Infection Control & Hospital Epidemiology最新文献

{"title":"A cluster of three extrapulmonary Mycobacterium abscessus infections linked to well-maintained water-based heater-cooler devices","authors":"Jessica L. Seidelman, Arthur W. Baker, Sarah S. Lewis, Bobby G. Warren, Aaron Barrett, Amanda Graves, Carly King, Bonnie Taylor, Jill Engel, Desiree Bonnadonna, Carmelo Milano, Richard J. Wallace, Matthew Stiegel, Deverick J. Anderson, Becky A. Smith","doi":"10.1017/ice.2023.273","DOIUrl":"https://doi.org/10.1017/ice.2023.273","url":null,"abstract":"<span>Background:</span><p>Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated <span>M. abscessus</span> (HA-Mab) put in place following a prior institutional outbreak of <span>M. abscessus</span> alerted investigators to a cluster of 3 extrapulmonary <span>M. abscessus</span> infections among patients who had undergone cardiothoracic surgery.</p><span>Methods:</span><p>Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of <span>M. abscessus</span> in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental <span>M. abscessus</span> isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.</p><span>Results:</span><p>Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. <span>M. abscessus</span> was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of <span>M. abscessus</span> from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.</p><span>Conclusions:</span><p>Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted <span>M. abscessus</span> to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138825571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopy-related outbreaks and pseudo-outbreaks: A systematic review","authors":"Loukas Kakoullis, Sofia Economidou, Preeti Mehrotra, George Panos, Theodoros Karampitsakos, Grigorios Stratakos, Argyrios Tzouvelekis, Fotios Sampsonas","doi":"10.1017/ice.2023.250","DOIUrl":"https://doi.org/10.1017/ice.2023.250","url":null,"abstract":"Objective: To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks. Design: Systematic review. Setting: Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy. Methods: PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms “bronchoscopy,” “outbreak,” and “pseudo-outbreak” from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables. Results: In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were <jats:italic>Pseudomonas aeruginosa</jats:italic>, <jats:italic>Mycobacterium tuberculosis</jats:italic>, nontuberculous mycobacteria (NTM), <jats:italic>Klebsiella pneumoniae</jats:italic>, <jats:italic>Serratia marcescens</jats:italic>, <jats:italic>Stenotrophomonas maltophilia</jats:italic>, <jats:italic>Legionella pneumophila</jats:italic>, and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of <jats:italic>P. aeruginosa</jats:italic> (r = 0.351; <jats:italic>P</jats:italic> = .002) and <jats:italic>K. pneumoniae</jats:italic> (r = 0.346; <jats:italic>P</jats:italic> = .002), and between the presence of a contaminated water source and NTM (r = 0.331; <jats:italic>P</jats:italic> = .004) or <jats:italic>L. pneumophila</jats:italic> (r = 0.280; <jats:italic>P</jats:italic> = .015). Conclusions: Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staphylococcus epidermidis joint isolates: Whole-genome sequencing demonstrates evidence of hospital transmission and common antimicrobial resistance","authors":"Samantha J. Simon, Mohamad Sater, Ian Herriott, Miriam Huntley, Emma Briars, Brian L. Hollenbeck","doi":"10.1017/ice.2023.253","DOIUrl":"https://doi.org/10.1017/ice.2023.253","url":null,"abstract":"Objective: We investigated genetic, epidemiologic, and environmental factors contributing to positive <jats:italic>Staphylococcus epidermidis</jats:italic> joint cultures. Design: Retrospective cohort study with whole-genome sequencing (WGS). Patients: We identified <jats:italic>S. epidermidis</jats:italic> isolates from hip or knee cultures in patients with 1 or more prior corresponding intra-articular procedure at our hospital. Methods: WGS and single-nucleotide polymorphism–based clonality analyses were performed, including species identification, in silico multilocus sequence typing (MLST), phylogenomic analysis, and genotypic assessment of the prevalence of specific antibiotic resistance and virulence genes. Epidemiologic review was performed to compare cluster and noncluster cases. Results: In total, 60 phenotypically distinct <jats:italic>S. epidermidis</jats:italic> isolates were identified. After removal of duplicates and impure samples, 48 isolates were used for the phylogenomic analysis, and 45 (93.7%) isolates were included in the clonality analysis. Notably, 5 <jats:italic>S. epidermidis</jats:italic> strains (10.4%) showed phenotypic susceptibility to