Control Of Healthcare-associated Infections Research Articles

Effects of a Multi-Intervention Multimedia Infection Controlmoduleon Critical Care Nurses’ Knowledge and Practice of Prevention and Control of Healthcare-Associated Infections

Effects of a Multi-Intervention Multimedia Infection Controlmoduleon Critical Care Nurses’ Knowledge and Practice of Prevention and Control of Healthcare-Associated Infections

Factors influencing Healthcare-associated Infection Control of Caregivers

Factors influencing Healthcare-associated Infection Control of Caregivers

Mental health status among Chinese healthcare-associated infection control professionals during the outbreak of coronavirus disease 2019: A national cross-sectional survey.

Recently, the coronavirus disease 2019 (COVID-19) epidemic has greatly threatened global public health. The responsibility of healthcare-associated infection control professionals (ICPs) is to prevent and control the nosocomial infections. The mental health status of ICPs deserves more attention, however, the correlational research is still lacking. This study aims to investigate the incidence and risk factors of mental health status among ICPs in China during the outbreak of COVID-19.A national cross-sectional survey was performed. The online questionnaire was completed by 9228 ICPs from 3776 hospitals throughout China. Data collection tools were used, including demographics data questionnaire, the Chinese version of the 12-item general health questionnaire (GHQ-12) and the Chinese version of the psychological capital questionnaire (PCQ) for medical staff. Univariate and multivariable analyses were conducted.The total score of mental health of Chinese ICPs was 3.45 ± 2.57. 5608 (60.77%) ICPs might have mental health problems. The psychological capital was in the upper-middle level with an average score of 3.72 ± 0.38. An increased mental health problem risk was associated with the greater self-efficacy and working in the public hospital; a significantly lower risk was obtained by working in the second-class hospital rather than in the third-class hospitals. Besides, mental health problem risk of ICPs working in hospitals of the western economic region or northeast economic region was more significant than that in hospitals of the central economic region. However, a lower risk was caused by the unmarried than married, and working years in department ≤1 year contributed to the lower risk than that >20 years. Moreover, fewer working hours per week, higher values of hope, and optimism each were contributed to a lower risk.Chinese healthcare-associated ICPs were under different levels of mental health problems in fighting against COVID-19. More importantly, we should actively deal with the mental health problem of ICPs and help them get rid of psychological disorders.

The Healthcare-associated infections (HAIs) and infection Control link nurse as a strategy to face them: review of literature

Healthcare-associated infections (HAIs) are the most common adverse event in hospitals and a major public health problem with a negative impact on morbidity, mortality and quality of life. Governmental and non-governmental organizations are developing and strengthening plans to improve Infection and Prevention Control (IPC) programmes. Adopting reliable, effective and integrated IPC programmes can prevent 50% of HAIs. Implementation of a Infection Control Link Nurse (ICLN) system at the health care facility level is one of these. To obtain from a literature review evidence-based recommendations and practical instruments for developing and implementing a training course for ICLN. A literature review was conducted by searching the Cochrane Library, PubMed, Cinahl without time limits, until July 2019. PICO methodology was adopted to build the research question and the Prisma Flow Diagram chosen for the selection of studies. Results The final review included 4 studies which dealt with the following main topics: selection of the personnel, profile, educational pathway, activities and factors that affects ICLN. Even though there is no accordance on duration and contents of LN training courses, its usefulness is well accepted. Using expert clinical nurses on prevention, control and management of HAIs for LN programmes is useful when they are capable of being opinion leaders and trainers among their teams, as well as a formal connection to management areas and administrators.

