Hospital Infection Control Team Research Articles

An outbreak of Burkholderia cepacia complex exit site infection among peritoneal dialysis patients caused by contaminated spray dressing

Wound dressing is intended to provide a physical barrier from microorganisms. Spray dressing is convenient and can be applied to wounds of various contours. In July 2020, a cluster of four Burkholderia cepacia complex (BCC) exit site infections was identified among peritoneal dialysis patients in a regional hospital in Hong Kong. In response, our hospital infection control team conducted an epidemiologic investigation. We conducted a retrospective cohort study of peritoneal dialysis patients with culture-confirmed BCC exit site infections from January 2011 to July 2020. Outbreak investigations, including case finding, molecular typing and post-outbreak surveillance, were performed. A substantial increase in BCC exit site infections has been observed since 2013, rising from 0.23 in 2012 to 1.09 episodes per 100 patient-year in 2015, with the number of cases in the first half of 2020 already surpassing the total from 2019. The potential source had been traced to a spray dressing introduced to exit site care in December 2012. Burkholderia cepacia complex was isolated from both the unopened and in-use sprays from the same lot. Multilocus sequence typing analysis confirmed their genetic relatedness. The spray dressing was subsequently removed from exit site care. Post-outbreak surveillance over two years showed a marked and sustained decrease in BCC exit site infection. Water-based spray dressing can be a source of BCC causing wound infections. The use of contaminated spray dressing, especially in chronic wounds with proximity to indwelling catheters, may pose an inherent risk to patients.

Healthcare-associated infections and antimicrobial use in acute care hospitals in Greece, 2022; results of the third point prevalence survey

BackgroundThe burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011–2012, and 10% and 55.6% in 2016–2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic.MethodsA cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed.ResultsFrom 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively.ConclusionsThe 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.

Polyclonal Burkholderia cepacia complex outbreak caused by contaminated chlorhexidine gluconate solution

Background:Burkholderia cepacia complex is an opportunistic environmental pathogen that has been linked to nosocomial outbreaks. We describe an outbreak of bacteremia caused by Burkholderia cenocepacia from a contaminated chlorhexidine gluconate solution. Methods: The hospital infection control team carried out an outbreak investigation on February 21, 2021, when 3 adult hemodialysis patients developed B. cenocepacia bacteremia. Patient demographics and clinical profile were reviewed retrospectively. Potential sources of infection were identified, and environmental screening was performed in several units. Processes of catheter care in the hemodialysis unit were reviewed. Water samples from the hemodialysis unit, and samples of solutions used in patient care were sent for culture. Isolates from patients and from environmental samples were sent for 16S rRNA gene sequencing to determine genetic relatedness. Results: In total, 16 patients, 8 of whom were male, developed B. cenocepacia bacteremia during the investigated period. The median age was 68 years (range, 19–83), and 15 of 16 had at least 1 comorbidity. All patients used a central venous catheter (CVC) for hemodialysis, and 11 (70%) of these 16 were temporary. Chlorhexidine gluconate solution was routinely used as part of CVC care and 1 bottle was shared among 4 hemodialysis stations. On suspicion of contamination, all identified chlorhexidine bottles were recalled on February 26, 2021, and random samples from 15 opened and 19 unopened bottles were sent for culture from the following units: hemodialysis (n = 2), ICU (n = 14), wards (n = 6), and 4 each from transplant surgery, and delivery suites. O0f 34 sampled bottles, 17 grew B. cenocepacia: 8 opened and 9 unopened bottles. The Bayesian inference tree (Fig. 1) supports the hypothesis that patient samples and the samples from the chlorhexidine solutions were most probably related to each other based on the 16S rRNA sequences. However, the individual identities of the specific sample sequences could not be determined using the analyzed region of the gene, possibly due to low quality of the sequences received. No new cases of B. cenocepacia were identified after recall of the chlorhexidine solution, and the outbreak was deemed resolved on March 24, 2021. Conclusions: Medical solutions routinely used in patient care can cause outbreaks and should be suspected as a potential source of infection by infection control teams.Disclosures: None

Extending infection prevention and control nursing (IPCN) provision to weekends at one National Health Service hospital in the United Kingdom: A feasibility and acceptability study.

