Assess Infection Control Practices Research Articles

1756. Takeaways from Investigation of a Large Invasive Group A Streptococcus Outbreak in a Skilled Nursing Facility, Virginia, 2022-2023

Abstract Background Group A Streptococcus (GAS) primarily infects the respiratory tract, skin, and soft tissue. Invasive GAS (iGAS), in which the bacteria infect a normally sterile body site, is severe and can be life threatening, especially in older adults. The Virginia Department of Health investigated a prolonged iGAS outbreak in a skilled nursing facility from March 2022 - April 2023. Cases continued despite multipronged outbreak response. Methods A case was defined as GAS isolated from a sterile or nonsterile body site. Cases were identified through active surveillance, retrospective chart review, colonization screening by skin/throat swab, and culture. Multiple onsite visits were conducted to assess infection control practices at the facility. Genotyping (emm type) analysis was performed on resident and staff isolates. Results From March 2022 to April 2023, 30 (71.4%) GAS cases were identified among facility residents, and 12 (28.6%) cases among staff. Ten residents (23.8%) died. GAS was isolated from throat (21, 50%), wounds (14, 33.3%), from more than one site (2, 4.8%), and invasive infections (5, 11.9%). Twenty (47.6%) cases were identified through colonization screening; the carriage rate among residents was 7% (16 positive out of 230) and 2.8% among staff (4 positives out of 142). Sequencing was conducted on 34 isolates, 33 (97%) were emm type 89 and were within < 10 single nucleotide polymorphisms (SNP) apart. Infection prevention assessments identified gaps in hand hygiene, wound care, and environmental cleaning and disinfection. Conclusion Genotyping results suggested common source exposure. GAS might have transmitted several times between colonized or infected residents and staff which caused the extended outbreak. Multiple challenges at the facility contributed to a prolonged outbreak despite aggressive interventions. Challenges included high staff turnover; use of agency staff since the beginning of the COVID-19 pandemic; change in facility ownership; suboptimal infection prevention practices including wound care; and lack of appropriate active surveillance for GAS infections. Review of epidemiological data, frequent onsite infection prevention assessments, numerous educational sessions, and active follow-up were all crucial strategies for outbreak mitigation. Disclosures All Authors: No reported disclosures

Increased Adherence to Infection Control Practices Among Medical Laboratory Technicians During the COVID-19 Pandemic: A Self-Reported Survey Study.

Background:The adherence of medical laboratory technicians (MLT) to infection control guidelines is essential for reducing the risk of exposure to infectious agents. This study explored the adherence of MLT towards infection control practices during the COVID-19 pandemic.Method:The study population consisted of MLT (n = 444) who worked in private and government health sectors in Jordan. A self-reported survey was used to collect data from participants.Findings:More than 87% of the participants reported adherence to hand-washing guidelines and using personal protective equipment (PPE) when interacting with patients (74.5%), and handling clinical samples (70.0%). Besides, 88.1%, 48.2%, and 7.7% reported wearing of lab coats, face masks, and goggles, at all times, respectively. The majority reported increased adherence to infection control practices during the COVID-19 pandemic. This includes increased PPE use at the workplace (94.2%), increased frequency of disinfection of laboratory surfaces (92.4%) and laboratory equipment (86.7%), and increased frequency of handwashing/use of antiseptics (94.6%). Having a graduate degree was significantly associated with increased adherence of participants to the daily use of goggles/eye protection (p = 0.002), and the use of PPE while handling clinical samples (p = 0.011). Having work experience of >10 years was associated with increased adherence to the use of PPE while handling clinical samples (p = 0.001).Conclusion:MLT reported very good adherence with most assessed infection control practices. In addition, they reported increased conformity with infection control guidelines during the COVID-19 pandemic.