Magnetoelectric Polymer-Based Nanocomposites with Magnetically Controlled Antimicrobial Activity

The emergence of antimicrobial resistance is considered a public health problem due to the overuse and misuse of antibiotics which are losing efficacy toward an increasing number of microorganisms. Advanced antimicrobial strategies via development of alternative drugs and materials able to control microbial infections, especially in clinical settings, are urgently needed. In this work, nanocomposite films were developed from the piezoelectric polyvinylidene fluoride (PVDF) polymer, filled with nickel nanowires (NiNws) in an attempt to control and enhance the antimicrobial activity of the materials via applying a magnetic stimulus. The material was achieved through crystallization of PVDF in the electroactive β-phase upon incorporation of anisotropic and negatively charged NiNws in the polymeric matrix at a concentration of 1.5 wt %. The nanocomposites have shown to possess certain antimicrobial properties, which could be considerably boosted through the application of a magnetic field. In fact, more than 55% of bacterial growth inhibition was obtained by employing controlled dynamic magnetic conditions for representative Gram-positive and Gram-negative bacteria, compared to only 25% inhibition obtained under static conditions, i.e., without magnetic stimuli application, with the antibiofilm activity clearly improved as well upon dynamic conditions. This work demonstrates a proof-of-concept for materials able to boost on demand their antimicrobial activity and opens the room for applications in novel medical devices with improved control of healthcare-associated infections.

Water, sanitation, and hygiene (WASH) in healthcare facilities of 14 low- and middle-income countries: to what extent is WASH implemented and what are the ‘drivers’ of improvement in their service levels?

AbstractPrevention and control of healthcare-associated infections through the provision of water, sanitation, and hygiene (WASH) in healthcare facilities (HCF) is inadequate in low- and middle-income countries (LMICs), resulting in high patient morbidity and mortality, additional costs, and increased risk of antibiotic resistance. There is little evidence describing factors leading to improved WASH conditions in LMICs. We aim to identify the extent to which WASH is implemented in HCFs in LMICs and understand the ‘drivers’ of improvement in their service levels. WASH service levels in 14 LMICs were descriptively analysed, and potential drivers of service-level differences were explored using univariable and multivariable mixed-model logistic regression analyses. Descriptive analysis showed a lack of adequate water quality, sanitation, hand, and environmental hygiene, and waste disposal. We found that the presence of infection prevention and control protocols (IPCPs), having an IPC/WASH focal person at the facility, and conducting WASH training for staff were associated with higher levels of WASH services. This study demonstrates a lack of basic WASH services in HCF in LMICs. We show that there are potential interventions, such as implementing IPCPs, identifying WASH leaders in HCF, and conducting training that may lead to service improvements.

Antimicrobial drug resistance and infection prevention/control: lessons from tuberculosis

Antimicrobial drug resistance (AMR) is increasing rapidly worldwide, causing an estimated 700,000 deaths annually over the past decade, en route to becoming the leading global threat to public health by 2050 with an estimated 10 million deaths per year (more than heart disease, cancer, and stroke), while reducing global wealth by US$100 trillion. Yet AMR has not received the attention and action required to change this trajectory. Appropriate infection prevention and control (IPC) measures are needed to prevent transmission of infections to healthcare workers (HCWs), other patients, families, and the general public. In this review, we discuss a notable case study of AMR: highly drug-resistant tuberculosis (TB) has emerged repeatedly over the past 70 years as new drugs have been introduced, leading to new diagnostics, therapeutics, funding, public health strategies, and, in high-income countries, effective IPC measures that curtailed transmission. We review current efforts to control and prevent AMR using the example of drug-resistant tuberculosis to highlight important themes including laboratory systems, surveillance, control and prevention of healthcare-associated infections (especially among HCWs), better coordination across disciplines and diseases, and powerful advocacy/social change initiatives grounded in social and behavioral sciences. These strategies are the foundation of an effective response to the AMR threat to public health.

Incidence of surgical site infection in colon surgery according to RENAVE methodology: Prospective study 2017–2019

BackgroundNavarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. Methods416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30 days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. ResultsThe cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories 2 and 3. ConclusionsThe incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results.

Does healthcare worker education improve adherence to standard precautions for controlling health care-associated infections?

Does healthcare worker education improve adherence to standard precautions for controlling health care-associated infections?