Hospital Infection Prevention and Control Teams (IPCTs) provide clinical cover during weekdays with on call support at weekends. We report the results of a 6-month pilot of extending infection prevention and control nursing (IPCN) clinical cover to weekends at one National Health Service trust in the United Kingdom. We examined daily episodes of infection prevention and control (IPC) clinical advice given before and during the pilot of extended IPCN to weekends. Stakeholders rated the value, impact, and their awareness of the new extended IPCN cover. Episodes of clinical advice given were more evenly distributed across the weeks during the pilot. Advantages for infection management, patient flow, and clinical workload were seen. IPCN clinical cover at weekends is feasible and valued by stakeholders.

Decreasing the Rate of Surgical Site Infection in Patients Operated by Cesarean Section in a Tertiary Care Hospital in India: A Quality Improvement Initiative.

Background Surgical site infections (SSIs) are a substantial cause of maternal morbidity and are associated with a significant increase in hospital stay and cost. The prevention of SSI is complex and requires the integration of a range of measures before, during, and after surgery. Jawaharlal Nehru Medical College (JNMC), Aligarh Muslim University (AMU) is one of the referral centers of India with a huge influx of patients. Methods The project was undertaken by the Department of Obstetrics and Gynaecology, JNMC, AMU, Aligarh. Our department was sensitized to the need for quality improvement (QI) through Laqshya, a Government of India initiative for labor rooms in 2018. We were facing problems like a high surgical site infection rate, poor documentation and records, no standard protocols, overcrowding, and no admission discharge policy. There was a high rate of surgical site infections, leading to maternal morbidity, increased days of hospitalization, more usage of antibiotics, and increased financial burden. A multidisciplinary quality improvement (QI) team was formed comprising obstetricians and gynecologists, the hospital infection control team, the head of the neonatology unit, staff nurses, and multitasking staff (MTS) workers. Results The baseline data were collected for a period of one month and it was found that the rate of SSIwas around 30%. Our aim was to decrease the rate of SSI from 30% to less than 5% over a period of six months. The QI team worked meticulously, implemented evidence-based measures, regularly analyzed the results, and devised measures to overcome the obstacles. The point-of-care improvement (POCQI) model was adopted for the project. The rate of SSI decreased significantly in our patients and the rates are around 5% persistently. Conclusion The project not only helped in decreasing the infection rates but also led to vast improvements in the department with the formulation of an antibiotic policy, surgical safety checklist, and admission-discharge policy.

‘Consociatio vita minabatur procursus’: Citrobacter freundii outbreak causing periculosus neonatal septicaemia in neonatal intensive care unit of tertiary care hospital

