Active Infection Control Program Research Articles

A SARS-CoV-2 outbreak associated with vaccine breakthrough in an acute care hospital

BackgroundWe aimed to analyze an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of health care workers were vaccinated.MethodsWe investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed coronavirus disease 2019 (COVID-19) in patients, health care workers, and caregivers.ResultsDuring the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction testing. There were infections in 61 health care workers, 18 patients, and 15 caregivers; 74.5% (70/94) were vaccine breakthrough infections. Most transmissions appeared to be caused by three index cases, which accounted for 86.2% (81/94) of transmissions. Forty-seven (58.0%, 47/81) cases were associated with the hospital staff cafeteria and offices located in the basement. Among health care workers and caregivers, only one required oxygen supplementation. In contrast, among patients, there were four fatal cases (22.2%, 4/18), 3 of which were unvaccinated.ConclusionsSuperspreading infection among fully vaccinated individuals occurred in an acute care hospital while the delta variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.

A SARS-CoV-2 outbreak due to vaccine breakthrough in an acute-care hospital

Background: The δ (delta) variant has spread rapidly worldwide and has become the predominant strain of SARS-CoV-2. We analyzed an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of healthcare workers were vaccinated. Methods: We investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed COVID-19 in patients, healthcare workers, and caregivers. Results: During the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction (rtPCR) testing. Testing identified infections in 61 health care workers, 18 patients, and 15 caregivers, and 70 (74.5%) of 94 cases were vaccine breakthrough infections. We detected 3 superspreading events: in the hospital staff cafeteria and offices (n = 47 cases, 50%), the 8th floor of the main building (n = 22 cases, 23.4%), and the 7th floor in the maternal and child healthcare center (n = 12 cases, 12.8%). These superspreading events accounted for 81 (86.2%) of 94 transmissions (Fig. 1, 2). The median interval between completion of vaccination and COVID-19 infection was 117 days (range, 18–187). There was no significant difference in the mean Ct value of the RdRp/ORF1ab gene between fully vaccinated individuals (mean 20.87, SD±6.28) and unvaccinated individuals (mean 19.94, SD±5.37, P = .52) at the time of diagnosis. Among healthcare workers and caregivers, only 1 required oxygen supplementation. In contrast, among 18 patients, there were 4 fatal cases (22.2%), 3 of whom were unvaccinated (Table 1). Conclusions: Superspreading infection among fully vaccinated individuals occurred in an acute-care hospital while the δ (delta) variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.Funding: NoneDisclosures: None

The role of infection control in curbing Carbapenem resistance

Carbapenem resistant Gram-negative pathogens have become a threat to many countries in Western Pacific Region. These microorganisms are difficult to treat and pose challenges for control strategies. Much of the emergence and spread of carbapenem resistant Gram-negative pathogens can be contributed to the non-judicious use of broad-spectrum antibiotics and poor infection control. Once antimicrobial resistance emerges, it can have a significant impact on patient morbidity and mortality, as well as increased health care costs. Antimicrobial stewardship is a key component of a multifaceted approach to preventing the emergence of carbapenem resistant Gram-negative pathogens. Application of antimicrobial stewardship to resource-limited setting can be challenging. The antimicrobial stewardship program at Thammasat University Hospital, which has been associated with appropriateness of antibiotic use and improved treatment rates, decreased failure rates, and reduced healthcare-related costs, is an example of this multifaceted, multidisciplinary approach. The components of our antimicrobial stewardship program include continuous education, introduction of the antibiogram, antibiotic guideline, and antibiotic prescription forms with an antimicrobial stewardship team to continuously monitor the consumption of and audit the use of antibiotics with real-time, bed-side discussion with prescribing physicians. This antimicrobial stewardship program began in 2004 and appears to have been sustained over a 8-year period. Nevertheless, to sustain or even further improve these results, lasting and repeated efforts will be needed. Integrating infection control efforts into educational and antimicrobial stewardship programs is warranted. Active infection control program in resource-limited settings for carbapenem resistant Gram-negative pathogens may include modified active surveillance, contact isolation, cohorting patients with carbapenem resistant Gram-negative pathogens, 5 moment hand hygiene, environmental cleaning, as well as monitoring healthcare workers and providing prompt feedback. These strategies must be modified to fit the local setting, organizational culture, and infrastructure. Intensified efforts in infection control programs and antibiotic stewardship serve as key components for long-term success. Given the limited information of infection control for carbapenem resistant Gram-negative pathogens in resource-limited setting, additional well-designed studies are needed to explore various aspects of outcomes of antimicrobial stewardship and infection control in resource-limited settings.