oxacillin yet harbored <jats:italic>mecA</jats:italic>, and 3 (6.2%) strains showed phenotypic resistance despite not having <jats:italic>mecA</jats:italic>. <jats:italic>Smr</jats:italic> was found in all isolates, and <jats:italic>mupA</jats:italic> positivity was not observed. We also identified 6 clonal clusters from the clonality analysis, which accounted for 14 (31.1%) of the 45 <jats:italic>S. epidermidis</jats:italic> isolates. Our epidemiologic investigation revealed ties to common aspirations or operative procedures, although no specific common source was identified. Conclusions: Most <jats:italic>S. epidermidis</jats:italic> isolates from clinical joint samples are diverse in origin, but we identified an important subset of 31.1% that belonged to subclinical healthcare–associated clusters. Clusters appeared to resolve spontaneously over time, suggesting the benefit of routine hospital infection control and disinfection practices.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of a blood-culture diagnostic stewardship intervention on utilization rates and antimicrobial stewardship","authors":"Melinda C. Wang, Kelvin J. Zhou, Sabra L. Shay, James P. Herlihy, Muhammad A. Siddique, Sergio Trevino Castillo, Todd M. Lasco, Miriam Barrett, Mayar Al Mohajer","doi":"10.1017/ice.2023.265","DOIUrl":"https://doi.org/10.1017/ice.2023.265","url":null,"abstract":"<p>Blood-culture overutilization is associated with increased cost and excessive antimicrobial use. We implemented an intervention in the adult intensive care unit (ICU), combining education based on the DISTRIBUTE algorithm and restriction to infectious diseases and ICU providers. Our intervention led to reduced blood-culture utilization without affecting safety metrics.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of environmental cleaning protocol featuring PX-UV in reducing the incidence of multidrug-resistant gram-negative healthcare-associated infection and colonization in intensive care units in Thailand","authors":"Supavit Vaivoothpinyo, Ornnicha Sathitakorn, Kittiya Jantarathaneewat, David J. Weber, Piyaporn Apisarnthanarak, Sasinuch Rutjanawech, Pichaya Tantiyavarong, Anucha Apisarnthanarak","doi":"10.1017/ice.2023.255","DOIUrl":"https://doi.org/10.1017/ice.2023.255","url":null,"abstract":"<p>In this quasi-experimental study, implementing PX-UV to the standard environmental cleaning protocol was associated with a reduction in the overall incidence of multidrug-resistant (MDR) gram-negative organisms (<span>P</span> = .01) and MDR <span>Acinetobacter baumannii</span> (<span>P</span> = .001) in intervention intensive care units. However, the intervention did not reduce patient length of stay and 30-day mortality.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent colonization of Candida auris among inpatients rescreened as part of a weekly surveillance program","authors":"Sebastian P. Arenas, Patrice J. Persad, Samira Patel, Dipen J. Parekh, Tanira B.D. Ferreira, Mirian Farinas, D. Joseph Sexton, Meghan Lyman, Hayley B. Gershengorn, Bhavarth S. Shukla","doi":"10.1017/ice.2023.251","DOIUrl":"https://doi.org/10.1017/ice.2023.251","url":null,"abstract":"<p>We established a surveillance program to evaluate persistence of <span>C. auris</span> colonization among hospitalized patients. Overall, 17 patients (34%) had ≥1 negative result followed by a positive test, and 7 (41%) of these patients had ≥2 consecutive negative tests.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138579947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the hospital bed in hospital-onset Clostridioides difficile: A retrospective study with mediation analysis","authors":"Lucy S. Witt, Jessica Howard-Anderson, Radhika Prakash-Asrani, Elizabeth Overton, Jesse T. Jacob","doi":"10.1017/ice.2023.254","DOIUrl":"https://doi.org/10.1017/ice.2023.254","url":null,"abstract":"<span>Objective:</span><p>To determine whether residing in a hospital bed that previously held an occupant with <span>Clostridioides difficile</span> increases the risk of hospital-onset <span>C. difficile</span> infection (HO-CDI).</p><span>Methods:</span><p>In this retrospective cohort study, we used a real-time location system to track the movement of hospital beds in 2 academic hospitals from April 2018 to August 2019. We abstracted patient demographics, clinical characteristics, and <span>C. difficile</span> polymerase chain reaction (PCR) results from the medical record. We defined patients as being exposed to a potentially “contaminated” bed or room if, within the preceding 7 days from their HO-CDI diagnosis, they resided in a bed or room respectively, that held an occupant with <span>C. difficile</span> in the previous 90 days. We used multivariable logistic regression to determine whether residing in a contaminated bed was associated with HO-CDI after controlling for time at risk and requiring intensive care. We assessed mediation and interaction from a contaminated hospital room.