Transmission of Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae in Georgia, 2018–2019

Background: In April 2019, the Georgia Department of Public Health (DPH) initiated whole-genome sequencing (WGS) on NDM-producing Enterobacteriaceae identified since January 2018. The WGS data analyzed at CDC identified related Klebsiella pneumoniae isolates with hypervirulence markers from 2 patients. Carbapenemase-producing hypervirulent K. pneumoniae (CP-hvKP) are rarely reported in the United States, but they can to cause serious, highly resistant, invasive infections. We conducted an investigation to identify cases and prevent spread. Methods: We defined a case as NDM-producing K. pneumoniae with ≥4 hypervirulence markers identified by WGS, isolated from any specimen source from a Georgia patient. We reviewed the case patient’s medical history to identify potentially affected facilities. We also performed PCR-based colonization screening and retrospective and prospective laboratory-based surveillance. Finally, we assessed facility infection control practices. Results: Overall, 7 cases from 3 case patients (A, B, and C) were identified (Fig. 1). The index case specimen was collected from case-patient A at ventilator-capable skilled nursing facility 1 (vSNF1) in May 2018. Case-patient A had been hospitalized for 1 month in India before transfer to the United States. Case-patient B’s initial isolate was collected in January 2019 on admission to vSNF2 from a critical access hospital (CAH). The CAH laboratory retrospectively identified case-patient C, who overlapped with case-patient B at the CAH in October 2018. The CAH and the vSNF2 are geographically distant from vSNF1. Case-patients B and C had no known epidemiologic links to case-patient A. Colonization screening occurred at vSNF1 in May 2018, following detection of NDM-producing K. pneumoniae from case-patient A ∼1 year before determining that the isolate carried hypervirulence markers. Among 30 residents screened, 1 had NDM and several had other carbapenemases. Subsequent screening did not identify additional NDM. Colonization screening of 112 vSNF2 residents and 13 CAH patients in 2019 did not reveal additional case patients; case-patient B resided at vSNF2 at the time of screening and remained colonized. At all 3 facilities, the DPH assessed infection control practices, issued recommendations to resolve lapses, and monitored implementation. The DPH sequenced all 27 Georgia NDM–K. pneumoniae isolates identified since January 2018; all were different multilocus sequence types from the CP-hvKP isolates, and none possessed hypervirulence markers. Conclusions: We hypothesize that CP-hvKP was imported by a patient hospitalized in India and spread to 3 Georgia facilities in 2 distinct geographic regions through indirect patient transfers. Although a response to contain NDM at vSNF1 in 2018 likely limited CP-hvKP transmission, WGS identified hvKP and established the relatedness of isolates from distinct regions, thereby directing the DPH’s additional containment activities to halt transmission.Funding: NoneDisclosures: None

Awareness and Practices of Dental Students and Dentists Regarding Infection Control in Prosthodontic Clinics

Background:Patient safety is a priority for achieving higher quality health care standards and human error> reduction.Objective:The aim of this study was to evaluate the level of appropriate infection control practices in a prosthodontic clinic in Jeddah, Saudi Arabia.Methods:This cross-sectional study included 460 dental students and dentists recruited from five centers. Data were collected by self-administered questionnaires> composed of 25 questions. The questionnaires> assessed infection control practices in prosthodontic clinics, including wearable barriers, disinfection measures among patients, disinfection of laboratory submissions, and proper infection control. Other questions assessed sources of knowledge, self-evaluation of knowledge, implementation, and satisfaction with knowledge application.Results:Total correct answers for proper practice (16 questions) had a mean of 12.5 with a standard deviation of 2.8. The most commonly practiced procedure was wearing a mask (99.8%) and the least was sterilizing the facebow before its use by the patient (53.7%). Participants from governmental colleges (m = 13.67, SD = 2.17) had significantly higher scores than participants from private colleges (m = 12.35, SD = 2.9),p<0.001. Only 2.8% had never attended a lecture, and only 13.8% had never had hands-on training for infection control. Despite 49.1% evaluating themselves as having very poor to poor knowledge, 90.7% had fair to very good valuation of their infection control implementations, and 87.6% were satisfied with their knowledge and performance levels.Conclusion:Dental students and dentists have high levels of adequate infection control practices in the prosthodontic clinic despite the moderate level of their satisfaction with their knowledge.

