Enhanced Infection Control Research Articles

Enhancing Patients Outcomes and Infection Control through Smart Indoor Air Quality Monitoring Systems

Enhancing Patients Outcomes and Infection Control through Smart Indoor Air Quality Monitoring Systems

The Impact of Infection Control Policies on Hospital Acquired Infections by MDROs from 2016 to 2023.

Hospital-acquired infections (HAIs) caused by multidrug-resistant organisms (MDROs) pose a significant challenge to healthcare systems. The present study aimed to evaluate the impact of the infection policy to COVID-19 on the incidence of HAIs caused by MDROs. We conducted an eight-years retrospective analysis at a hospital in Shanghai, China. Bloodstream, sputum, and urinary tract cultures of MDROs obtained 48h after admission were collected monthly from January 2016 to Dec 2023. Occupied bed days (OBDs) were used to generate monthly HAI incidences per 10,000 OBDs. The study period was divided into pre-control, in-control, and post-control cohorts, in January 2020 and January 2022. The incidence was compared using interrupted time-series regression. In total, 6763 MDRO cultures were identified, comprising 1058 bloodstream, 4581 sputum, and 1124 urine cultures derived from 4549 patients. The incidence rates of all HAIs were 8.68 per 10,000 OBDs in the pre-control cohort, 9.76 per 10,000 OBDs in the in-control cohort and 12.58 per 10,000 OBDs in the post-control cohorts, respectively. A downward trend in the incidence of HAI was observed in the post-control cohort (p<0.05). This study demonstrates that while the COVID-19 pandemic poses a significant challenge to infection control within hospitals, it provides a unique opportunity to enhance infection control measures and evaluate their effectiveness. In addition, these findings highlight the need for more targeted prevention and control strategies against different pathogens in future epidemics.

Revolutionizing Infection Control: Autonomous UV-C Disinfection Robots in Healthcare Environments

Healthcare-associated Infections (HAIs) continue to present a significant challenge in healthcare settings, particularly within operating rooms and patient rooms where the risk of contamination is high. Despite rigorous cleaning protocols, traditional methods often struggle to fully eradicate microorganisms, contributing to a notable percentage of HAIs, especially among surgical patients. This paper examines the potential of ultraviolet (UV) light technology, specifically within the C band range (200-280nm), as a promising adjunct to conventional cleaning practices. UV-C light has demonstrated remarkable efficacy in deactivating bacteria, viruses, and fungi by disrupting their DNA, rendering them incapable of replication. This technology offers a versatile solution for sterilizing air, water, and surfaces, including hard-to-reach areas inaccessible to manual cleaning. Incorporating UV-C robots into routine cleaning procedures holds promise in augmenting the effectiveness of environmental decontamination efforts. By addressing the limitations of traditional cleaning methods and targeting residual pathogens, the integration of UV-C technology has the potential to significantly reduce the incidence of HAIs. Furthermore, the implementation of UV-C robots in healthcare facilities could lead to improved patient outcomes, reduced healthcare costs associated with treating HAIs, and a safer environment for both patients and healthcare workers. This paper synthesizes current evidence and highlights the implications of adopting UV-C technology as a crucial step toward enhancing infection control measures in healthcare settings.

Pseudomonas aeruginosa: Prevalence in Human and Animal Products, Virulence and Antibiotic Resistance Aspects

Pseudomonas aeruginosa (P. aeruginosa) is considered as pathogen that able to cause a number of diseases syndromes in the community and in hospitals. According to reports, the virulence factors and antibiotic resistances of P. aeruginosa it seem to consider them challenging to treat. The current review try to spot high lights on the prevalence of P. aeruginosa from various sources, in addition to assess the risk to the public's health, and concreted the definitive way for a diagnosis. This will help the medical staff to create a surveillance system and enhance infection control procedures.

Microbial Contamination During Long-term Ex Vivo Normothermic Machine Perfusion of Human Livers.

