Costs of Infection Control and Special Challenges during the Covid-19 Pandemic: Experiences in a Military Hospital

Infection prevention and control (IPC) is a set of evidence-based practices of hospital epidemiology aiming to prevent and control healthcare-associated infections. The aim of the present study was two-fold. First, we estimated the costs of IPC in the Medical Centre of the Hungarian Defence Forces (MCHDF) in Hungary using a bottom-up microcosting approach. Second, we analysed how the involvement of the MCHDF in Covid-19 care changed the occurrence of multidrug-resistant infections in the hospital. Our results showed that depending on the type of ward, the daily costs of standard care ranged between 3,809–8,589 HUF, while the costs of isolation were between 9,203–11,200 HUF. Daily costs were highest in the intensive care unit (ICU). Total costs per patient ranged between 20,875–78,904 HUF for standard care and 79,996–282,892 HUF for isolation with highest values in the Neonatal Intensive Care Unit (NICU). The incremental isolation cost per patient compared to standard care ranged between 20,363–158,216 HUF. When the MCHDF became a Covid-19 care centre, the incidence of introduced Clostridium difficile and multidrug resistant cases increased by nearly 200 per cent and 40 per cent, respectively. Our results can be used as basic input data for the economic evaluation of IPC strategies and highlights an important IPC aspect to be considered for the redistribution of hospital capacities during the Covid-19 pandemic.

Download Full-text

Healthcare-Associated Infections in Neonatal Intensive Care Unit of Military Hospital of Tunis.

10.26226/morressier.57d034d3d462b80292383be3 ◽

2016 ◽

Author(s):

Nadia KASDALLAH

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Military Hospital ◽

Healthcare Associated Infections ◽

Healthcare Associated

Download Full-text

PO-0535 Sustainable Reduction Of Positive Blood Cultures In A Tertiary Neonatal Intensive Care Unit: Impact Of Infection Prevention And Control Measures Over A 5 Year Period

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-307384.1179 ◽

2014 ◽

Vol 99 (Suppl 2) ◽

pp. A424.2-A425

Author(s):

S Fang ◽

V Longstaff ◽

E Vanderpool ◽

S Husain ◽

A Claxton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prevention And Control ◽

Neonatal Intensive Care ◽

Infection Prevention ◽

Blood Cultures ◽

Control Measures ◽

Infection Prevention And Control ◽

Prevention And Control Measures ◽

And Control

Download Full-text

Evolution of the environmental microbiota of a new neonatal intensive care unit (NICU) and implications for infection prevention and control

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.396 ◽

2020 ◽

pp. 1-6

Author(s):

Philip Zachariah ◽

Felix D. Rozenberg ◽

Stephania Stump ◽

Dagmara I. Moscoso ◽

Ganga Krishnamurthy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Prevention And Control ◽

Neonatal Intensive Care ◽

Infection Prevention ◽

Patient Transfer ◽

Infection Prevention And Control ◽

Differential Abundance ◽

And Control

Abstract Objective: To describe changes in the environmental microbiota of a new neonatal intensive care unit (NICU) and potential implications for infection prevention and control (IPC) efforts. Design: Prospective observational study. Setting: A newly constructed level IV neonatal cardiac intensive care unit (NCICU) before and after patient introduction and the original NICU prior to patient transfer. Methods: Environmental samples were obtained from the original NICU prior to patient transfer to a new NCICU. Serial sampling of patient rooms and provider areas of the new NICU was conducted immediately prior to patient introduction and over an 11-month study period. Microbiota at each sampling point were characterized using Illumina sequencing of the V3/V4 region of the 16S rRNA gene. Microbiota characteristics (α and β diversity and differential abundance) were compared based on time, location, and clinical factors (room-level antibiotic use and patient turnover). Results: An immediate increase in the environmental differential abundance of gut anaerobes were seen after patient introduction. There was an increase in the relative abundance of Staphylococcus spp, Klebsiella spp, Pseudomonas spp, and Streptococcus spp over time. The new NCICU consistently showed more diverse microbiota and remained distinct from the original NICU. The microbiota of the provider areas of the NCICU eventually formed a cluster separate from the patient rooms. Patient turnover increased room-level microbiota diversity. Conclusion: Microbiota characteristics of the new NICU were distinct from the original ICU despite housing similar patients. Patient and provider areas developed distinct microbiota profiles. Non–culture-based methods may be a useful adjunct to current IPC practice.