56 SUCCESSFUL CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A UROLOGY WARD POSSIBLY DUE TO AVOIDANCE OF ANTIMICROBIAL PROPHYLAXIS IN MINIMALLY INVASIVE SURGERY: OUR 11 YEARS TRIAL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 201256 SUCCESSFUL CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN A UROLOGY WARD POSSIBLY DUE TO AVOIDANCE OF ANTIMICROBIAL PROPHYLAXIS IN MINIMALLY INVASIVE SURGERY: OUR 11 YEARS TRIAL Manabu Tatokoro, Hitoshi Masuda, Toshiki Kijima, Soichiro Yoshida, Mizuaki Sakura, Minato Yokoyama, Kazutaka Saito, Fumitaka Koga, Yasuhisa Fujii, Satoru Kawakami, and Kazunori Kihara Manabu TatokoroManabu Tatokoro Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Toshiki KijimaToshiki Kijima Tokyo, Japan More articles by this author , Soichiro YoshidaSoichiro Yoshida Tokyo, Japan More articles by this author , Mizuaki SakuraMizuaki Sakura Tokyo, Japan More articles by this author , Minato YokoyamaMinato Yokoyama Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author , Satoru KawakamiSatoru Kawakami Tokyo, Japan More articles by this author , and Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.101AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES MRSA results in longer hospitalization, increased expenses, and poorer patient prognosis. The indiscriminate use of antibiotics has been identified as an important factor in the increasing dissemination of MRSA. Although most hospitals control the inappropriate use of antibiotics, the incidence of MRSA has continued to increase. To eradicate MRSA, since 2001 we have implemented a stepwise infection control strategy that includes an avoidance in antimicrobial prophylaxis (AMP) based on surgical wound classification. Elsewhere, we have reported that AMP could be gradually reduced in gasless single port urologic surgery without increasing surgical site infections (Int J Urol. 2007 and 2008). METHODS The study was conducted at a university hospital in central Tokyo. Until 2000, no active infection control program had been implemented. In 2001, we introduced a stepwise infection control strategy in the urology ward. In 2007, active surveillance for MRSA in all urological patients was commenced. MRSA was classified as ‘imported' when it was identified within 72 hrs of admission or if the patient was previously known to be an MRSA carrier, whereas it was classified as ‘acquired' when it was identified more than 72 hrs after admission. Clinically significant MRSA infection (CSMI) was defined as an MRSA infection associated with clinical symptoms. The incidence rate (IR), expressed as the annual number of cases per 1000 patient years, was calculated and the trend analysis was assessed using a Poisson regression. RESULTS Over the study period, 139,866 patients (pts), including 10,201 urology pts, were admitted to our Hospital. Of them, 3,719, including 134 urology pts, were diagnosed with MRSA. Although the IR of MRSA increased in the hospital, it decreased significantly in the urology ward (p < 0.01). Of the urology pts with MRSA, 33.6% were classified as ‘imported', and 66.4% were ‘acquired'. In the urology ward, the IR of acquired MRSA decreased significantly with time (p <0.01), although the IR of imported MRSA did not change. 69 CSMI were identified and the IR of CSMI decreased (p < 0.01). CONCLUSIONS Avoidance of AMP in minimally invasive surgery might contribute to reduction of hospital-acquired MRSA. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e24 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manabu Tatokoro Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Toshiki Kijima Tokyo, Japan More articles by this author Soichiro Yoshida Tokyo, Japan More articles by this author Mizuaki Sakura Tokyo, Japan More articles by this author Minato Yokoyama Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Satoru Kawakami Tokyo, Japan More articles by this author Kazunori Kihara Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Device-associated infection rates in 398 intensive care units in Shanghai, China: International Nosocomial Infection Control Consortium (INICC) findings