Normothermic machine perfusion permits the ex vivo preservation of human livers before transplantation. Long-term perfusion for days-to-weeks provides the opportunity for enhanced pretransplant assessment and potential regeneration of organs. However, this risks microbial contamination and infection of the recipient if the organ is transplanted. An understanding of perfusate microbial contamination is required to inform infection control procedures and antimicrobial prophylaxis for this technology. We modified a liver perfusion machine for long-term use by adding long-term oxygenators and a dialysis filter. Human livers that were not suitable for transplantation were perfused using a red-cell-based perfusate under aseptic and normothermic conditions (36 °C) with a goal of 14 d. Cephazolin was added to the perfusate for antimicrobial prophylaxis. Perfusate and bile were sampled every 72 h for microbial culture. Eighteen partial human livers (9 left lateral segment grafts and 9 extended right grafts) were perfused using our perfusion system. The median survival was 7.2 d. All organs surviving longer than 7 d (9/18) had negative perfusate cultures at 24 and 48 h. Half of the grafts (9/18) became culture-positive by the end of perfusion. Microbial contaminants included Gram-negative (Pseudomonas species, Proteus mirabilis, Stenotrophomonas maltophilia) and Gram-positive bacteria (Staphylococcus epidermidis, Enterococcus faecalis, and Bacillus species) as well as yeast (Candida albicans). Microbial contamination of perfusate is common during long-term perfusion of human livers with both exogenous and endogenous sources. Enhanced infection control practices and review of targeted antimicrobial prophylaxis are likely to be necessary for translation into the clinical arena.

Outbreak of Burkholderia Cepaciae Bacteremia in Neonatal Units of a Public Sector Hospital in Karachi, Pakistan

Aim: This study aimed to determine the occurrence of Burkholderia cepaciae outbreak in neonatal units, identifying the source, defining the best therapy for B. Cepaciae, and enhancing infection control practices. Methods: All neonates with BCC bacteremia during the study period were included. Data were gathered through the microbiology database, medical charts, laboratory data, and infection control surveys. Disk diffusion methodology was used in accordance with CLSI. Information from environmental cultures and feedback was included in the study. Results: The results showed varying patient demographics across the three pediatric wards, with differences in weight, gender distribution, hospital stay duration, and diagnoses. Trends of outbreak were identified with varying patterns in different wards. An intervention was performed, leading to general improvements in infectious disease control practices, and Burkholderia cepaciae was found to be most sensitive to Levofloxacin and Trimethoprim-Sulfamethoxazole. Conclusion: The study identified suspected sources and defined susceptibility profiles for empirical therapy for B. Cepaciae, contributing to the prevention of future outbreaks. Challenges in implementation underscore the need for proper administration and continuous emphasis on correct implementation of infection control practices. Keywords: BCC bacteremia, neonates, outbreak, Burkholderia cepaciae, infection control practices, Civil Hospital Karachi

Surgical site infection following abdominal cancer surgery: a retrospective study in a tertiary care cancer hospital

Background: Surgical site infections (SSIs) are significant complications following abdominal cancer surgery, resulting in patient discomfort, prolonged hospitalization, and increased healthcare costs. Despite efforts to mitigate their occurrence, SSIs remain a challenge in healthcare settings, particularly in low- and middle-income countries. Materials and Methods: This retrospective cross-sectional study aimed to determine the incidence, risk factors, microbiological patterns, and impact of SSIs in patients undergoing open abdominal cancer surgery at a tertiary cancer hospital in Nepal. Results: A total of 206 patients were included in the study, with an SSI incidence of 35.4%. Superficial SSIs accounted for 87.7% of cases, while 12.2% were deep or organ/space infections. The study explored various risk factors, including patient demographics, wound classification, surgical type, and preoperative conditions, and although certain factors showed associations, none reached statistical significance. Notably, longer surgical duration was linked to a higher risk of SSIs. Patients with SSIs experienced significantly longer hospital stays compared to those without SSIs. The predominant pathogens isolated were Escherichia coli, Staphylococcus aureus, and Citrobacter freundii, many of which displayed multidrug resistance. Conclusions: These findings highlight the need for tailored prevention strategies, prudent antibiotic use, and enhanced infection control measures in this high-risk population undergoing abdominal cancer surgery.