Abstract Background: Citrobacter freundii is a common cause of neonatal intensive care unit (NICU) outbreaks, causing high morbidity and mortality as a hospital-acquired pathogen. This is the first study from our geographic region, which makes it of utmost importance for spreading awareness about this unusual pathogen amongst healthcare settings. Aim: Investigating an outbreak caused by C. freundii in the NICU of a tertiary care hospital. Settings and Design: During the month of May 2023, an outbreak of C. freundii causing neonatal septicaemia was suspected in the NICU of a tertiary care hospital in Western Uttar Pradesh. The outbreak was investigated and surveillance conducted by the hospital infection control (HIC) team, to find a source of the infection by root cause analysis (RCA), to study clinical profiles and outcomes, to determine their antimicrobial susceptibility pattern, to take corrective action preventive action (CAPA). Materials and Methods: A total of 132 blood samples were tested for blood culture and sensitivity using the BD FX40 system. Positive flagged bottles were processed for Gram stain and sub-cultured on 5% sheep blood agar and MacConkey’s agar media plates. Final bacterial identification and antibiotic susceptibility were done with an automated BD-Phoenix M-50 system. Results: C. freundii with similar antimicrobial susceptibility was identified in seven neonates, contributing to a major percentage of neonatal blood culture positivity of 13.7%, out of a total positivity rate of 38.63%. The mortality rate of this outbreak was 28.57%. The HIC team investigates this outbreak for CAPA and RCA. On environmental surveillance, C. freundii was isolated from infant incubators, dressing trolleys, and laryngoscope blades of the NICU. Discussion: C. freundii association in Blood culture from critical areas patients is life-threatening ‘Consociatio Vita Minabatur Procursus’. Direct access to the bloodstream causing neonatal septicaemia in a short time is a concern for its potential severity, making it as ‘Periculosus Pathogen’. Laboratory automation and implementation of strict infection control strategies in critical areas can improve clinical outcomes and prevent future outbreaks.

Potential of use of modern information technology solutions in the work of hospital infection control team, including antibiotic therapy optimisation, reduction of alert pathogen infections and vaccination popularisation

Potential of use of modern information technology solutions in the work of hospital infection control team, including antibiotic therapy optimisation, reduction of alert pathogen infections and vaccination popularisation

Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams

Features| August 2022 Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams Dustin R. Long, MD; Dustin R. Long, MD Search for other works by this author on: This Site PubMed Google Scholar Vanessa Makarewicz, RN, MN, CIC; Vanessa Makarewicz, RN, MN, CIC Search for other works by this author on: This Site PubMed Google Scholar Chloe Bryson-Cahn, MD; Chloe Bryson-Cahn, MD Search for other works by this author on: This Site PubMed Google Scholar Arman Dagal, MD, FRCA, MHA Arman Dagal, MD, FRCA, MHA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 19–20. https://doi.org/10.1097/01.ASM.0000855656.97932.62 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Dustin R. Long, Vanessa Makarewicz, Chloe Bryson-Cahn, Arman Dagal; Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams. ASA Monitor 2022; 86:19–20 doi: https://doi.org/10.1097/01.ASM.0000855656.97932.62 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: nosocomial infection, partnerships, prevention Infection prevention and control (IPC) are critical elements of perioperative quality and safety. Healthcare-associated infection is the leading cause of postoperative complications and hospital readmissions (asamonitor.pub/3tk4yG9). Perioperative teams and pre-anesthesia clinics are uniquely positioned to implement interventions that reduce postoperative infection (Anesthesiology June 2022). However, anesthesiologists have not historically partnered with IPC (or “hospital epidemiology”) teams, and conflicting perspectives have occasionally produced discord between these groups (asamonitor.pub/3p3IgVo). Despite the role of anesthesiologists as perioperative physicians, representation from our specialty is lacking in national guidelines for surgical antimicrobial prophylaxis and the prevention of surgical site infection (Am J Health Syst Pharm 2013;70:195-283; JAMA Surg 2017;152:784-91). This is now changing, as reflected in the work of Randy Loftus, David Birnbach, and Andrew Bowdle (AMA Netw Open 2020;3:e201934; Anesth Analg 2020;131:37-42; Br J Anaesth 2019;123:531-4; Anesth Analg 2015;120:853-60; Anesth... You do not currently have access to this content.

A retrospective observational insight into COVID-19 exposures resulting from personal protective equipment (PPE) breaches.