Positive deviance in infection prevention and control: A systematic literature review.

Healthcare-associated infections (HAIs) remain a major challenge. Various strategies have been tried to prevent or control HAIs. Positive deviance, a strategy that has been used in the last decade, is based on the observation that a few at-risk individuals follow uncommon, useful practices and that, consequently, they experience better outcomes than their peers who share similar risks. We performed a systematic literature review to measure the impact of positive deviance in controlling HAIs. A systematic search strategy was used to search PubMed, CINAHL, Scopus, and Embase through May 2020 for studies evaluating positive deviance as a single intervention or as part of an initiative to prevent or control healthcare-associated infections. The risk of bias was evaluated using the Downs and Black score. Of 542 articles potentially eligible for review, 14 articles were included for further analysis. All studies were observational, quasi-experimental (before-and-after intervention) studies. Hand hygiene was the outcome in 8 studies (57%), and an improvement was observed in association with implementation of positive deviance as a single intervention in all of them. Overall HAI rates were measured in 5 studies (36%), and positive deviance was associated with an observed reduction in 4 (80%) of them. Methicillin-resistant Staphylococcus aureus infections were evaluated in 5 studies (36%), and positive deviance containing bundles were successful in all of them. Positive deviance may be an effective strategy to improve hand hygiene and control HAIs. Further studies are needed to confirm this effect.

Healthcare-associated infection control and biosecurity measures for nurses in the emergency department of a National Essalud Hospital [Healthcare-associated infection control and biosecurity measures for nurses in the emergency department of a National Essalud Hospital

Biosecurity measures are indispensable in the work of nursing care to ensure the quality and impact of nursing care interventions in the areas of care. Objective: To determine the relationship between biosecurity measures and healthcare-associated infection control in the work of nurses in the emergency department of a National Hospital, Essalud, 2019. The methodology was a quantitative, correlational, cross-sectional, non-experimental design, whose population consisted of 152 nurses working in the emergency area, for which 3 instruments were applied: Scale of knowledge of biosecurity measures with 14 items with multiple answers, Checklist of biosecurity measures with 17 items, and Handwashing checklist with 11 items, both instruments with a dichotomous scale. Both instruments were evaluated by experts and their reliability was 0.8. The results obtained show that there is a significant positive average correlation between the variables measured of biosecurity and the control of infections associated to health care. It is concluded that nurses' knowledge of biosecurity measures and HAIs pose a high risk to health personnel and patients. Therefore, it is essential to continue training, monitoring, follow-up and control to ensure the quality and impact of nursing care in emergency services.

중소병원 간호사의 감염예방 표준주의 지침 수행도에 미치는 영향요인

The purpose of this study was to identify the factors that influence the performance to guidelines for the standard precaution of infection prevention for nurses who work in small and medium-sized hospitals. The subjects for this study consisted of 184 nurses from five small and medium-sized hospitals having below 300 beds located in B city. The collected data were analyzed according to frequency, percentage, mean and standard deviation, t-test, one way ANOVA, Scheffé test, Pearson Correlation Coefficient and Multiple regression. The research found that the factors that influence nurses’ Standard precautions were working department(β=-.346 p.001), report after exposure on accident(β=-.229, p=.004), marital status(β=-.216, p.001), knowledge(β=.193, p=.003), and attitude(β=-.144, p=.028). The explained variance for performance was 29.8%(F=10.711, p.001). Based on the findings, it is necessary to improve the safety-climate and continuous educational program, and administrative support should be provide on improve nurses’ performance of standard precautions for healthcare-associated infection control in small- and medium-sized hospitals.

Ultrasensitive Label-Free Detection of Unamplified Multidrug-Resistance Bacteria Genes with a Bimodal Waveguide Interferometric Biosensor.