Enhancing Infection Control: A Comprehensive Analysis of Microbial Testing and Clinical Accuracy Assessment

Objective: To analyze the value of microbiological testing in the treatment of urinary tract infections. Methods:A total of 552 patients with urinary tract infections, diagnosed and treated between January and December 2021, were selected for this study. They were divided into observation and control groups, each consisting of 276 cases, using the random number table method. The observation group underwent microbial testing, while the control group underwent routine examinations to compare the diagnosis rate, overall treatment effectiveness, and infection status between the two groups. Results: The observation group exhibited significantly improved diagnosis rate, treatment effectiveness, and infection status compared to the control group (P &lt; 0.05). Conclusion: The application of microbial testing in the treatment of urinary tract infections demonstrates high clinical applicability.

A51Educational effectiveness of a high-consequence infectious disease training course using ultraviolet simulation

High-consequence infectious diseases (HCID) are pathogens which spread easily between people, have high mortality rates, and lack effective treatment [1]. Examples include Ebola and Lassa fever. Most emerging pandemics, including COVID-19, are initially classified as HCID. Assessment of patients with suspected HCID infection is an advanced procedural skill requiring application of enhanced infection control measures including patient isolation, personal protective equipment, and decontamination. There is a risk of healthcare worker infection if procedures are not followed [2]. HCID often present in non-specialist centres; there is a need for an accessible, educationally effective HCID course for NHS staff. We developed a course for clinicians in infectious disease and emergency medicine, in collaboration with the Health &amp; Safety Executive and clinicians in the UK-HCID network. The course uses a blended approach; theoretical components are taught with online learning. Practical components are taught with high-fidelity, multidisciplinary simulation using VIOLET, a mannequin which coughs, vomits and sweats ultraviolet markers ( Ultraviolet tracers are used to replicate contact and airborne transmission of infectious pathogens in simulation scenarios Between 01/12/22 and 01/04/23, 57 specialized clinicians participated. All participants passed post-course competency-based practical assessments. Participants demonstrated significant gains in knowledge between pre- and post-course tests (mean score 61% vs. 83%, This is the first HCID simulation course internationally using ultraviolet markers to allow visualization of contamination. The course appears to be an effective educational intervention and improves learner confidence in PPE use. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Antimicrobial Stewardship in the Hospital Setting: A Narrative Review.

The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the "End of the Miracle Drugs" due to the unjustifiable overuse and misuse of antibiotics has prompted a critical reassessment of their usage. In response, numerous relevant medical societies have initiated a concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, grounded in evidence-based guidelines and designed to guide antibiotic utilization. Crucial to this initiative is the establishment of multidisciplinary teams within each hospital, led by a dedicated Infectious Diseases physician. This team includes clinical pharmacists, clinical microbiologists, hospital epidemiologists, infection control experts, and specialized nurses who receive intensive training in the field. These teams have evidence-supported strategies aiming to mitigate resistance, such as conducting prospective audits and providing feedback, including the innovative 'Handshake Stewardship' approach, implementing formulary restrictions and preauthorization protocols, disseminating educational materials, promoting antibiotic de-escalation practices, employing rapid diagnostic techniques, and enhancing infection prevention and control measures. While initial outcomes have demonstrated success in reducing resistance rates, ongoing research is imperative to explore novel stewardship interventions.

