Cases Of Nosocomial Transmission Research Articles

Monkeypox and the health-care environment

Historically, fewer than a dozen cases of health care-associated human monkeypox have been reported in endemic African countries, including in the Democratic Republic of Congo (1983),1 Republic of the Congo (2003),2 Central African Republic (2015–16),3 and Nigeria (2017–18).4 Although all of these exposures occurred in hospital environments, the exact modes of transmission could not be identified. Among healthcare-associated monkeypox cases exported to countries outside of Africa between 2003 and 2021, at least 250 health-care workers have had variable unprotected exposures to the monkeypox virus in the hospital setting;5 however, only one case of nosocomial transmission has been reported in the literature.

Impact of In-Hospital infection with SARS-CoV-2 among Inpatients at a university hospital

ObjectiveThe objective of this study was to evaluate the incidence of nosocomial infection and the impact of cross-transmission of SARS-CoV-2 among inpatients at a tertiary care teaching hospital. MethodsThis was a retrospective cohort study involving inpatients admitted to a tertiary university hospital in the city of São Paulo, Brazil, between March 2020 and February 2021. Cases were identified on the basis of a positive reverse-transcription polymerase chain reaction result for SARS-CoV-2 and the review of electronic medical records. Nosocomial transmission was defined by applying the criteria established by the Brazilian National Health Regulatory Agency. ResultsWe identified 2146 cases of SARS-CoV-2 infection, 185 (8.6%) of which were considered cases of nosocomial transmission. The mean age was 58.3 years. The incidence density was 1.78 cases per 1,000 patient-days on the general wards, being highest on the cardiac surgery ward, and only 0.16 per 1,000 patient-days on the COVID-19 wards. Of the 185 patients evaluated, 115 (62.2%) were men, 150 (81.1%) cases had at least one comorbidity, and 104 (56.2%) evolved to death. ConclusionsDespite the preventive measures taken, nosocomial transmission of SARS-CoV-2 occurred throughout our hospital. Such measures should be intensified when the incidence of community transmission peaks.

Risk of SARS-CoV-2 Transmission in Health Care Personnel Working in a Pediatric COVID-19 Unit.

The paucity of symptoms and the difficulties in wearing personal protective equipment make children a potential source of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for health care workers (HCWs). Previous experience in pediatric settings reported high rate of intrahospital SARS-CoV-2 transmission in HCWs caring for children. We aimed at investigating the rate and determinants of SARS-CoV-2 infection among HCWs working in a regional reference center in the Southern Italy. A prospective observational study was conducted to monitor the occurrence of SARS-CoV-2 infections among HCWs and investigate the relation between the infection rate and hours of exposure or number and characteristics of procedures, including nasopharyngeal swab, high-flow oxygen delivery, suctioning of airway secretions, sputum induction, and nebulizer administration. After 5 months of monitoring, 425.6 hours of SARS-CoV-2 exposure (18.5 hours per person), and 920 hospital procedures, no case of nosocomial transmission was reported among the 23 HCWs enrolled in the study. The application of stringent preventive measures, also outside the area dedicated to patients' care, can effectively control infection spreading also in pediatric settings.

Containing COVID-19 in the Emergency Department: The Role of Improved Case Detection and Segregation of Suspect Cases.