BackgroundHealthcare workers (HCWs) stand the risk of acquiring infection directly, while attending to patients or indirectly while handling and testing patient specimens. Considering this, the present study was planned to assess Personal Protective Equipment (PPE) breaches and exposures among HCWs working in COVID-19 wards/ screening areas and to evaluate their COVID-19 positivity rates post-exposure concerning the level of exposure, type of PPE breach, and the cadre of HCWs exposed in COVID-19 wards.MethodsThis retrospective cross-sectional study involved the analysis of all instances of PPE breaches which occurred during a period of nine months from June 2020 to February 2021 at a tertiary care level hospital in Central India. The analysis included all exposures involving any cadre of HCWs that occurred while handling the patients or while doffing the contaminated PPE in COVID -19 wards.ResultsA total of 347 PPE breaches were analyzed from the available records of the Hospital Infection Control team repository. Amongst the 347 breaches, 268 (77.2%) were classified as low-risk exposures and 79 (22.8%) as high-risk exposures. Cadre wise distribution of high and low-risk exposures revealed that, PPE breaches occurred most commonly in the category of nursing officers (n = 174, 50.1%). Among all of the breaches, 15.2% of high-risk exposures and 2.6% of low-risk exposures resulted in COVID-19 positivity with a cumulative positivity of 5.4%. Collectively, non-mask related breaches accounted for the majority (63.2%) of the positive COVID-19 cases.ConclusionAppropriate use of PPE by HCWs is vital for their protection. However, breaches in the use of PPE may occur while managing COVID-19 patients due to physical and mental exhaustion among HCWs resulting from work overload. Early identification and appropriate management of HCWs with high-risk exposures can help prevent transmission to other hospital staff and patients, thus preserving resources and workforce.

Effectiveness of using online surveillance in reporting healthcare-associated infections

The aim of this study was to investigate the feasibility of using online surveillance form in reporting healthcare associated infections. This research is a quantitative research with a pre-experimental one group pre-test – post-test design method. The intervention given is giving the form manually and giving the form online. Respondents in this study were Infection Prevention and Control Link Nurses in the inpatient, intensive, and operating rooms at the Bali Mandara General Hospital with a total of 37 nurses. Data collection was carried out from January 2020 to December 2021 using the healthcare associated infections reporting form developed by the hospital infection control team. Data were analysed using paired T-test with 95% confidence level. Phlebitis reported significantly increase after the application of online surveillance form. The nurses’ compliance on filling the form both device-related and surgical site infection surveillance as the enactment of online form is 100%, with on time reporting increasing from 73,2% to 98,8%. Nurses assume that the accessible and simplicity of the online forms encourage them to fill the forms completely. Delays in reporting surveillance still occur and need encouragement from supervisor to improve compliance.

Development of an Automated Hospital Infection Control Surveillance Toolkit

Background:Infection control systems allow the healthcare facility to detect, manage, prevent and control the infection or risk of infection. It helps to improve healthcare quality by allowing hospital infection control (HIC) team to focus on prevention and intervention efforts during the outbreaks.Objectives:To design, develop and implement an automated HIC surveillance Toolkit for Infection Prevention and Control Department based on user requirements.Methods:This study was carried out in a multi-speciality hospital in Southern India. The study was carried out in four phases; the first phase included the observation of current documentation practice of Infection Prevention and Control Department. During the second phase, a formal discussion was conducted with the infection control team to collect the data to add to the HIC surveillance toolkit. The third phase included the design and development of the toolkit using ASP.NET and Standard Query Language (SQL) database server. During the fourth phase, a prospective cross-sectional survey was conducted to assess the end-user satisfaction towards the Toolkit using a structured and validated checklist based on 5-point Likert scale from extremely satisfied to not satisfied (score 5–1).Results:Based on the observation of existing documentation and reporting practice, a discussion was carried out with the infection control team to identify the templates to be added to the toolkit. Once identified, a web-based toolkit was designed and developed using ASP.NET and stored using SQL database server. The developed toolkit was implemented in the hospital and provided to the HIC team to use. The finding of the assessment of 15 features of HIC surveillance toolkit indicated that the end-users were very satisfied with the support of toolkit in documenting and reporting of infection-related data.Conclusion:HIC surveillance toolkit, allows the HIC team to capture, store, manage data, compare, and calculate the infection control rate and compliance rate. It also increases the ease of surveillance and reporting. It aids in reducing hospital-acquired infection (HAI) rates, simplifies the workflow of HIC and improves healthcare quality.