Post-Operative Wound Infections and its Risk Factors in Surgical Wards at Rajshahi Medical College Hospital

Post-operative wound infections are a pressing concern in surgical wards, contributing to increased morbidity, mortality, healthcare costs, and prolonged hospital stays. This study investigates the prevalence and risk factors of postoperative wound infections in the surgical wards of Rajshahi Medical College Hospital in Bangladesh. A cross-sectional design was employed, encompassing 300 participants who underwent surgical procedures at the hospital. Structured questionnaires and observational techniques were used to collect data on demographic attributes, hand hygiene practices, dressing techniques, sterilization procedures, environmental cleanliness, and patient-related elements. The study revealed that among the participants, 135 (45.0%) practiced hand washing before dressing, while 198 (66.0%) practiced hand washing after dressing. The dressing technique of the doctor or nurse was perceived as proper by 154 participants (51.3%), while 174 (58.0%) reported that dressing materials were sterilized. Moreover, 183 participants (61.0%) perceived the bed sheets to be clean, while 161 (53.7%) considered the cleanliness of the patient's dress to be satisfactory. Additionally, 196 participants (65.3%) reported that the instruments used were sterilized, and 191 (63.7%) found the arrangement of the trolley to be proper. Statistical analyses were performed to assess relationships between variables. No significant relationship was found between educational status and cleanliness of bed sheets (χ² = 0.41, df = 3, p &gt; 0.05), or between educational status and cleanliness of the patient's dress (χ² = 10.38, df = 3, p &gt; 0.05). These results suggest that educational status may not significantly impact these aspects of infection control. The study underscores the complex nature of postoperative wound infections and infection control practices. Findings align with previous research on surgical site infections (SSIs) and emphasize the importance of standardized protocols, consistent surveillance, and context-specific interventions. The study's contributions offer valuable insights for optimizing infection control strategies in similar healthcare settings. Through the implementation of recommended strategies, Rajshahi Medical College Hospital and other healthcare institutions can enhance infection control practices, ultimately leading to improved patient outcomes and reduced rates of post-operative wound infections.

Active surveillance of carbapenemase-producing Enterobacterales using genomic sequencing for hospital-based infection control interventions.

Whole-genome sequencing (WGS) is increasingly used to characterize hospital outbreaks of carbapenemase-producing Enterobacterales (CPE). However, access to WGS is variable and testing is often centralized, leading to delays in reporting of results. We describe the utility of a local sequencing service to promptly respond to facility needs over an 8-year period. The study was conducted at Royal Prince Alfred Hospital in Sydney, Australia. All CPE isolated from patient (screening and clinical) and environmental samples from 2015 onward underwent prospective WGS. Results were notified to the infection control unit in real time. When outbreaks were identified, WGS reports were also provided to senior clinicians and the hospital executive administration. Enhanced infection control interventions were refined based on the genomic data. In total, 141 CPE isolates were detected from 123 patients and 5 environmental samples. We identified 9 outbreaks, 4 of which occurred in high-risk wards (intensive care unit and/or solid-organ transplant ward). The largest outbreak involved Enterobacterales containing an NDM gene. WGS detected unexpected links among patients, which led to further investigation of epidemiological data that uncovered the outpatient setting and contaminated equipment as reservoirs for ongoing transmission. Targeted interventions as part of outbreak management halted further transmission. WGS has transitioned from an emerging technology to an integral part of local CPE control strategies. Our results show the value of embedding this technology in routine surveillance, with timely reports generated in clinically relevant timeframes to inform and optimize local control measures for greatest impact.

A systematic review of dentists' psychological wellbeing during the COVID-19 pandemic.