To determine device-associated healthcare-associated infection (DA-HAI) rates and the microorganism profile in 398 intensive care units (ICUs) of 70 hospitals in Shanghai, China. An open-label, prospective, cohort, active DA-HAI surveillance study was conducted on patients admitted to 398 tertiary-care ICUs in China from September 2004 to December 2009, implementing the methodology developed by the International Nosocomial Infection Control Consortium (INICC). The data were collected in the participating ICUs, and uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). We analyzed the rates of DAI-HAI, ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI), and their microorganism profiles. During the 5 years and 4 months of the study, 391 527 patients hospitalized in an ICU for an aggregate of 3,245,244 days, acquired 20,866 DA-HAIs, an overall rate of 5.3% (95% confidence interval (CI) 5.3-5.4) and 6.4 (95% CI 6.3-6.5) infections per 1000 ICU-days. VAP posed the greatest risk (20.8 per 1000 ventilator-days, 95% CI 20.4-21.1), followed by CAUTI (6.4 per 1000 catheter-days, 95% CI 6.3-6.6) and CLABSI (3.1 per 1000 catheter-days, 95% CI 3.0-3.2). The most common isolated microorganism was Acinetobacter baumannii (19.1%), followed by Pseudomonas aeruginosa (17.2%), Klebsiella pneumoniae (11.9%), and Staphylococcus aureus (11.9%). DA-HAIs in the ICUs of Shanghai pose a far greater threat to patient safety than in ICUs in the USA. This is particularly the case for the VAP rate, which is much higher than the rates found in developed countries. Active infection control programs that carry out infection surveillance and implement prevention guidelines can improve patient safety and must become a priority.

Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings

This study investigated the rate of device-associated health care-associated infection (DA-HAI), microbiological profiles, bacterial resistance, length of stay (LOS), and mortality rate in 9 intensive care units (ICUs) of 3 hospital members of the International Nosocomial Infection Control Consortium (INICC) in the Philippines. This was an open-label, prospective cohort, active DA-HAI surveillance study of adult, pediatric, and newborn patients admitted to 9 tertiary care ICUs in the Philippines between January 2005 and December 2009, implementing methodology developed by the INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters using proprietary software. DA-HAI rates were registered based on definitions promulgated by the Centers for Disease Control and Prevention's National Healthcare Safety Network. Over a 5-year period, 4952 patients hospitalized in ICUs for a total of 40,733 days acquired 199 DA-HAIs, for an overall rate of 4.9 infections per 1,000 ICU-days. Ventilator-associated pneumonia posed the greatest risk (16.7 per 1,000 ventilator-days in the adult ICUs, 12.8 per 1,000 ventilator-days in the pediatric ICU, and 0.44 per 1,000 ventilator-days in the neonatal ICUs), followed by central line-associated bloodstream infections (4.6 per 1,000 catheter-days in the adult ICUs, 8.23 per 1,000 ventilator-days in the pediatric ICU, and 9.6 per 1,000 ventilator-days in the neonatal ICUs) and catheter-associated urinary tract infections (4.2 per 1,000 catheter-days in the adult ICUs and 0.0 in the pediatric ICU). DA-HAIs pose far greater threats to patient safety in Philippine ICUs than in US ICUs. The establishment of active infection control programs that involve infection surveillance and implement guidelines for prevention can improve patient safety and should become a priority.

Device-Associated Nosocomial Infections in 55 Intensive Care Units of 8 Developing Countries

Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) System report, the U.S. pooled mean rates of central venous catheter (CVC)-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections were 4.0 per 1000 CVC days, 5.4 per 1000 mechanical ventilator days, and 3.9 per Foley catheter days, respectively. To ascertain the incidence of device-associated infections in the ICUs of developing countries. Multicenter, prospective cohort surveillance of device-associated infection by using the CDC NNIS System definitions. 55 ICUs of 46 hospitals in Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, and Turkey that are members of the International Nosocomial Infection Control Consortium (INICC). Rates of device-associated infection per 100 patients and per 1000 device days. During 2002-2005, 21,069 patients who were hospitalized in ICUs for an aggregate 137,740 days acquired 3095 device-associated infections for an overall rate of 14.7% or 22.5 infections per 1000 ICU days. Ventilator-associated pneumonia posed the greatest risk (41% of all device-associated infections or 24.1 cases [range, 10.0 to 52.7 cases] per 1000 ventilator days), followed by CVC-related bloodstream infections (30% of all device-associated infections or 12.5 cases [range, 7.8 to 18.5 cases] per 1000 catheter days) and catheter-associated urinary tract infections (29% of all device-associated infections or 8.9 cases [range, 1.7 to 12.8 cases] per 1000 catheter days). Notably, 84% of Staphylococcus aureus infections were caused by methicillin-resistant strains, 51% of Enterobacteriaceae isolates were resistant to ceftriaxone, and 59% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones. The crude mortality rate for patients with device-associated infections ranged from 35.2% (for CVC-associated bloodstream infection) to 44.9% (for ventilator-associated pneumonia). These initial data are not adequate to represent any entire country, and likely variations in the efficiency of surveillance and institutional resources may have affected the rates that were detected. Device-associated infections in the ICUs of these developing countries pose greater threats to patient safety than in U.S. ICUs. Active infection control programs that perform surveillance of infection and implement guidelines for prevention can improve patient safety and must become a priority in every country.