Infections by multidrug-resistant bacteria are becoming a major healthcare emergence with millions of reported cases every year and an increasing incidence of deaths. An advanced diagnostic platform able to directly detect and identify antimicrobial resistance in a faster way than conventional techniques could help in the adoption of early and accurate therapeutic interventions, limiting the actual negative impact on patient outcomes. With this objective, we have developed a new biosensor methodology using an ultrasensitive nanophotonic bimodal waveguide interferometer (BiMW), which allows a rapid and direct detection, without amplification, of two prevalent and clinically relevant Gram-negative antimicrobial resistance encoding sequences: the extended-spectrum betalactamase-encoding gene blaCTX-M-15 and the carbapenemase-encoding gene blaNDM-5 We demonstrate the extreme sensitivity and specificity of our biosensor methodology for the detection of both gene sequences. Our results show that the BiMW biosensor can be employed as an ultrasensitive (attomolar level) and specific diagnostic tool for rapidly (less than 30 min) identifying drug resistance. The BiMW nanobiosensor holds great promise as a powerful tool for the control and management of healthcare-associated infections by multidrug-resistant bacteria.

Analyzing Healthcare Workers’ Perspectives on Healthcare-Associated Infections and Infection Control Practices Using Video Reflexive Ethnography (VRE)

Background: This study explores the perspectives of healthcare workers on the healthcare-associated infection (HAI) and infection control measures in a tertiary-care unit, through a self-administered questionnaire, semi-structured interviews, and reflexive sessions based on video-recorded sterile procedures performed in respondents’ work contexts. Video reflexive ethnography (VRE) is a method that provides feedback to medical practitioners through reflection analysis, whereby practitioners identify problems and find solutions. Methods: Quantitative questionnaire data were used to assess the knowledge of HAI among 50 healthcare workers and their attitude toward practice of infection control measures. Semistructured interviews based on an interview guide were used to collect qualitative data from 25 doctors and nurses. The interviews were audio recorded and transcribed verbatim immediately. Also, routine sterile procedures in the wards and intensive care unit were video recorded, and the footage was discussed by the infection control team and the personnel involved in the videos. This discussion was video recorded and transcribed. Both interview data and reflexive discussion of video-graph were analyzed using a thematic analysis. The quantitative data were analyzed using the Kruskal–Wallis test. Results: The quantitative data revealed no difference in the knowledge, attitude, and practice scores used to evaluate the infection control practices among the healthcare workers. We identified 4 themes from the qualitative data: (1) knowledge of HAI and infection control, (2) infection control measures in practice, (3) the shortfall in infection control measures and HAI, and (4) required implementation. Although the qualitative data indicated that the participants had excellent compliance with hand hygiene and personal protective equipment (PPE) use, the VRE and reflective sessions indicated otherwise. Some astounding lapses were revealed, like failure to engage in boundary maintenance between sterile and nonsterile areas, failure to observe proper hand hygiene measures, and use of traditional hijab face covers (used in an unsterile environment as well) instead of surgical masks. These findings demonstrate the advantage of combining VRE with qualitative and quantitative methodology to deduct the lapses in the practice of infection control among healthcare workers. Conclusions: Introduction of training programs focused on HAI and infection control measures in the educational system will help better inform medical and nursing students. Live video demonstrations of appropriate infection control practices during sterile procedures would be highly beneficial to educate the healthcare workers on correct infection control practices. Lapses in the use of PPE can be a possible reason for the outbreak of MERS-CoV, an endemic disease, in this part of Saudi Arabia.Disclosures: NoneFunding: None

22 -Year Results of an Intensive Care Unit Infection Control Program in Ribeirao Preto, Brazil