Background The COVID-19 pandemic presented significant challenges to healthcare workers worldwide, including the effect on the psychological wellbeing of dentists.Aims To evaluate the impact of the early phases of the pandemic on the psychological health, long-term wellbeing and clinical service provision of dentists, as well as the identification of the key risk and protective factors for adverse mental health outcomes (MHOs) in this group.Methods A systematic review of cross-sectional studies (n = 53) from public and private dentistry sectors was employed to delineate the risk and protective factors for adverse MHOs.Results Self-reports from these studies (1 December 2019 to 31 December 2021), involving 45,671 dentists worldwide were analysed. Study findings were classified according to their psychological impact (as risk or protective factors), categorised as 'operational' or 'organisational' and subdivided into 'psychosocial', 'occupational', 'sociodemographic' and 'environmental' elements. A GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) certainty of evidence score was calculated for all the identified factors.Conclusions This review confirmed the negative impact of the pandemic on the MHOs of dentists worldwide. Pivotal risk factors included fear of infection, transmission to families, lack of personal protective equipment and possible direct contact with infected patients. Enhanced infection control protocols, individual resilience and organisational support were identified as important protective factors.

Gut microbiology of UK care home residents: a cross-sectional analysis from a randomised controlled trial

ObjectiveTo describe the prevalence of potentially clinically relevant gut pathogens and associations with the carriage of resistant organisms in UK care home residents. MethodsStool samples were collected pre-randomisation from care home residents participating in a randomised placebo-controlled trial. Cultivable clinically relevant bacteria were analysed. Antimicrobial susceptibility testing was performed by agar dilution (amoxicillin, co-amoxiclav, gentamicin, trimethoprim, nitrofurantoin, and ciprofloxacin). We also aimed to detect resistance to third-generation cephalosporins, carbapenems, and vancomycin. ResultsStool samples were available for 159/310 residents participating in the trial (51%) from 23 care homes between 2016 and 2018. In total, 402 bacterial isolates were cultured from 158 stool samples and 29 different species were cultured. The five most common species were Escherichia coli (155/158, 98%), Pseudomonas aeruginosa (40/158, 25%), Enterococcus faecalis (35/158, 22%), Enterococcus faecium (30/158, 19%), and Proteus mirabilis (25/158, 16%). Enterobacterales isolates were cultured from 157 samples (99%), and resistance to at least one of the tested antimicrobials was found in 119 of these (76%). There were high levels of variation in outcomes by care home. DiscussionWe demonstrated that care home residents harbour significant levels of antimicrobial-resistant organisms in their stool. This work emphasises the importance of both enhanced infection control practices and antimicrobial stewardship programmes to support the appropriate use of antimicrobials in this setting.

Challenges in the Prevention of Surgical Site Infections in India

Surgical site infections (SSIs) are health-care-associated infections that burden not only patients undergoing various surgical procedures but the health-care facilities providing care as well. Although preventable, SSIs contribute to complicated and lengthy hospital stays for patients undergoing surgeries, especially in developing countries more than in developed nations. Anticipating and implementing measures to curtail such preventable events in a health-care facility are of utmost importance in providing quality health care. Enhancing and strengthening infection control practices lie in the hands of all health-care workers coming in contact with a patient from the time of admission to discharge. The standard guidelines and protocols are in place by various organizations worldwide on SSI prevention. These guideline-based recommendations are discussed in this review to guide clinicians, microbiologists, infection control specialists, and nurses to excel in safe surgery practices, thereby achieving effective and sustainable patient care. Apart from this, hurdles in our country and ways of handling the same are also discussed.

Neonatal Bloodstream Infection with Ceftazidime-Avibactam-Resistant blaKPC-2-Producing Klebsiella pneumoniae Carrying blaVEB-25.