2458. A comprehensive approach to ending an outbreak of rare OXA-72 producing carbapenem-resistant Acinetobacter baumannii at a Community Hospital, Kansas City, MO, 2018

BackgroundIn 2018, an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) containing a rare β-lactamase (OXA-72) was detected at Research Medical Center, a 511 bed community hospital in Kansas City, MO. We describe a coordinated effort among hospital infection control personnel and public health to control the outbreak.MethodsWe defined a case as isolation of OXA-72-producing CRAB from any clinical culture collected from a hospitalized patient during 2018. We assessed infection control practices, including adherence to transmission-based precautions and hand hygiene, environmental cleaning and patient transfers. After patients with CRAB were discharged, terminal cleaning was performed using bleach and environmental cultures were collected; rooms were closed to new patients until CRAB was not isolated. Whole-genome sequencing and bioinformatics analyses were performed.ResultsFrom January through October, CRAB was isolated from clinical cultures among 20 patients; 6 OXA-72-positive cases were identified during June and July. We found practices for cleaning and disinfection of shared medical equipment were not clearly delineated among nursing and environmental services staff and we ensured responsibilities were well defined. W restricted all patients with CRAB to certain medical units in order to limit the spread. In total, 248 environmental cultures were collected; 151 (61%) from inside patient rooms and 97 (39%) from shared medical equipment or surfaces outside patient rooms. Overall, Acintobacter baumannii was isolated from 39 (16%) environmental cultures (21 from inside rooms and 18 from outside rooms); 5 isolates were confirmed to contain OXA-72. Using WGS, we compared 6 clinical and 5 environmental OXA-72 CRAB isolates; all were determined to be genetically related (0–6 single nucleotide polymorphisms, 88.4% core genome) (figure). No additional cases were identified after these interventions.ConclusionWe identified widespread CRAB environmental contamination, illustrating the challenges of eradicating CRAB from the hospital environment. We developed a comprehensive approach focusing on infection control, environmental cleaning and culturing, and patient movement to stop the outbreak. Disclosures All authors: No reported disclosures.

1254. Outbreak of Mycobacterium chelonae Skin Infections Associated With Human Chorionic Gonadotropin Injections at Weight Loss Clinics

BackgroundIn December 2016, a dermatologist notified the Minnesota Department of Health (MDH) of three patients with skin lesions after self-administration of human chorionic gonadotropin (HCG) injections supplied by same weight loss clinic chain (Chain X); one lesion had been diagnosed as a nontuberculous mycobacteria (NTM) infection. We investigated to identify the etiology, determine contributing transmission factors, and to prevent additional cases.MethodsWe defined a case as a skin or soft tissue lesion with a suspected infectious etiology in a Minnesota resident occurring within three months after HCG injection at or near an injection site. To find cases we sent health alerts to clinicians and clinical laboratories throughout Minnesota with diagnostic guidance, and we requested Chain X to notify all exposed patients. We visited two Chain X clinics to assess infection control practices, to collect invoices for product traceback, and to collect products for microbiological testing. All NTM isolates were identified by line probe assay and subtyped by pulsed-field gel electrophoresis (PFGE) at MDH.ResultsWe identified six cases with illness onset dates ranging from April to November 2016. All patients were adult women who did not share HCG vials. Four patients had clinical specimens that grew NTM; all isolates were identified as Mycobacterium chelonae that were indistinguishable by PFGE. Three patients with confirmed M. chelonae infection obtained HCG at Clinic A, and one from Clinic B, but sharing of reconstituted HCG by the two clinics could not be excluded. We identified several infection control breaches at both clinics including improper reconstitution of HCG and incorrect use of single use vials. The most likely source of the HCG was an unregistered out-of-state compounding pharmacy.ConclusionThis common source outbreak was likely due to contamination introduced either at a weight loss clinic or a compounding pharmacy. HCG injections are not US FDA-approved for weight loss, and their use may involve compounded products dispensed by alternative care settings that lack infection control expertise and regulatory oversight. This outbreak highlights the important role physician reporting of disease clusters plays in uncovering unsafe practices.Disclosures All authors: No reported disclosures.

Infection Control Prevention Practices on Pulmonary TB Transmission among Health Care Personnel of Selected Hospital in India

