multidrug Resistant ◽

University Hospital ◽

Control Group ◽

Case Group ◽

Icu Patients ◽

Thoracic Drainage ◽

Tertiary Care Facility

Introduction: The widespread use of tigecycline raises the question of increasing infection rates of Pseudomonas aeruginosa (PA) in ICUs which are not affected by this antibiotic. Objective: The aim of this study was to determine if treatment with tigecycline is a risk factor for PA infection in ICU patients. Methodology: A retrospective and observational study was conducted at Erciyes University Hospital, Turkey, between 2008 and 2010. The Erciyes University Hospital is a 1300-bed tertiary care facility. The patients included in this study were hospitalized in four adult ICUs. Patients with PA infections (case group) were compared with patients with nosocomial infection other than PA (control group). Results: A total of 1,167 patients with any nosocomial infections were included in the study. Two hundred and seventy eight (23.8%) of the patients had PA infection during their ICU stay. Fifty nine patients (21.2%) in the case group received tigecycline before developing PA infections, which were found to be significantly more frequent than in the controls (p < 0.01). Multivariate analysis showed that risk factors for PA infection were previous tigecycline use (4 times), external ventricular shunt (4.2 times), thoracic drainage catheter (2.5 times) and tracheostomy (1.6 times). Conclusion: Our results contribute to the need for new studies to determine the safety of tigecycline use, especially for the treatment of critically ill patients. Since tigecycline seems to be an alternative for the treatment of multidrug resistant (MDR) microorganisms, rational use of this antibiotic in ICU patients is essential.

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Colistin Resistance in KPC-2- and SHV-5-Producing Klebsiella pneumoniae Clinical Isolates in Bulgaria

Chemotherapy ◽

10.1159/000464275 ◽

2017 ◽

Vol 62 (6) ◽

pp. 339-342 ◽

Cited By ~ 2

Author(s):

Encho Savov ◽

Iva Todorova ◽

Lida Politi ◽

Angelina Trifonova ◽

Maja Borisova ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Tertiary Care ◽

Multidrug Resistant ◽

University Hospital ◽

Colistin Resistance ◽

Klebsiella Species ◽

Microbial Identification ◽

Clonal Type ◽

Intrinsic Mechanism ◽

Vitek 2

Background/Aims: Colistin resistance is increasingly recognized among carbapenemase-producing Klebsiella pneumoniae isolates in several European regions. The current study documents the appearance of colistin resistance among KPC-2 and SHV-5-produning K. pneumoniae strains in Bulgaria. Methods: Four colistin-resistant K. pneumoniae isolates were recovered from 2 patients hospitalized in the anesthesiology and resuscitation clinic of a tertiary care university hospital in Sofia, Bulgaria. Microbial identification and antimicrobial susceptibility testing was performed by Vitek 2 (Biomerieux, France). β-Lactamase genes were amplified using a panel of primers for detection of all MBL-types, KPCs, plasmid-mediated AmpCs in single PCR reactions, OXA-type carbapenemases, extended-spectrum β-lactamases (ESBLs) and TEM enzymes. The colistin-resistant mcr-1 gene was also investigated using previously described primers and conditions. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to investigate clonality. Results: The 4 K. pneumoniae isolates exhibited colistin MICs >16 mg/L and showed multidrug-resistant phenotypes, remaining intermediately susceptible only to gentamicin. They were clustered into a single PFGE clonal type and MLST assigned them to sequence type 258. All isolates possessed KPC-2 carbapenemase and SHV-5 ESBL. They were negative for the plasmid-mediated colistin-resistant mcr-1 gene, possibly implying an intrinsic mechanism of resistance. Conclusions: Although colistin use in Bulgaria only started moderately during 2014, the findings of the current study notify the appearance of colistin resistance among carbapenemase-producing Klebsiella species in another European region.

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A Pseudo-Outbreak due toAcinetobacterSpecies (GIM-1) Contamination of the Pneumatic Transport System of a Large University Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/678413 ◽

2014 ◽

Vol 35 (11) ◽

pp. 1364-1372 ◽

Cited By ~ 3

Author(s):

Mathias Herrmann ◽

Sven Jungmann ◽

Alexander Halfmann ◽

Alik Dawson ◽

Martin Kaase ◽

...

Keyword(s):