Surgeons' perspectives on surgical wound infection rate data in Queensland, Australia

The results of the Study on the Efficacy of Nosocomial Infection Control (SENIC) project demonstrated that hospitals with active infection control programs had lower rates of nosocomial infection than those without such programs. A key component of these programs was the inclusion of a systematic method for monitoring nosocomial infection and reporting these infections to clinicians. To identify the perspectives of surgeons in Queensland, Australia, regarding infection rate data in terms of its accuracy and usefulness as well as their perceptions regarding acceptable infection rates for surgical procedures classified as "clean" or "contaminated." A postal survey was conducted, with a convenience sample of 510 surgeons. More than 40% (n = 88) of respondents believed that the acceptable infection rate associated with clean surgical procedures should be less than 1%, a rate much lower than the threshold of 1.4% to 4.1% set by the Australian Council on Healthcare Standards (ACHS). Almost 30% (n = 55) of respondents reported that they would accept infection rates of 10% or higher for contaminated surgical procedures, which is higher than the ACHS threshold of 1.4% to 7.9%. Respondents identified failure to include postdischarge infections in the data and difficulties standardizing criteria for diagnosis of infection as the major impediments to the accuracy and usefulness of data provided. The results of this study have significant implications in relation to the preparation of surgical site infection reports, especially in relation to the inclusion of postdischarge surveillance data and information regarding pathogens, antibiotic sensitivities, and comorbidities of patients developing surgical site infection. Surgeons also identified the need to include information regarding the use of standardized definitions in the diagnosis of wound infection and parameters that allow comparison of infection rates to improve their perceptions regarding data accuracy and usefulness.

Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea.

To determine whether surveillance and infection control interventions decrease the incidence of catheter-related (CR) bloodstream infections (BSIs) in Korea. A medical-surgical intensive care unit (ICU) of a university hospital in Korea. The CR infection rate of the intervention period was compared to that of historical controls for a 4-month period. All patients with a central venous catheter in the intensive care unit (ICU) from October 1998 to January 1999. Active infection control programs were initiated during the intervention period. Data collected included patient characteristics, risk factors of CR infection, and the microbiology laboratory results. Laboratory-proven CR infection rates were compared between the intervention group and control group. 304 catheters were inserted into 248 patients. The intervention group and the control group showed similar characteristics, but more patients in the intervention group received steroid therapy, and subclavian insertion was more common in the intervention group. CR BSI occurred in 1.3 per 1,000 catheter-days in the intervention group and 4.2 in the control group (binomial test, P=.14). CR infections were associated with the duration of ICU admission by multivariate logistic regression. The data suggested that an active infection surveillance and control program could reduce the rate of CR

Foodborne Disease Outbreaks in Nursing Homes, 1975 Through 1987

--To describe the epidemiology of foodborne disease outbreaks in nursing homes and to identify where preventive efforts might be focused. --Reports by state and local health departments of foodborne disease outbreaks occurring from January 1, 1975, through December 31, 1987. --Foodborne disease outbreaks reported to the Centers for Disease Control, Atlanta, Ga, on standard investigation forms. --Each foodborne disease outbreak report was examined by an epidemiologist or statistician. Outbreaks were considered to have a known pathogen if confirmed by laboratory tests, and a known vehicle when an epidemiologic investigation implicated a specific food item. --From 1975 through 1987, 26 states reported 115 outbreaks of foodborne disease in nursing homes, causing illness in 4944 persons and death in 51. These outbreaks represented 2% of all reported foodborne disease outbreaks and 19% of outbreak-associated deaths in this period. Of 52 outbreaks with a known cause, Salmonella was the most frequently reported pathogen, accounting for 52% of outbreaks and 81% of deaths. Salmonella enteritidis outbreaks accounted for 56% of the Salmonella-associated deaths since 1981. The implicated food vehicles in S enteritidis outbreaks were made with eggs or prepared with equipment contaminated with eggs. Staphylococcal foodborne disease was the next most commonly identified cause, accounting for 23% of outbreaks. --Since the elderly are at high risk for serious morbidity from foodborne disease, nursing homes should practice careful food handling, preparation, and storage procedures; provide education for food handlers; and have active infection control programs to rapidly detect and control outbreaks of foodborne disease.