Introduction: Fundamental infection control practices in India revolve around biomedical waste management and disposal of sharps; while Airborne Infection Control (AIC) measures are mostly absent from the protocol of health care facilities. Aim: To assess infection control practices that a health care personnel follows to prevent transmission of Tuberculosis (TB) and to evaluate the resources and facilities available in the area and also to identify the factors which helps to improve the practices. Materials and Methods: A mixed methodological study was carried out to assess the infection control practices for prevention of pulmonary TB. This study was conducted among 82 health care personnel between 2nd January 2017 and 4th February 2017. Health care personnel (20-35 years) and people who worked in TB units were recruited from a multi-specialty tertiary care hospital. An observation checklist on infection control practices was developed to assess the preventive practices followed by acknowledge questionnaire. Complete enumerated sampling was used for observing the practices. A focus group discussion was conducted after analysing the Survey findings among health care personnel by purposive sampling. Thematic analysis was used to analyse and identify the emerging themes. Results: The mean age of the participants was 25.76±5.968 years. Non-compliance was found in infection control practices among health care personnel in preventing TB transmission. A total of 58.5% of the participants have good knowledge, 74.1% had answered correctly in the area of personal protective equipment. Intermittent interruption of supply (e.g., N95 masks), lack of knowledge, lack of adherence to infection control practices and lack of awareness by the patients were found to be the factors for non-compliance. Conclusion: This study emphasizes the challenges faced in infection control preventive practices in a resource limited countries and how collective efforts may change and strengthen the practices using available resources.

Investigation of a Contaminated, Nationally Distributed, Organ Transplant Preservation Solution — United States, 2016–2017

BackgroundIn December 2016, bacterial contamination of an organ preservation solution (OPS) was reported by Transplant Center A in Iowa. Annually, >20,000 abdominal organs are transplanted in the United States; OPS is used for organ storage. We investigated the scope of OPS contamination and its association with adverse events in patients.MethodsWe assessed infection control practices related to OPS at Transplant Centers A and B in Iowa and the local organ procurement organization (OPO). We issued national notifications about OPS contamination and requested transplant centers to report product-related concerns or potential patient harm. Among transplant recipients at Center A, we compared adverse events (fever, bacteremia, surgical site infection, peritonitis, or pyelonephritis within 14 days of transplantation) during October–December 2015 with October–December 2016, the presumed window of exposure to contaminated OPS. Isolates from OPS were characterized.ResultsNo infection control deficiencies were identified at Transplant Centers A, B, or the OPO. In January 2017, contaminated OPS from the same manufacturer was reported by Transplant Center C in Texas. Nationally, there were no reports of patient harm definitively linked to OPS. Post-transplant adverse events at Center A did not increase between fourth quarter 2015 (5/12 [42%]) and 2016 (2/15 [13%]). Organisms recovered from OPS included Pantoea agglomerans and Enterococcus gallinarum (Center A) and Pseudomonas koreensis (Center C). Five Pantoea isolates from ≥3 opened OPS bags were indistinguishable by pulsed-field gel electrophoresis. The OPS distributor issued recalls and suspended production. The US Food and Drug Administration identified deficiencies in current good manufacturing practices at manufacturing and distribution facilities, including inadequate validation of OPS sterility.ConclusionBacterial contamination of a nationally distributed product was identified by astute clinicians. The investigation found no illnesses were directly linked to the product. Prompt reporting of concerns about potentially contaminated healthcare products, which might put patients at risk, is critical for swift public health action.Disclosures All authors: No reported disclosures.

Surgical site infections: Problem of multidrug-resistant bacteria

Objectives The present study aimed (a) to determine the prevalence and risk factors of surgical site infections (SSIs) at Menoufia University Hospitals; (b) to determine bacterial pathogens and their antimicrobial susceptibility patterns frequently causing SSIs; (c) to determine the prevalence of multidrug-resistant (MDR) bacteria; and (d) to assess infection control practices related to surgeries. Background SSI is the most surveyed and frequent type of healthcare-associated infection. A high prevalence of MDR strains has been observed in patients with SSIs. Patients and methods This study involved 148 patients who were admitted and chosen randomly from the General Surgery and Orthopedics Departments of Menoufia University Hospitals. Isolated organisms and antimicrobial susceptibility were identified. Detection of and phenotypic confirmation of MDR strains were carried out according to Clinical and Laboratory Standards Institute guidelines. Correlation between compliance rate of the surgical team to infection control measures in operating theater and SSI rate was determined. Results Prevalence of SSI was found to be 67.6%. The most common type of operative wounds were contaminated wounds and the most common wound infections were superficial wounds. The most frequently isolated species was Staphylococcus aureus (27.4%). Methicillin resistance was detected in S. aureus and coagulase-negative staphylococci by 88.3 and 62.5%, respectively. Extended spectrum β-lactamases were detected in 65.1% of Enterobacteriaceae isolates and metallo-β-lactamases in 73% of Gram-negative isolates. MDR isolates were detected in 37.2%. Furthermore, a reverse correlation between compliance rate and infection rate was detected. Conclusion In our study, there was a high prevalence of SSI and great problem of MDR bacteria with reflected difficulty in managing SSIs. Focused efforts should be directed to support infection control strategies.