Background: Healthcare-associated infection (HAI) control programs have improved patient care all over the world. Our program was implemented in 1997 in a general intensive care unit (ICU) based upon surveillance of HAI with regular infection rates feedback to the ICU team and implementation of best practices such as hand hygiene (HH) and oral care for ventilated patients, optimal care, and early removal of invasive devices. Objective: To report our decreasing HAI rates in the past 22 years. Methods: Hospital Sao Francisco 20-bed ICU admits 120–140 surgical and clinical patients monthly, with 90% occupancy. The HAI infection control team implemented HAI surveillance and developed several protocols for HAI prevention. In the past 5 years, ICU personnel initiated the collection of several indicators using random direct observations of HH compliance, central venous catheter correct care, and appropriated oral care, among others. HAI definitions followed Brazilian Health Ministry HAI definitions and were expressed as infections per 1,000 patient days (total HAI rate) and device-related infections per 1,000 device days. Catheter-associated urinary tract infection (CAUTI), central-line–associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates are reported here. The study period spanned January 1997 to August 2019. Measurement of antibiotic utilization (ie, meropenem, vancomycin, and piperacillin-tazobactam) was calculated by dividing the of antibiotic consumed vials by the daily defined dose and patient days. Results: The total HAI, CAUTI, CLABSI, and VAP rates dropped 70%, 85%, 84%, and 87%, respectively, from 1997 to 2019 (Table 1). From 2009 to 2019, we detected decreases in hospital use of meropenem from 52 to 38, in vancomycin from 50 to 40, and in piperacillin-tazobactam from 144 to 88. Conclusions: HAI control programs can be effective in ICUs, with impressive results, but it requires time and considerable effort. Data on compliance with basic infection control measures should accompany HAI data and should be shared with the ICU team because ICU team participation is essential to keeping the program alive. Broad-spectrum antibiotics use also decreased, with potential benefits to the hospital flora.Funding: NoneDisclosures: None

Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).

Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery. Retrospective case-control study. Four academic medical centers. Children aged 0-22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries. Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0. Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005-$10,362) and $6,502 (95% CI, $2,261-$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, -$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022-$8,719). Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

Hand hygiene

Abstract: The World Health Organization (WHO) defines Health Care-Associated Infection (HCAI) as an infection a patient acquired in health care settings. In Canada, more than 220,000 patients are infected by HCAIs annually, with 8,500 to 12,000 of these patients resulting in death, thus becoming the fourth leading cause of death for Canadians. Hand hygiene practice is the most critical measure to prevent HCAIs, however, research indicates that in hospitals worldwide, just 40% of health care workers abide by the advised hand hygiene guidelines. A new effective HCAI control and prevention program is needed to sustain benefits, building on prior interventions such as including hand hygiene education that stresses the necessity of this practice in the protocol, providing factual proof of the effectiveness of hand hygiene, the acknowledgment by senior staff of their responsibility as role models for all staff, innovative technological methods, and regular auditing/feedback. With the current outbreak of coronavirus disease (COVID-19) that has infected millions around the world, a new HCAI control and prevention program can increase the compliance rate of handwashing with alcohol-based hand rub/sanitizer amongst healthcare professionals thus aiding in prevention and control of spread within the community.

Investigation of nurses' attitude towards open visitation policy in intensive care unit and analysis of influence factors