ObjectivesPatients with COVID‐19 may present with respiratory syndromes indistinguishable from common viruses. This poses a challenge for early detection during triage in the emergency department (ED). Over a 3‐month period, our ED aimed to minimize nosocomial transmission by using broader suspect case criteria for better detection and using appropriate personal protective equipment (PPE) for health care workers (HCWs).MethodsAll ED admissions with respiratory syndromes over a 3‐month period were tested for COVID‐19. The sensitivity and specificity of screening criteria in detecting COVID‐19 were assessed. A risk‐stratified approach was adopted for PPE usage in the ED, based on high‐risk “fever areas” and lower‐risk zones. When a case of COVID‐19 was confirmed, surveillance was conducted for potentially exposed patients and HCWs.ResultsA total of 1,841 cases presenting with respiratory syndromes required admission over the study period. Among these, 70 cases of COVID‐19 were subsequently confirmed. The majority (84.2%, 59/70) were detected at ED triage because they fulfilled suspect case criteria. Of these, 34 met the official screening criteria; an additional 25 were detected by the broader internal screening criteria. Over the 12‐week period, the cumulative sensitivity of internal screening criteria was 84.3% (95% confidence interval [CI] = 73.6% to 91.9%), whereas the sensitivity of the official screening criteria was 48.6% (95% CI = 36.4% to 60.8%). Given the broadened internal criteria, the preexisting ED “fever area” was insufficient and had to be expanded. However, there were no cases of nosocomial transmission from intra‐ED exposure, despite extensive surveillance.ConclusionFrontline physicians need to be given leeway to decide on the disposition of cases based on clinical suspicion during an ongoing outbreak of COVID‐19. If a broader criterion is used at ED triage, ED facilities and isolation facilities need to be readied to accommodate a surge of suspect cases. Usage of appropriate PPE is essential in minimizing nosocomial transmission.

The first clusters of Middle East respiratory syndrome coronavirus in Oman: Time to act

IntroductionMiddle East respiratory syndrome coronavirus (MERS-CoV), is an emerging infectious disease of growing global importance. This review describes the latest MERS-CoV clusters and the first cases of nosocomial transmission within health care facilities in Oman. We have highlighted lessons learned and proposed steps to prevent healthcare-associated infections. MethodsA descriptive analysis of MERS-CoV cases was conducted between January 23 and February 16, 2019. The data from officials and other published sources used. ResultsThirteen laboratory-confirmed cases of MERS-CoV were reported from three simultaneous clusters from two governorates without an epidemiological link between the clusters. Two clusters were reported from North Al Batinah Governorate, with nine cases (69%) and 1 cluster from South Ash Sharqiyah Governorate with four cases (31%). In total, four deaths were reported (case fatality rate 31%). Four cases (31%) reported were household contacts from the first cluster, 3 (23%) were nosocomial transmission in health care facilities (two for first and one from the second cluster) and 7 (54%) were community-acquired cases. ConclusionsThe first local clusters of MERS-CoV reported with evidence suggestive of healthcare and household-associated transmission. Early diagnosis and strict implementation of infection control measures remain fundamental in preventing and managing MERS-CoV infection.

An Unusual Case of Nosocomial Transmission of HIV Infection

Investigators now report a rare case of HIV transmission in 2017 between two hospitalized patients, based on sequence analysis and epidemiologic

Exposure of Health Care Workers to Crimean-Congo Hemorrhagic Fever in Senegal: An Investigation of Two Imported Cases

Introduction: Crimean Congo hemorrhagic fever (CCHF) is a potentially fatal arbovirus with a high risk for nosocomial transmission. The goals of this study were to describe two cases of imported CCHF in Senegal and to evaluate health care worker exposure during the hospitalization of these two cases. Methodology: Exposed health care workers were identified, administered a questionnaire, and kept were under clinical surveillance for 9 days. The level of risk associated with exposure was determined using the French National Institute of Health Surveillance (InVS) classification system. Results: Two cases of CCHF transferred to Senegal from Mauritania, were admitted to the Infectious Diseases Service at Fann Teaching Hospital. The first case was admitted with diffuse hemorrhage and coma; the second case was admitted with febrile gastroenteritis. Both cases were fatal. The length of hospitalization was 06 hours and 07 days respectively. A total of 60 health care workers were exposed, including 11 doctors, 13 medical students, 14 nurses, 11 support staff, 09 nursing students, and 2 administrative staff. The majority of health care workers had a high-risk exposure (n=43, 65.2%). Moderate-risk exposure occurred among 21.2% (n=14) and low-risk exposure occurred among 13.6% (n=9). The high- risk was particularly prevalent among physicians (91,7%), support staff (91.7%) and nurses (66.7%). None of the contacts had clinical signs of CCHF during the monitoring period and none received prophylaxis with ribavirin. There were no known cases of nosocomial transmission. Conclusion: Despite high-risk exposure among the majority of health workers, no secondary cases were identified. Important strategies were identified to decrease the risk of nosocomial transmission for future cases of viral hemorrhagic fever in our hospital.