Evolving epidemiology of carbapenemase-producing Enterobacterales: one hospital's infection prevention and control response over nine years

Preventing carbapenemase-producing Enterobacterales (CPE) transmission is a significant challenge for hospital infection prevention and control teams (IPCTs). Control measures include screening at-risk patients, contact tracing, and the isolation of carriers with contact precautions. The evolution of infection prevention and control measures was assessed in a tertiary acute care hospital with predominately multi-bedded patient accommodation, from 2011 to 2019 as cases of CPE increased. The implications for, and the response and actions of, the IPCT were also reviewed. CPE data collected prospectively from our laboratory, IPCT, and outbreak meeting records were reviewed to assess how the IPCT adapted to the changing epidemiology, from sporadic cases, to outbreaks and to localized endemic CPE. Of 178 cases, 152 (85%) were healthcare-associated and there was a marked increase in cases from 2017. The number of screening samples tested annually increased from 1190 in 2011 to 16,837 in 2019, and six outbreaks were documented, with larger outbreaks identified in later years. OXA-48 carbapenemase was detected in 88% of isolates and attendance at outbreak meetings alone accounted for 463.5 h of IPCT members, and related staff time. Despite considerable efforts and time invested by the IPCT, the number of CPE cases is increasing year-on-year, with more outbreaks being reported in later years, albeit partly in response to increased screening requirements. Infrastructural deficits, the changing epidemiology of CPE, and national policy are major factors in the increasing number of cases.

An outbreak of Ralstonia pickettii bloodstream infection among pediatric leukemia patients.

Ralstonia pickettii is an opportunistic waterborne microbe which can survive in many kinds of solutions. Contamination of these solutions may result as outbreaks, which can be mortal for immuncompromised patients. Herein we report an outbreak of R. pickettii related to contaminated saline infusion in our center. This study was conducted in Ankara Pediatric City Hospital. An outbreak occured in Pediatric Hematology and Oncology Unit between August 28, 2019 and September 13, 2019. When the outbreak occured, infection control team began an investigation. Environmental samples were collected in order to find the source of the outbreak. A total of 11 patients with catheter related blood stream infection caused by R. pickettii who were diagnosed with leukemia were affected. None of the patients infected with R. pickettii died during the outbreak. A total of seventy environmental samples were cultured with the purpose of finding the source of outbreak. R. pickettii grew in normal saline solution culture and all isolates had the same clone of R. pickettii. The outbreak lasted two weeks and was controlled by stopping the usage and sending back the saline solutions belonging to the same manufacturing batch. We reported an outbreak of R. pickettii BSIs in highly immunocompromised patients due to contaminated intravascular solution, which was rapidly controlled by infection control measures. Vigilant surveillance by hospital infection control teams and prompt investigation to identify the source of nosocomial infections are crucial to stop an outbreak.

Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None

Enterococcus spp. resistentes à vancomicina e a sua disseminação em infecções no ambiente hospitalar

Objetivo: Descrever os principais fatores de virulência associado a esse patógeno, com ênfase nas espécies E. faecium e. faecalis, demostrando os principais genes de resistência envolvidos nas espécies citadas, bem como, relatar a forma de disseminação destas em ambientes hospitalares. Metodologia: O presente artigo, foi elaborado mediante Revisão da Literatura, baseando-se em materiais indexados nas bases de dados: PubMed, SciELO e Google Acadêmico, publicados entre os anos 2010 a 2020. Para seleção, os critérios foram aplicados na seguinte ordem: (a) leitura exploratória; (b) leitura seletiva, (c) seleção do material em adequação aos objetivos da pesquisa. Resultados: Foram encontrados 789 arquivos, destes, 38 foram selecionados para este artigo. Conclusão: A adoção de práticas pela equipe de Controle de Infecção Hospitalar, se faz muito importante, contribuindo para melhorias na qualidade do atendimento em saúde, aumentando assim, a segurança de toda a equipe de profissionais e pacientes.