A Cluster of Group A Streptococcal Infections in a Skilled Nursing Facility-the Potential Role of Healthcare Worker Presenteeism.

To determine the extent of a group A streptococcus (GAS) cluster (2 residents with invasive GAS (invasive case-patients), 2 carriers) caused by a single strain (T antigen type 2 and M protein gene subtype 2.0 (T2, emm 2.0)), evaluate factors contributing to transmission, and provide recommendations for disease control. Cross-sectional analysis and retrospective review. Skilled nursing facility (SNF). SNF residents and staff. The initial cluster was identified through laboratory notification and screening of SNF residents with wounds. Laboratory and SNF administrative records were subsequently reviewed to identify additional residents with GAS, oropharyngeal and wound (if present) swabs were collected from SNF staff and residents to examine GAS colonization, staff were surveyed to assess infection control practices and risk factors for GAS colonization, epidemiologic links between case-patients and persons colonized with GAS were determined, and facility infection control practices were assessed. No additional invasive case-patients were identified. Oropharyngeal swabs obtained from all 167 SNF residents were negative; one wound swab grew GAS that was the same as the outbreak strain (T2, emm 2.0). The outbreak strain was not identified in any of the 162 staff members. One of six staff members diagnosed with GAS pharyngitis worked while ill and had direct contact with invasive case-patients within a few weeks before their onset of symptoms. Additional minor breaches in infection control were noted. Sick healthcare workers may have introduced GAS into the SNF, with propagation by infection control lapses. "Presenteeism," or working while ill, may introduce and transmit GAS to vulnerable in SNF populations. Identification of an invasive GAS case-patient should trigger a prompt response by facilities to prevent further transmission and workplace culture, and policies should be in place to discourage presenteeism in healthcare settings.

Hepatitis C Virus Screening and Management of Seroconversions in Hemodialysis Facilities

Over the past two decades, healthcare-associated exposure has increasingly been proved to be a means of hepatitis C virus (HCV) transmission, especially in hemodialysis facilities. The prevalence of HCV among hemodialysis patients is known to be several times greater than that of the general population of the United States, and chronic HCV infection is associated with significant morbidity and mortality among these patients. During 2008-2011, HCV infection outbreaks were identified in multiple US hemodialysis facilities, resulting in at least 46 new HCV infections among hemodialysis patients. These outbreaks, linked to infection control breaches, also highlight the failure of some facilities to follow established guidelines for routine HCV antibody (anti-HCV) screening and response to new HCV infection among hemodialysis patients. Current national guidelines recommend screening of hemodialysis patients for anti-HCV on facility admission and, for susceptible patients, on a semiannual basis. Here, we seek to underscore the importance of compliance with national recommendations for anti-HCV screening of hemodialysis patients and actions to be taken in the event of possible HCV transmission within a hemodialysis facility. These include general steps to ensure that: hemodialysis patients are routinely screened for anti-HCV to facilitate early detection of new infections; newly infected patients are informed of the change in their HCV status and undergo clinical evaluation; and public health officials are notified of new HCV infections in a timely manner. We then focus on the need to assess infection control practices at the facility, with particular attention given to safe handling of injectable medications, hand hygiene and disinfection practices. In the absence of a vaccine, routine screening and adherence to standard infection control practices will remain the key strategies for preventing HCV transmission in hemodialysis units.

Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility

Effective measures exist to prevent health care-associated hepatitis B virus (HBV) transmission, yet outbreaks continue to occur. In 2008, the Los Angeles County Department of Public Health identified an outbreak of HBV infections among psychiatric long-term care facility residents. Residents underwent HBV serologic testing and were classified as acutely infected, chronically infected, susceptible, or immune. Persons residing in the facility during 2008 were enrolled in a retrospective cohort study to identify risk factors for acute HBV infection. We assessed infection control practices at the facility. Nine of 81 residents (11%) enrolled in the cohort study had acute HBV infection. Five of 15 residents (33%) undergoing podiatric care on a single day subsequently developed acute infection (rate ratio, 4.33; 95% confidence interval, 1.18-15.92). Infection control observations of the consulting podiatrist revealed opportunities for cross-contamination of instruments with blood. Other potential health care and behavioral modes of transmission were identified as well. Residents were offered HBV vaccination, and infection control recommendations were implemented by the podiatrist and facility. Of the multiple potential transmission modes identified, exposure to HBV during podiatry was likely the dominant mode in this outbreak. Long-term care facilities should ensure compliance with infection control standards among staff and consulting health care providers.