</p><span>Results:</span><p>Of 25,032 hospital encounters with 18,860 unique patients, we identified 237 cases of HO-CDI. Exposure to a contaminated bed was associated with HO-CDI in unadjusted analyses (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4–2.31) and adjusted analyses (OR, 1.5; 95% CI, 1.2–2.0). Most of this effect was due to both mediation from and interaction with a contaminated hospital room.</p><span>Conclusions:</span><p>Residing in a hospital bed or room that previously had a patient with <span>C. difficile</span> increases the risk of HO-CDI. Increased attention to cleaning and disinfecting the healthcare environment may reduce hospital transmission of <span>C. difficile</span>.</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of a coronavirus disease 2019 (COVID-19) vaccine booster with control of a COVID-19 outbreak in a long-term care facility in Switzerland, November to December 2021","authors":"Thomas W. Leiblein, Annemarie Winistörfer, Kurt Seiler, Rudolf Hauri, Rami Sommerstein","doi":"10.1017/ice.2023.240","DOIUrl":"https://doi.org/10.1017/ice.2023.240","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) outbreaks in long-term care facilities are often correlated with high case fatality rates. We describe the association of administration of an mRNA booster with the control of an outbreak. Our findings highlight the possibility of vaccine booster early in an outbreak as a promising method to mitigate the spread of infection.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying individual and organizational predictors of accidental exposure to blood (AEB) among hospital healthcare workers: A longitudinal study","authors":"René Sosata Bun, Karim Aït Bouziad, Oumou Salama Daouda, Katiuska Miliani, Anastasia Eworo, Florence Espinasse, Delphine Seytre, Anne Casetta, Simone Nérome, Laura Temime, Mounia N. Hocine, Pascal Astagneau","doi":"10.1017/ice.2023.248","DOIUrl":"https://doi.org/10.1017/ice.2023.248","url":null,"abstract":"Background: Accidental exposure to blood (AEB) poses a risk of bloodborne infections for healthcare workers (HCWs) during hospital activities. In this study, we identified individual behavioral and organizational predictors of AEB among HCWs. Methods: The study was a prospective, 1-year follow-up cohort study conducted in university hospitals in Paris, France. Data were collected from the Stress at Work and Infectious Risk in Patients and Caregivers (STRIPPS) study. Eligible participants included nurses, nursing assistants, midwives, and physicians from 32 randomly selected wards in 4 hospitals. AEB occurrences were reported at baseline, 4 months, 8 months, and 12 months, and descriptive statistical and multilevel risk-factor analyses were performed. Results: The study included 730 HCWs from 32 wards, predominantly nurses (52.6%), nursing assistants (41.1%), physicians (4.8%), and midwives (1.5%). The incidence rate of AEB remained stable across the 4 visits. The multilevel longitudinal analysis identified several significant predictors of AEB occurrence. Individual-level predictors included younger age, occupation as nurses or midwives, irregular work schedule, rotating shifts, and lack of support from supervisors. The use of external nurses was the most significant ward-level predictor associated with AEB occurrence. Conclusions: AEBs among HCWs are strongly associated with organizational predictors, highlighting the importance of complementing infection control policies with improved staff management and targeted training. This approach can help reduce AEB occurrences and enhance workplace safety for HCWs.","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of computerized clinical decision support system to reduce unnecessary nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) testing","authors":"Duc N. Huynh, Punit J. Shah, Sage B. Greenlee, S. Wesley Long, Muhammad Yasser Alsafadi","doi":"10.1017/ice.2023.256","DOIUrl":"https://doi.org/10.1017/ice.2023.256","url":null,"abstract":"<p>Our health system implemented a novel clinical decision-support system to reduce unnecessary duplicate nasal methicillin-resistant <span>Staphylococcus aureus</span> (MRSA) polymerase chain reaction (PCR) orders. In an 8-month period, the rate of duplicate MRSA PCR orders within 7 days declined from 4.7% (370 of 7,861) to 1.2% (120 of 9,833).</p>","PeriodicalId":13558,"journal":{"name":"Infection Control & Hospital Epidemiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138575831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}