Investigation of Burkholderia cepacia complex bacteremia outbreak in a neonatal intensive care unit: a\xa0case series\xa0

IntroductionBurkholderia cepacia complex is a ubiquitous organism with a high virulence potential. It is found most commonly in moist environments. Hospital outbreaks have been reported from diverse sources such as contaminated faucets, nebulizers, disinfectant solutions, multidose antibiotic vials, tap water, bottled water, nasal sprays, and ultrasound gels. In this article, we present our experience in investigating and successfully managing an outbreak of nosocomial transmission of Burkholderia cepacia sepsis in the neonatal intensive care unit at SGT Hospital, Haryana, India.Case presentationDuring the month of March, multiple Burkholderia cepacia complex isolates were recovered from blood cultures of Caucasian babies admitted to the neonatal intensive care unit of our hospital. The organisms were multidrug-resistant, with in vitro sensitivity to meropenem alone (minimum inhibitory concentration = 4 μg/ml). An outbreak was suspected, and the neonatal intensive care unit in-charge and hospital infection control teams were alerted. Outbreak investigation was initiated, and surveillance samples were collected. Burkholderia cepacia complex was successfully isolated from suction apparatus. The isolates were phenotypically typed (biotyping and antimicrobial susceptibility testing) and found to be identical.ConclusionsIn our study, the index case might have been exposed to infection due to a physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures played a significant role in curtailing this outbreak.

Bacteriological study of indwelling central venous catheter among patients in ICU

Aim: The aim is to study the bacteriological profile of indwelling central venous catheter (CVC) among patients in intensive care unit (ICU). Settings and Design: The study was conducted on admitted patients with indwelling CVC in medical ICU, surgical ICU, and critical care unit of Krishna hospital, Karad. The study design was a prospective observational study. Materials and Methods: Two hundreded patients admitted with an indwelling, CVC. These patients were followed daily for the development of catheter related blood stream infections (CRBSIs) 48 h after insertion of CVC, in which case two sets of blood samples were drawn along with catheter tip and skin swab for culture. Statistical Methods: Incidence of CRBSIs was measured per 1000 catheter days. Results: Among 200 suspected cases with indwelling CVC, 1028 catheter days were observed, and CRBSI rate was 61.28/1000 catheter days. The incidence of CRBSIs were detected in 63 (31.5%) patients. Conclusions: This prospective study has highlighted the incidence, aerobic bacteriological profile of CVC infections, and also the changing trends in the susceptibility pattern of the isolates to routinely used antibiotics in our tertiary care centre. Combined efforts of the microbiologist, clinicians, and hospital infection control team are needed to tackle CRBSI. A proper training program of hospital staffs, maintenance of proper hand hygiene, following up of proper guidelines of catheter insertion, and maintaining aseptic precaution, prior to CVC insertion can reduce CRBSI.

Risk factors for healthcare associated infections and in-hospital mortality in neurological intensive care unit in tertiary hospital in Belgrade, Serbia: A prospective cohort study