Transport System ◽

Tertiary Care ◽

Multidrug Resistant ◽

Pneumatic Transport ◽

Positive Patient ◽

University Hospital ◽

Potential Hazard ◽

Outbreak Management ◽

Carbapenem Resistant ◽

Management Procedures

Objective.To establish the source and contamination routes resulting in positive clinical and surveillance microbiological cultures with carbapenem-resistant, GIM-1 metallo-β-lactamase–positiveAcinetobacter pitiiandAcinetobacter radioresistensfrom 21 patients in 8 departmentsDesign.Retrospective, descriptive study.Setting.A 1,300-bed tertiary care academic medical facility consisting of 90 buildings linked by a pneumatic transport system (PTS).Methods.Microbiological workup of the cluster strains included matrix-assisted laser desorption/ionization time-of-flight species identification, phenotypic carbapenemase tests, polymerase chain reaction–based genotyping of carbapenemase, and pulsed-field gel electrophoresis. Outbreak management procedures were employed according to institutional regulations.Results.The rarity of GIM-1Acinetobacterspecies in the hospital and region, the lack of epidemiological links between patients, and the fact that in some patients the apparent colonization was clearly nonnosocomial prompted the suspicion of a pseudo-outbreak. Numerous environmental cultures were positive for GIM-1-positiveAcinetobacter(including archived sample requisition forms, PTS capsules, cultures from line-diverter and dispenser stations, and sterilized transport capsules following PTS delivery). Moreover, it was observed that condensation fluid from subterranean PTS tubing resulted in water entry in PTS capsules, possibly conferring specimen contamination. After extensive system disinfection, environmental surveys of the PTS were negative, and no further positive patient specimens were encountered.Conclusions.This is the first report of a PTS-associated pseudo-outbreak. The large number of falsely positive patient-related specimens in conjunction with the potential hazard of airborne and contact spread of multidrug-resistant microorganisms (in this case, GIM-1 carbapenem-resistantAcinetobacterspecies) underscores the need for implementation of infection control–based monitoring and operating procedures in a hospital PTS.

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Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit

Scientific Reports ◽

10.1038/s41598-021-85443-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kévin Boussion ◽

Nathalie Zappella ◽

Nathalie Grall ◽

Lara Ribeiro-Parenti ◽

Grégory Papin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Outcomes ◽

Clinical Characteristics ◽

Tertiary Care ◽

University Hospital ◽

Coagulase Negative Staphylococci ◽

One Year ◽

Abdominal Infections ◽

Hospital Acquired

AbstractThe pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.

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Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

The International Arabic Journal of Antimicrobial Agents ◽

10.3823/834 ◽

2019 ◽

Vol 9 (2) ◽

Author(s):

Asem A. Shehabi ◽

Noor Issam Shishtawi ◽

Manar Al-lawama

Keyword(s):

Virulence Factors ◽

Antimicrobial Agents ◽

Care Center ◽

Tertiary Care ◽

Multidrug Resistant ◽

University Hospital ◽

Pediatric Clinic ◽

Antimicrobial Resistance Genes ◽

Infant Feces ◽

Neonates And Infants

Background: Pseudomonas.aeruginosa is among the most common opportunistic hospital pathogens, which exhibit an innate resistance and has developed increasing resistance to many useful antimicrobial agents over the last decades. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants. Methods: A total of 302 feces samples were obtained randamely from neonates and infants admitted to Pediatric Clinic and the Neonate Intensive Care Unit (NICU)/Jordan University Hospital (JUH), over a 9-months period(2016- 2017). Fecal samples were cultured for P.aeruginosa and their growth was identified and tested using microbiological and antibiotic susceptibility methods. Additionly, virulence factors, antimicrobial resistance genes and genotypes were detected using Polymerase Chain Reaction (PCR). Results: A total of 16/302 (5.3%) of P. aeruginosa isolates were recovered from feces samples. Antimicrobial susceptibility of the isolates ranged between the lowest 18.75% to meropenem and highest of 87.5% to azetreonam among 9 tested drugs. The percentage of specific genes of ESBLs and MBLs in 16 P.aeruginosa isolates were the following: blaOXA-50, blaTEM, blaCTX-M , blaVIM ,blaKPC , blaSHV ,blaGES, and blaVEB were detected at the rate of 13(81.2%), 13(81.2%), 12(75%), 12(75%), 11(68.7%), 10(62.5%), 2(12.5),1(6.2%), respectively. The percentage of the potential virulence genes in the same isolates were detected as follow: lasB, algD , toxA, exo S and exo U at the rate of 100%, 87.5% , 81.2%, 81.2%,31.2, respectively. All P.aeruginosa isolates observed to develop beta-hemolysis on both human and sheep blood agar, and to produce either pyoverdin ((56.3%) or pyocyanin (43.7%). Conclusions: The present study demonstrates high occurrence of multidrug resistant P.aeruginosa isolates in infant feces which carried high rates of important genes of ESBLs and MBLs and potential virulence factors.

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Enterobacterial infection in Saudi Arabia: First record of Klebsiella pneumoniae with triple carbapenemase genes resistance

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11056 ◽

2019 ◽

Vol 13 (04) ◽

pp. 334-341 ◽

Cited By ~ 2

Author(s):

Mubashir Ahmad Khan ◽

Amr M Mohamed ◽

Aftab Faiz ◽

Jawwad Ahmad

Keyword(s):