Download Full-text

A Decrease in the Number of Cases of Necrotizing Enterocolitis Associated with the Enhancement of Infection Prevention and Control Measures during aStaphylococcus aureusOutbreak in a Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/663343 ◽

2012 ◽

Vol 33 (1) ◽

pp. 29-33 ◽

Cited By ~ 10

Author(s):

Brigitte Lemyre ◽

Wenlong Xiu ◽

Nicole Rouvinez Bouali ◽

Janet Brintnell ◽

Jo-Anne Janigan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Prevention And Control ◽

Neonatal Intensive Care ◽

Infection Prevention ◽

Control Measures ◽

Infection Prevention And Control ◽

Prevention And Control Measures ◽

And Control

Objective.Most cases of necrotizing enterocolitis (NEC) are sporadic, but outbreaks in hospital settings suggest an infectious cause. Our neonatal intensive care unit (NICU) experienced an outbreak of methicillin-sensitiveStaphylococcus aureus(MSSA). We aimed to assess whether the enhancement of infection prevention and control measures would be associated with a reduction in the number of cases of NEC.Design.Retrospective chart review.Setting.A 24-bed, university-affiliated, inborn level 3 NICU.Participants.Infants of less than 30 weeks gestation or birth weight ≤ 1,500 g admitted to the NICU between January 2007 and December 2008 were considered at risk of NEC. All cases of NEC were reviewed.Interventions.Infection prevention and control measures, including hand hygiene education, were enhanced during the outbreak. Avoidance of overcapacity in the NICU was reinforced, environmental services (ES) measures were enhanced, and ES hours were increased.Results.Two hundred eighty-two at-risk infants were admitted during the study. Their gestational age and birth weight (mean ± SD) were 28.2 ± 2.7 weeks and 1,031 ± 290 g, respectively. The proportion of NEC was 18/110 (16.4%) before the outbreak, 1/54 (1.8%) during the outbreak, and 4/118 (3.4%) after the outbreak. After adjustment for gestational age, birth weight, gender, and singleton versus multiple births, the proportion was lower in the postoutbreak period than in the preoutbreak period (P< .002).Conclusion.Although this observational study cannot establish a causal relationship, there was a significant decrease in the incidence of NEC following implementation of enhanced infection prevention and control measures to manage an MSSA outbreak.Infect Control Hosp Epidemiol2012;33(1):29-33

Download Full-text

INVESTIGATION AND CONTROL OF AN OUTBREAK OF MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII INFECTION IN A NEONATAL INTENSIVE CARE UNIT

10.26226/morressier.58fa1768d462b80290b51850 ◽

2017 ◽

Author(s):

Benhur Şirvan Cetin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Acinetobacter Baumannii ◽

Neonatal Intensive Care ◽

Multidrug Resistant ◽

And Control

Download Full-text

Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit

BMC Infectious Diseases ◽

10.1186/s12879-021-06295-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhijie Zhang ◽

Yu Cao ◽

Yanjian Li ◽

Xufang Chen ◽

Chen Ding ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Biofilm Formation ◽

Prevention And Control ◽

Neonatal Intensive Care ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Anti Fungal ◽

Hospital Acquired ◽

And Control

Abstract Background Candida pelliculosa is an ecological fungal species that can cause infections in immunocompromised individuals. Numerous studies globally have shown that C. pelliculosa infects neonates. An outbreak recently occurred in our neonatal intensive care unit; therefore, we aimed to evaluate the risk factors in this hospital-acquired fungal infection. Methods We performed a case-control study, analysing the potential risk factors for neonatal infections of C. pelliculosa so that infection prevention and control could be implemented in our units. Isolated strains were tested for drug resistance and biofilm formation, important factors for fungal transmission that give rise to hospital-acquired infections. Results The use of three or more broad-spectrum antimicrobials or long hospital stays were associated with higher likelihoods of infection with C. pelliculosa. The fungus was not identified on the hands of healthcare workers or in the environment. All fungal isolates were susceptible to anti-fungal medications, and after anti-fungal treatment, all infected patients recovered. Strict infection prevention and control procedures efficiently suppressed infection transmission. Intact adhesin-encoding genes, shown by genome analysis, indicated possible routes for fungal transmission. Conclusions The use of three or more broad-spectrum antimicrobials or a lengthy hospital stay is theoretically associated with the risk of infection with C. pelliculosa. Strains that we isolated are susceptible to anti-fungal medications, and these were eliminated by treating all patients with an antifungal. Transmission is likely via adhesion to the cell surface and biofilm formation.

Download Full-text

Molecular and epidemiologic investigation of a rhinovirus outbreak in a neonatal intensive care unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.311 ◽

2018 ◽

Vol 40 (2) ◽

pp. 245-247

Author(s):

Kenza Rahmouni El Idrissi ◽

Sandra Isabel ◽

Julie Carbonneau ◽

Martine Lafond ◽

Caroline Quach ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Horizontal Transmission ◽

Epidemiologic Study ◽

Multiple Sources ◽

Epidemiologic Investigation ◽

Single Clade ◽

Healthcare Associated

We performed a molecular and epidemiologic study of a healthcare-associated rhinovirus outbreak to better understand transmission in neonatal intensive care settings. Sequencing of the 7 outbreak strains revealed 4 distinct clades, indicating multiple sources. A single clade infected 3 patients in adjacent rooms, suggesting horizontal transmission. We observed 1 rhinovirus-associated death.

Download Full-text

A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00820-8 ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Stefanie Kampmeier ◽

Hauke Tönnies ◽

Carlos L. Correa-Martinez ◽

Alexander Mellmann ◽

Vera Schwierzeck

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Prevention ◽

Control Measures ◽

Whole Genome Sequence ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

Download Full-text