Background/Aim. Patients in a neurologic intensive care unit (ICU) are especially susceptible to healthcare-associated infections (HAIs). HAIs are cause of significant morbidity and mortality. Aim of this study was to assess the incidence of HAIs, to identify significant risk factors (RFs) and causative microorganisms for HAIs and to identify RFs for inhospital mortality in a neurological ICU. Methods. A prospective cohort study was conducted in the six-bed ICU of the Clinic for Neurology, Military Medical Academy in Belgrade from January 1, 2014 to December 31, 2016. Active surveillance on HAIs was performed by the hospital infection control team, using methodologies of the European Centre for Disease Prevention and Control and the National Healthcare Safety Network/Centres for Disease Prevention and Control. Results. One hundred forty eight patients with a total of 2,708 patient-days were enrolled. There were 49 HAIs in 39 patients during the study period. The incidence and incidence density of HAIs were 26.3% and 18.1 per 1000 patient-days, respectively. The most frequent HAIs were urinary tract infections (15.5%), pneumonia (10.1%) and bloodstream infections (4%). RFs independently associated with HAIs in the neurological ICU were: urinary catheter [risk ratio (RR): 5.6; 95% confidence interval (CI): 1.153?27.632], urinary catheter-days (RR: 1.1; 95% CI: 1.057?1.188), central-line days (RR: 1.1; 95% CI: 1.010? 1.150), and mechanical ventilation (RR: 0.3; 95% CI: 0.079? 0.859). The most common microorganism was Klebsiella spp. RFs independently associated with in-hospital mortality in the neurological ICU were: mechanical ventilation (RR: 6.5; 95% CI: 2.868?14.116), Glasgow Coma Score (RR: 2.7; 95% CI: 1.135?6,396), and age (RR: 1.03; 95% CI: 1.005? 1.055). Conclusion. Usage of invasive procedures during ICU hospitalization carries significant risk for development of HAIs. HAIs in ICU setting are most often caused by Gram-negative bacteria with substantial antimicrobial resistance. These results stress the importance of infection prevention.

Hospital Cleaning and Infection Control -The Collaboration between Hospital Cleaning Outsourced Staff and Infection Control Teams-

Hospital Cleaning and Infection Control -The Collaboration between Hospital Cleaning Outsourced Staff and Infection Control Teams-

2104. Impact of a Supervision and Education Directed Bundle in Ventilator-Associated Pneumonia (VAP) on a Pediatric Critical Care Unit of a Teaching Hospital

BackgroundProven measures to prevent VAP include 35–45¡ inclination of the head, prompt extubation, hand hygiene prior to intubation, oral hygiene with clorhexidine, minimize secretion pooling above the endothraqueal tube cuff. Adherence to these methods remains an angular point in preventing VAP’s. Increasing rates of VAP in the pediatric critical care unit (PICU) of a reference teaching hospital in Guatemala, led the Hospital Infection Prevention and Control (HIPC) team to implement a bundle to control VAP’s.MethodsA daily active surveillance to identify cases of VAP according to the Center for Disease Control (CDC) definition was done for 10 months before the HIPC intervention. The HAI implemented a bundle defined as: (1) head elevation (35¡ degree inclination), (2) hand hygiene, (3) oral hygiene with clorhexidine, (4) minimize secretion pooling, (5) daily evaluation of extubation, (6) daily surveillance, (7) continuous education of personnel, (8) adequate supplies distribution analysis. After the intervention rates and trends of VAP where analyzed for 30 months.ResultsIn the pre-intervention observational period the rates of VAP increased from 18 (September 2014) to 28 cases per 1,000 ventilator-days (June 2015). The first month after the bundle implementation (July 2015) a 50% VAP rate decreased was evidenced. A constant decrease in VAP rates was reported in the 24 months after the implementation of the bundle, reaching the lowest rate in August 2017 (five cases per 1,000 ventilator-days). For administrative reasons adherence to oral hygiene with clorhexidine was sub-optimal due to a lack of supplies from August 2017 to December 2017 which coincided with an increase in VAP rates from five to 14 per cases 1,000 ventilator-days.ConclusionA notable and constant reduction of VAP rates in the PICU was achieved after the implementation of the bundle. Even though many of the measures included in the bundle were already protocoled in the PICU, a probable lack of adherence could explain the high rates observed pre-intervention. By adding the continuous education and supervision of the personnel by a member of the HIPC team, to previously proven methods, the VAP rates decreased in almost 80%. This makes a strong case for the idea that protocols without continuous enforcement might not be enough to control infections.Disclosures All authors: No reported disclosures.