Saudi Arabia ◽

Klebsiella Pneumoniae ◽

Tertiary Care ◽

First Record ◽

Multidrug Resistant ◽

Western Region ◽

Disk Diffusion Test ◽

Resistant Genes ◽

Blood Specimens ◽

One Year

Introduction: Carbapenemase producing Enterobacteriaceae are emerging as important pathogens worldwide with serious effects on patients’ outcome. The study aimed to investigate the emergence of carbapenemases associated with enterobacterial infection in Western region of Saudi Arabia. Methodology: Clinical isolates from suspected patients with enterobacterial infection were investigated over a one-year period from four tertiary care hospitals of Makkah, Saudi Arabia. All isolates were identified using Vitek-2 system and then screened for potential carbapenemase production using disk diffusion test. Suspected isolates with reduced susceptibility to carbapenems were further investigated for blaNDM-1, blaKPC and blaOXA-48 resistant genes. Results: Out of 120 confirmed Enterobacteriaceae isolates, Klebsiella pneumoniae and Escherichia coli comprised the largest proportion (35% and 34.2%, respectively) of encountered infections. Twenty-six (21.7%) isolates showed resistance to carbapenems, the majority of which (21/26) were K. pneumoniae. Remarkably, 17 isolates carried triple resistant genes KPC/NDM-1/OXA-48 while the other 4 carried double resistant genes (KPC/OXA-48) or (NDM-1/OXA-48). The current study revealed that the mentioned triple resistance genes have the higher incidence with significant association risk among males (COR 4.5; CI: 1.9-17.3; P = 0.018), non-Saudi nationalities (COR 4.9; CI: 1.5-19.3; P = 0.003), ICU-obtained specimens (COR 3.6; CI: 1.5-8.4; P = 0.002) and blood specimens (COR 2.8; CI: 1.1-6.9; P = 0.02). Conclusion: Multidrug-resistant Enterobacteriaceae isolates in particular K. pneumoniae co-harboring KPC, NDM-1 and OXA-48 genes are emerging in Western region, Saudi Arabia. This is the first record of triple carbapenemase genes co-producing K. pneumoniae associated with enterobacterial infection.

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Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

Infection Control and Hospital Epidemiology ◽

10.1086/591741 ◽

2008 ◽

Vol 29 (10) ◽

pp. 901-913 ◽

Cited By ~ 117

Author(s):

Adam L. Cohen ◽

David Calfee ◽

Scott K. Fridkin ◽

Susan S. Huang ◽

John A. Jernigan ◽

...

Keyword(s):

Healthcare Workers ◽

Infection Prevention ◽

Healthcare Setting ◽

Multidrug Resistant ◽

Infection Prevention And Control ◽

Healthcare Settings ◽

Multidrug Resistant Organisms ◽

Vulnerable Patient ◽

Trends Over Time ◽

And Control

Monitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and practical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of infection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in documenting trends over time within their facility and should not be used for interfacility comparison.

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Comparison of endotracheal intubation learning curves with tracheoscopic ventilation tube for simulated difficult intubation between expert and novice anesthesiologists.

10.21203/rs.2.21893/v1 ◽

2020 ◽

Author(s):

Heezoo Kim ◽

Dong Kyu Lee ◽

Choong Hun Lee ◽

Myung-Hoon Gong ◽

Jung Suk Oh

Keyword(s):

Failure Rate ◽

Difficult Intubation ◽

Tertiary Care ◽

Median Number ◽

Learning Curves ◽

University Hospital ◽

Ventilation Tube ◽

Single Lumen ◽

Cusum Analysis ◽

Tracheoscopic Ventilation Tube

Abstract Background: Tracheoscopic ventilation tube (TVT) is a specially designed single-lumen endotracheal tube with a camera. It was developed to facilitate endobronchial blocker insertion without bronchoscopy; its ability to explore anatomy received attention for difficult intubations. To clarify the feasibility of TVT in difficult intubation, we evaluated the learning curves of intubation between novice and expert. Methods: 182 patients who presented as Cormack-Lehane (CL) grade IIb and III with cervical in-line stabilization, and 4 trainees (2 novices, 2 experts) at single tertiary care teaching university hospital. All trainees performed intubation with TVT during laryngoscopy. Intubation attempts were limited to two times, each within 30 seconds. For every attempt, trainees visualized an imaginary pathway from the teeth to vocal cords and then shaped the stylet. Intubation was confirmed by three successive ETCO 2 measurements > 30 mmHg. Using CUSUM analysis, the trial was continued until every trainee reached an acceptable failure rate. Results: Patients were constituted with 94.5% CL grade IIb and 5.5% grade III. The median number of acceptable performances (10% of the acceptable failure rate) was 36. Overall failure rate was 5.5% (95%CI: 2.2-8.8%), with 6.9% (95%CI: 2.0-11.8%) for novices and 3.7% (95%CI: 0.0-7.8%, P=0.165, Cohen’s h=0.14) for experts. Intubation time was longer in novices by about 3 seconds compared to experts (mean difference=2.8, 95%CI: 1.3-4.3, P<0.001, Cohen's d=0.57). Conclusions: Intubation with TVT in CL grades IIb and III was easy to learn and could be an alternative for difficult intubation. It required small cases to reach acceptable performance, and provided a short learning period even for novice anesthesiologists, with failure rates similar to those of experienced anesthesiologists.

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