Crimean-Congo haemorrhagic fever in travellers: A systematic review.

SummaryBackgroundThe recent Ebola epidemic has increased public awareness of the risk of travel associated viral haemorrhagic fever (VHF). International preparedness to manage imported cases Ebola virus infection was inadequate, highlighted by cases of nosocomial transmission. Crimean-Congo haemorrhagic fever (CCHF) is a re-emerging tick-borne VHF centred in the Eurasian region, affecting a large geographical area and with human-to-human transmission reported, especially in the healthcare setting.ObjectivesTo systematically review the characteristics of travel associated Crimean-Congo haemorrhagic fever.MethodsA systematic review of travel-associated cases of CCHF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) and ProMED databases were searched for reports published between January 1960 and January 2016. Three independent reviewers selected and reviewed studies and extracted data.Results21 cases of travel associated CCHF were identified, of which 12 died (3 outcome unknown) and 4 secondary (nosocomial) infections were reported. Risk occupations or activities for CCHF infection were reported in 8/12 cases when data were available. Travel from Asia to Asia occurred in 9 cases, Africa to Africa occurred in 5 cases, Africa to Europe in 3 cases, Asia to Europe in 2 cases and Europe to Europe in 2 cases.ConclusionCCHF related to travel is rare, is generally associated with at risk activities/occupation and is frequently fatal. Key to early diagnosis and prevention of nosocomial transmission is an understanding of CCHF risk factors and the geographical distribution of CCHF. International travel to CCHF endemic areas is increasing and clinicians and laboratory personnel managing returning travellers should maintain a high index of suspicion.

Clinical characteristics of hospital-onset Pneumocystis pneumonia and genotypes of Pneumocystis jirovecii in a single tertiary centre in Korea.

BackgroundPneumocystis pneumonia (PCP) may develop as a clinical manifestation of nosocomial pneumonia by means of either reactivation of resident P. jirovecii or de novo infection. However, there have been no studies describing the clinical characteristics of hospital-onset PCP.MethodsA retrospective review of medical records was performed to identify episodes of hospital-onset PCP in a tertiary care centre in Korea between May 2007 and January 2013. We investigated whether human-to-human contact during hospitalisation contributed to PCP development by molecular analysis of the genes encoding mitochondrial large ribosomal subunit (mtLSU) rRNA and dihydropteroate synthase (DHPS) and a review of hospitalisation history.ResultsDuring the study period, 129 patients (130 episodes) were diagnosed with PCP. Of these, respiratory specimens from 94 patients during 95 PCP episodes were available for analysis. Sixteen episodes (16.8%) were categorised as hospital-onset PCP. There was a trend toward a higher proportion of haematological malignancy (43.8% [7/16] vs. 20.3% [16/79]; P = 0.058) in patients with hospital-onset PCP compared to patients with community-onset PCP. mtLSU genotype 1 was the most common, occurring in 41 (43.2%) patients. There were four possible cases of nosocomial transmission. Mutation in DHPS was not observed in any PCP episode.ConclusionsPCP can be one of the causes of nosocomial pneumonia, although the mode of acquisition and transmission of P. jirovecii remains uncertain. mtLSU genotype 1 is the predominant P. jirovecii strain in Korea.

Monitoring hepatitis C infection in a major Swedish nephrology unit and molecular resolution of a new case of nosocomial transmission