To investigate the nurses' attitude towards open visitation policy in intensive care unit (ICU) and its potential influence factors, and further to provide evidence for carrying out this policy in ICU. A self-designed, anonymous online questionnaire of "attitude of ICU nurses to open visiting system in ICU" was performed in 31 provinces, autonomous regions and municipalities in China from October to December 2019, using convenient sampling method approach. Only nurses working in ICU (including specialized ICU, but excluding the critical ward in general ward) and willing to participate in the survey were included. The survey included 35 items, including the general information of each participant, the attitude towards the implementation of the open visitation system in ICU and its potential influencing factors. Ordinal Logistic regression analysis was used to identify the significant influencing factors. A total of 1 558 questionnaires were sent out and 1 546 effective questionnaires were retrieved, with a response rate of 99.2%. Overall, 32.2% of them agreed with the policy, 41.3% of them disagree with the policy and 26.5% of them were uncertain. The Ordinal Logistic regression analysis showed that the independent influencing factors of ICU nurses' attitude towards open visitation policy including the possibility of increasing healthcare-associated infection [disagree: β = 1.327, 95% confidence interval (95%CI) was 0.242 to 2.413, P = 0.017; uncertain: β = 0.697, 95%CI was 0.244 to 1.151, P = 0.003], the improvement of nurses' job satisfaction (disagree: β = -1.406, 95%CI was -1.750 to -1.062, P = 0.000; uncertain: β = -0.748, 95%CI was -1.030 to -0.466, P = 0.000), the information support for medical staffs from family members (disagree: β = -0.644, 95%CI was -1.048 to -0.240, P = 0.002; uncertain: β = -0.422, 95%CI was -0.721 to -0.124, P = 0.006), the feasibility that the family members can assist the nurses in the basic nursing for patients (uncertain: β = -0.465, 95%CI was -0.729 to -0.202, P = 0.001), reducing the time that a nurse spent on caring for the patients (uncertain: β = 0.349, 95%CI was 0.052 to 0.646, P = 0.021), improving early rehabilitation (disagree: β = -0.593, 95%CI was -1.166 to -0.019, P = 0.043), and getting psychological support for patients from family members (disagree: β = 1.293, 95%CI was 0.426 to 2.159, P = 0.003), family members' satisfaction (disagree: β = -0.981, 95%CI was -1.431 to -0.531, P = 0.000). ICU nurses in China have realized that open visitation policy has positive effect on patients' early rehabilitation, willing to live and satisfaction; meanwhile, this policy may need more improvement in many ways such as healthcare-associated infection control, disinfection and isolation, allocation of human resources and time spent treating and caring for patients.

KSNM/KSID/KOSHIC Guidance for Nuclear Medicine Department Against the Coronavirus Disease 2019 (COVID-19) Pandemic.

The dramatic spread of Coronavirus Disease 2019 (COVID-19) has profound impacts on every continent and life. Due to human-to-human transmission of COVID-19, nuclear medicine staffs also cannot escape the risk of infection from workplaces. Every staff in the nuclear medicine department must prepare for and respond to COVID-19 pandemic which tailored to the characteristics of our profession. This article provided the guidance prepared by the Korean Society of Nuclear Medicine (KSNM) in cooperation with the Korean Society of Infectious Disease (KSID) and Korean Society for Healthcare-Associated Infection Control and Prevention (KOSHIC) in managing the COVID-19 pandemic for the nuclear medicine department. We hope that this guidance will support every practice in nuclear medicine during this chaotic period.

Outbreak of Ralstonia mannitolilytica bacteraemia in patients undergoing haemodialysis at a tertiary hospital in Pretoria, South Africa

BackgroundRalstonia species are Gram-negative bacilli of low virulence. These organisms are capable of causing healthcare associated infections through contaminated solutions. In this study, we aimed to determine the source of Ralstonia mannitolilytica bacteraemia in affected patients in a haemodialysis unit.MethodsOur laboratory noted an increase in cases of bacteraemia caused by Ralstonia mannitililytica between May and June 2016. All affected patients underwent haemodialysis at the haemodialysis unit of an academic hospital. The reverse osmosis filter of the haemodialysis water system was found to be dysfunctional. We collected water for culture at various points of the dialysis system to determine the source of the organism implicated. ERIC-PCR was used to determine relatedness of patient and environmental isolates.ResultsSixteen patients were found to have Ralstonia mannitolilytica bacteraemia during the outbreak period. We cultured Ralstonia spp. from water collected in the dialysis system. This isolate and patient isolates were found to have the identical molecular banding pattern.ConclusionsAll patients were septic and received directed antibiotic therapy. There was 1 mortality. The source of the R. mannitolilytica infection in these patients was most likely the dialysis water as the identical organism was cultured from the dialysis water and the patients. The hospital management intervened and repaired the dialysis water system following which no further cases of R. mannitolilytca infections were detected. A multidisciplinary approach is required to control healthcare associated infections such as these. Routine maintenance of water systems in the hospital is essential to prevent clinical infections with R.mannitolilytica.