Although ceftazidime/avibactam (CAZ/AVI) has become an important option for treating adults and children, no data or recommendations exist for neonates. We report a neonatal sepsis case due to CAZ/AVI-resistant blaKPC-2-harboring Klebsiella pneumoniae carrying blaVEB-25 and the use of a customized active surveillance program in conjunction with enhanced infection control measures. The index case was an extremely premature neonate hospitalized for 110 days that had been previously treated with multiple antibiotics. Customized molecular surveillance was implemented at hospital level and enhanced infection control measures were taken for early recognition and prevention of outbreak. Detection and identification of blaVEB-25 was performed using next-generation sequencing. This was the first case of a bloodstream infection caused by KPC-producing K. pneumoniae that was resistant to CAZ/AVI without the presence of a metalo-β-lactamase in the multiplex PCR platform in a neonate. All 36 additional patients tested (12 in the same NICU and 24 from other hospital departments) carried wild-type blaVEB-1 but they did not harbor blaVEB-25. The emergence of blaVEB-25 is signal for the horizontal transfer of plasmids at hospital facilities and it is of greatest concern for maintaining a sharp vigilance for the surveillance of novel resistance mechanisms. Molecular diagnostics can guide appropriate antimicrobial therapy and the early implementation of infection control measures against antimicrobial resistance.

Surgical Site Infections During the Pandemic: The Impact of the "COVID Bundle".

A reduction in surgical site infections (SSIs) has been reported in several discrete patient populations during the COVID-19 pandemic. Herein, this study evaluates the impact of the COVID-19 pandemic on SSI in a large patient cohort incorporating multiple surgical disciplines. We hypothesize that enhanced infection control and heightened awareness of such measures is analogous to an SSI care bundle, the hypothetical "COVID bundle", and may impact SSI rates. Data collected for the American College of Surgeons National Surgical Quality Improvement Program between January 1, 2015, and April 1, 2021, were retrospectively analyzed. SSI rates were compared among time-dependent patient cohorts: Cohort A (pre-pandemic, N = 24,060, 87%) and Cohort B (pandemic, N = 3698, 13%). Time series and multivariable analyses predicted pre-pandemic and pandemic SSI trends and tested for association with timing of surgery. The overall SSI incidence was reduced in Cohort B versus Cohort A (2.8% vs. 4.5%, p < 0.001). Multivariable analysis indicated a downward SSI trend before pandemic onset (IRR 0.997, 95% CI 0.994, 1). At pandemic onset, the trend reduced by a relative factor of 39% (IRR 0.601, 95% CI 0.338, 1.069). SSI then trended upward during the pandemic (IRR 1.035, 95% CI 0.965, 1.111). SSI rates significantly trended downward in general surgical patients at pandemic onset (IRR 0.572, 95% CI 0.353, 0.928). Although overall SSI incidence was reduced during the pandemic, a statistically significant decrease in the predicted SSI rate only occurred in general surgical patients at pandemic onset. This trend may suggest a positive impact of the "COVID bundle" on SSI rates in these patients.

Antipathogenic coating agents to improve the innate hand-barrier mechanism

The human skin surface has an innate barrier mechanism against pathogens. Here, we developed an antipathogenic coating agent containing lactic acid (LA) and hexa-oxyethylene lauryl ether (C12EO6) by reproducing the innate hand-barrier mechanism. By reinforcing the hand barrier, we created a skin surface environment unsuitable for pathogen survival. An ex vivo study using an autopsy skin specimen demonstrated that the application of 1% LA + 0.2% C12EO6 on the skin surface reduced the survival time of Serratia marcescens, severe acute respiratory syndrome coronavirus 2, and influenza virus from 283.9 to 9.0 h, 10.8 to 0.3 h, and 1.8 to 0.2 h, respectively. In a clinical study, the count of viable Serratia marcescens was significantly reduced on skin coated with 1% LA + 0.2% C12EO6 (log reduction of 4.27 ± 0.39 in a 5 min reaction), demonstrating strong antibacterial activity. This strong antibacterial activity was maintained for >2 h on the skin surface. Additionally, 1% LA + 0.2% C12EO6 caused exceptionally low skin irritation. Hence, its application can greatly shorten pathogen survival time on the skin and can create and maintain a skin surface environment unsuitable for pathogen survival, thereby complementing current hand hygiene practices and achieving enhanced infection control.