Infection control practices and infectious complications in dermatological surgery

The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.

New Investigator Award

BACKGROUND/OBJECTIVES: The Special Care Nursery (SCN) notified Infection Control that two infants who had been transferred to a children's hospital were positive for Vancomycin-Resistant Enterococcus (VRE) upon admission screening. Active surveillance for enteric VRE was performed on the remaining SCN infants at our facility. METHODS: All infants in the SCN had stool sent for VRE culture. Observations were conducted to assess infection control practices. A multidisciplinary team was formed consisting of the Infection Control Practitioners, Medical Director of Infection Control, Chief Medical Officer, Medical Director of SCN, SCN nurse manager, SCN clinical nurse educator, Director of Women and Infant's Services, Housekeeping and Microbiology. Interventions consisted of immediate implementation of contact precautions, enhanced hand hygiene practices, cohorting of infants and nursing staff, and extensive cleaning of the SCN. Parents of VRE positive infants entered and left the SCN cohort area through a separate door. Education was provided to nursing staff, physicians and parents of SCN infants regarding modes of VRE transmission and means of prevention, hand hygiene, environmental contributions to VRE transmission, environmental cleanliness and cohorting measures. New admissions were geographically cohorted to a separate ancillary nursery until all VRE positive infants had been discharged home. RESULTS: Eight of the eleven (11) remaining SCN infants were positive for VRE by stool culture for a total of 10/13 (77%) VRE positive infants. After the interventions were implemented, no new cases of VRE were identified. Since the cluster, one hundred twelve (112) infants have been screened weekly during SCN admission and upon discharge home. To date, eighty-five (85) infants have been screened with at least one (1) stool culture, seventeen (17) received two (2) screens and ten (10) received three (3) screens. All screens have been negative for a statistically significant decrease in proportion of infants colonized with VRE admitted after the intervention (10/13 versus 0/112; p CONCLUSIONS: A multidisciplinary intervention consisting of active surveillance screening, cohorting, contact precautions, environmental cleaning and education resulted in rapidly abating this outbreak.

Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine?

To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit. A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit. A hemodialysis unit treating an average of 90 patients. A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient. HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit. The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.

Outbreak of Hepatitis C Virus Infection in a Hemodialysis Unit: Potential Transmission by the Hemodialysis Machine?

Objective:To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit.Design:A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit.Setting:A hemodialysis unit treating an average of 90 patients.Patients:A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient.Results:HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit.Conclusions:The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.

Infection control practices in the home: a survey of households of HIV-infected persons with hemophilia.

To assess infection control practices and risk for human immunodeficiency virus (HIV) transmission in households where home infusion for hemophilia is used. Cross-sectional prospective survey from 1992 through 1994. Hemophilia treatment centers. Human immunodeficiency virus (HIV)-infected persons with hemophilia who receive home infusions of clotting factor concentrate and their household members. Frequency of specific infection control practices in the home and the risk of HIV transmission to household members. We surveyed 235 persons from 75 families (79 HIV-infected persons with hemophilia and 156 household members) about infection control practices in the home. Forty-eight percent of household members surveyed helped with the infusion process. Of 74 members who assisted with infusion, 13 (18%) had sustained a needlestick injury, 11 of whom were injured during the past year. One hundred fifty household members tested for antibody to HIV were antibody negative. These household members had a total of 903 person-years of contact after HIV was diagnosed in the index case. Household members' adherence to recommended infection control measures was highest for washing hands after cleaning up infusion equipment and waste, and for using sharps disposal containers. Adherence was lowest for wearing gloves when helping with infusions and proper disposal of bloody waste from the infusion. No HIV transmission was found among persons living with HIV-infected persons with hemophilia, although there was a high rate of needlestick injuries during home infusion. Because persons who assisted with infusions often did not wear gloves and many households did not dispose of bloody waste properly, hemophilia treatment center personnel should emphasize these areas when training for home infusion. Adherence to appropriate infection control practices should help to keep the risk of HIV transmission in households extremely low.