Hepatitis C virus (HCV) infection is a frequent problem in hemodialysis units. The prevalence and incidence of HCV infection over a decade were studied in a nephrology unit affected by previous nosocomial HCV transmission. The HCV non-structural 5B protein gene was sequenced to achieve phylogenetic analysis of a new (incident) case of infection. Proportions of patients who were and were not infected with HCV remained similar over the period, as did the inflow and outflow of patients infected previously. In 1997, 12/157 (8%) of patients at the unit (treatment: hemodialysis, peritoneal dialysis, and renal transplant recipients) were positive in HCV RNA, whereas in 2007 the overall number was 9/239 (4%). One patient acquired an HCV infection, and the NS5B sequence in that case clustered with genotype 2b sequences found in patients from an earlier outbreak. Comparing the HCV from the incident patient with several stored longitudinal samples and cloned PCR products from the most likely source patient revealed close phylogenetic relationship with an HCV quasispecies member from the possible source. The source patient and the incident newly infected patient were not scheduled on the same dialysis shift, although the records showed that simultaneous treatment occurred on two occasions during the months preceding transmission. In conclusion, over the 10-year period, the proportion of HCV-infected patients at the unit was unchanged. Only one new infection occurred, which originated from a fellow patient's quasispecies. This establishes phylogenetic analysis as a valuable tool for tracing patient sources of HCV transmission.

Is Natural Ventilation a Useful Tool to Prevent the Airborne Spread of TB?

Airborne transmission of infections such as tuberculosis (TB) can be a major problem in health care establishments. Health care workers infected with TB can be unwitting disseminators of the infection, and expensive retrospective screening (of other health workers and patients) is required when the diagnosis is made. In the past, the benefits of natural ventilation in the treatment of TB were implicit in the design of the sanatoria wards (Figure 1). More recently, expensive negative pressure facilities have been installed to accommodate patients with TB, particularly following outbreaks of TB among patients with HIV/AIDS [1]. Figure 1 Los Angeles Sanatorium, Duarte, California, United States (Photo: City of Hope). Room air should be changed 10–12 times every hour to ensure sufficient dilution of the bacterial load. Actual room air changes often fall below this level because of deficiencies in the facility and lack of maintenance. Respiratory masks provide protection, but are often inadequately fitted to the face and are not used before diagnosis is reached. Communal areas such as waiting rooms do not even approach these criteria and remain a risk for transmission. In a single incident of a mother and child with undiagnosed TB in a ward over several weeks, 6.7% of patients and 1.9% of pediatric health care workers had tuberculin skin test conversions [2]. Screening was required in 16 pediatric patients and 293 health care workers. In many poorer countries, negative pressure ventilation may not be installed or monitored adequately [3]. Current recommendations are directed at the importance of early diagnosis and treatment in these areas, yet practice can often be less than ideal. In India facilities may be crowded and poorly ventilated, and they may lack infection control procedures [4]. The trainee medical staff is at particularly high risk of acquisition of TB [5]. However, many cases of nosocomial transmission are avoidable since the need for respiratory isolation can be accurately predicted on the basis of clinical and chest radiographic findings [6].

Crimean–Congo Hemorrhagic Fever: A Case of Nosocomial Transmission

Crimean–Congo Hemorrhagic Fever: A Case of Nosocomial Transmission

Detection of unsuspected cases of nosocomial transmission of tuberculosis by use of a molecular typing method.

The aim of this study was to use restriction fragment length polymorphism to detect unsuspected cases of nosocomial transmission of tuberculosis (TB) among patients who had been admitted to a university hospital. One hundred fifty-one samples of Mycobacterium tuberculosis isolated from patients with pulmonary TB were studied. The isolates from 37 patients (24.5%) defined 11 clusters. None of the patients infected with these cluster isolates had hospital stays that coincided with one another, and for 5.4% of the patients, the epidemiological link was clearly outside the hospital. Previous incarceration was associated with infection with cluster isolates. In addition, 109 patients without TB (41 of whom were infected with human immunodeficiency virus) who shared a room with patients who had TB were followed for 18-60 months. Among the patients who survived, secondary cases of TB due to nosocomial transmission were not detected.

Persistent Colonization During Therapy for MHaemophilus influenzae Type b Disease

In Reply.— I agree with Dr Barton's warning to avoid "complacency regarding the lack of communicability of H influenzae type b in acute care settings" and to continue to be alert to the remote possibility that intrahospital transmission of H influenzae type b disease may occur. However, in the meantime, policy decisions on the duration of isolation precautions for patients with H influenzae type b infections need to be made. Based on my data1 and on the fact that only one possible case of nosocomial transmission has been reported in an acute care hospital, 2 I think the current recommendation of the American Academy of Pediatrics remains appropriate.