A SARS-CoV-2 outbreak in a plastics manufacturing plant

BackgroundA SARS-CoV-2 outbreak with an attack rate of 14.3% was reported at a plastics manufacturing plant in England.MethodsBetween 23rd March and 13th May 2021, the COVID-OUT team undertook a comprehensive outbreak investigation, including environmental assessment, surface sampling, molecular and serological testing, and detailed questionnaires, to identify potential SARS-CoV-2 transmission routes, and workplace- and worker-related risk factors.ResultsWhile ventilation, indicated using real-time CO2 proxy measures, was generally adequate on-site, the technical office with the highest localized attack rate (21.4%) frequently reached peaks in CO2 of 2100ppm. SARS-CoV-2 RNA was found in low levels (Ct ≥35) in surface samples collected across the site. High noise levels (79dB) were recorded in the main production area, and study participants reported having close work contacts (73.1%) and sharing tools (75.5%). Only 20.0% of participants reported using a surgical mask and/or FFP2/FFP3 respirator at least half the time and 71.0% expressed concerns regarding potential pay decreases and/or unemployment due to self-isolation or workplace closure.ConclusionsThe findings reinforce the importance of enhanced infection control measures in manufacturing sectors, including improved ventilation with possible consideration of CO2 monitoring, utilising air cleaning interventions in enclosed environments, and provision of good-quality face masks (i.e., surgical masks or FFP2/FFP3 respirators) especially when social distancing cannot be maintained. Further research on the impacts of job security-related concerns is warranted.

Using Genomics To Investigate an Outbreak of Vancomycin-Resistant Enterococcus faecium ST78 at a Large Tertiary Hospital in Queensland.

To investigate an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) sequence type 78 (ST78) in a large tertiary Australian hospital. A collection of 63 VREfm ST78 isolates, identified during a routine genomic surveillance program, were subjected to genomic epidemiological analysis based on whole-genome sequencing (WGS) data. The population structure was reconstructed using phylogenetic analysis, and a collection of publicly available VREfm ST78 genomes were used to provide global context. Core genome single nucleotide polymorphism (SNP) distances and available clinical metadata were used to characterize outbreak clusters and reconstruct transmission events. In silico genotyping confirmed that all study isolates were vanB-type VREfm carrying virulence characteristics of the hospital-associated E. faecium. Phylogenetic analysis identified two distinct phylogenetic clades, only one of which was responsible for a hospital outbreak. Four outbreak subtypes could be defined with examples of recent transmissions. Inference on transmission trees suggested complex transmission routes with unknown environmental reservoirs mediating the outbreak. WGS-based cluster analysis with publicly available genomes identified closely related Australian ST78 and ST203 isolates, highlighting the capacity for WGS to resolve complex clonal relationships between the VREfm lineages. Whole genome-based analysis has provided a high-resolution description of an outbreak of vanB-type VREfm ST78 in a Queensland hospital. Combined routine genomic surveillance and epidemiological analysis have facilitated better understanding of the local epidemiology of this endemic strain, providing valuable insight for better targeted control of VREfm. IMPORTANCE Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of health care-associated infections (HAIs) globally. In Australia, the spread of hospital-adapted VREfm is largely driven by a single clonal group (clonal complex [CC]), CC17, to which the lineage ST78 belongs. While implementing a genomic surveillance program in Queensland, we observed increased incidence of ST78 colonizations and infections among patients. Here, we demonstrate the use of real-time genomic surveillance as a tool to support and enhance infection control (IC) practices. Our results show that real-time whole-genome sequencing (WGS) can efficiently disrupt outbreaks by identifying transmission routes that in turn can be targeted using resource-limited interventions. Additionally, we demonstrate that by placing local outbreaks in a global context, high-risk clones can be identified and targeted prior to them becoming established within clinical environments. Finally, the persistence of these organism within the hospital highlights the need for routine genomic surveillance as a management tool to control VRE transmission.