Support Infection Control Research Articles

Resistance Mechanisms, Epidemiology, and Approaches to Screening for Vancomycin-Resistant Enterococcus in the Health Care Setting

Infections attributable to vancomycin-resistant Enterococcus (VRE) strains have become increasingly prevalent over the past decade. Prompt identification of colonized patients combined with effective multifaceted infection control practices can reduce the transmission of VRE and aid in the prevention of hospital-acquired infections (HAIs). Increasingly, the clinical microbiology laboratory is being asked to support infection control efforts through the early identification of potential patient or environmental reservoirs. This review discusses the factors that contribute to the rise of VRE as an important health care-associated pathogen, the utility of laboratory screening and various infection control strategies, and the available laboratory methods to identify VRE in clinical specimens.

Infection control support training, in a hospital of KSA for containment of Middle East respiratory virus syndrome coronavirus (MERS-CoV)

Infection control support training, in a hospital of KSA for containment of Middle East respiratory virus syndrome coronavirus (MERS-CoV)

Root cause analysis to support infection control in healthcare premises

Infection control teams (ICTs) seek to prevent healthcare-associated infections (HCAIs). They undertake surveillance and prevention, promote safety and quality of care, and evaluate and manage risk. Root cause analysis (RCA) can support this work but is not widely used by ICTs. This paper describes how ICTs can use RCA to enhance their day-to-day work. Many different tools and methods exist for RCA. Its primary aim is to identify the factors that have led to HCAI, but RCA can also be used for near-misses. A team effort and multidisciplinary work are usually required. Published accounts and personal experience in the field indicate that an ICT that correctly uses RCA implements more effective prevention measures, improves practice and collaborative working, enhances teamwork, and reduces the risk of HCAI. RCA should be promoted among ICTs because it adds value to their work and helps to develop a hospital culture that anticipates and pre-empts problems.

Development of a multiplex real-time PCR for the rapid detection of the predominant beta-lactamase genes CTX-M, SHV, TEM and CIT-type AmpCs in Enterobacteriaceae.

Beta-lactamase resistant bacteria and especially ESBL producing Enterobacteriaceae are an increasing problem worldwide. For this reason a major interest in efficient and reliable methods for rapid screening of high sample numbers is recognizable. Therefore, a multiplex real-time PCR was developed to detect the predominant class A beta-lactamase genes bla CTX-M, bla SHV, bla TEM and CIT-type AmpCs in a one-step reaction. A set of 114 Enterobacteriaceae containing previously identified resistance gene subtypes and in addition 20 undefined animal and environmental isolates were used for the validation of this assay. To confirm the accessibility in variable settings, the real-time runs were performed analogous in two different laboratories using different real-time cyclers. The obtained results showed complete accordance between the real-time data and the predetermined genotypes. Even if sequence analyses are further necessary for a comprehensive characterization, this method was proofed to be reliable for rapid screening of high sample numbers and therefore could be an important tool for e. g. epidemiological purposes or support infection control measures.

Bacteremia Caused by <i>Acinetobacter baumannii</i>: Epidemiologic Features, Antimicrobial Susceptibility, and Outcomes

Acinetobacter baumannii bacteremia is becoming more prevalent and is associated with increasing morbidity and mortality. Escalating antibacterial resistance further contributes to therapeutic dilemmas, enhanced infection control support and poorer outcomes in patients infected with these bacteria. A retrospective analysis of patients whose blood cultures produced A. baumannii from January 2007 through January 2013 was performed. Data regarding the epidemiologic features, antimicrobial susceptibility and outcomes of patients with A. baumannii bacteremia were collected and analyzed. Sixty A. baumannii isolates each from a different patient were identified. The Charlson Comorbidity Index (≥3) was the greatest among patients with multi-drug resistance (MDR) compared to intermediate drug resistance (IDR) and pan-sensitive (PS) A. baumannii. The mean APACHE II scores for MDR, IDR and PS A. baumannii bacteremia were 21, 15 and 11, respectively (P < 0.05, MDR v. PS). Seventy-three percent of the isolates were resistant to quinolones, 44% to piperacillin/tazobactam, 45% to amikacin, 22% to imipenem, 0% to ticarcillin/clavulanate, and 0% to polymyxin. Among 28 patients with MDR A. baumannii bacteremia, 20 received inadequate empiric treatment, and 16 of these patients died (80%). Of the remaining eight patients with MDR bacteremia who received adequate empiric antibiotics, only two died (25%). The severity of underlying illness, degree of antibiotic resistance and receiving inadequate initial antibiotic therapy are associated with mortality among patients with bacteremia due to A. baumannii.

群馬県内での院内感染対策支援調査(相互チェック)の取り組み&amp;mdash;受け入れ病院からの報告&amp;mdash;

群馬県では2010年12月に群馬県ICD連絡協議会が設立され，2011年8月に当院を対象に第1回院内感染対策支援調査(相互チェック)が行われた．当院は第三者から評価を受けたことで，病院内の職員に感染対策の重要性を認識してもらう機会を得た．一方調査に来た各医療施設の職員にとっても，他施設の感染対策の実状を確認できる機会を得た．つまり今回の活動は，訪問する側，受ける側双方にとって利益があるものと考える． 群馬県内で院内感染対策支援調査をいち早く受けた施設として，今回の経験を多くの施設と共有し，今後の感染対策に生かしていきたいと考えている．

Infection control in United Kingdom neonatal units: variance in practice and the need for an evidence base

Infection prevention is a cornerstone of good neonatal care. There are, however, few research data to support infection control approaches in this population. Through a structured telephone interview we surveyed all neonatal units in the United Kingdom to identify infection control issues, practices and policies. Eighty seven percent of the 198 neonatal units participated. Twenty one units (12.2%) had closed with infection control issues in the last year; 14.1% had current infection control concerns; 81.5% of units decolonised MRSA positive infants, but over 15 regimens were used. Wide variations in hygiene measures were identified; 22.1% of units used theatre scrubs for all staff, 7.6% used aprons and 5.8% required gloves to be worn when entering clinical areas. Only 54% required hand washing and alcohol gel before entry to a patient care area; 11.6% required only the use of alcohol gel. Although infection control issues are resulting in neonatal unit closures and risks to patients, there are considerable variations in hygiene and screening practices. There is little data to support the safety or efficacy of decolonisation in neonatal populations, but this is widely practised. Research needs to be carried out to evaluate the effectiveness of screening practices and decolonisation in order that a consistent evidence-based approach can be applied.

26 patients with enterocutaneous fistula after abdominal operation

Objective Retrospeetively analyzed the clinical data of 26 patients with enterocutaneous fistula after abdominal operation admitted into our hospital,and summarize the experience of reducing the mortality rate of enterocutaneous fistula.Methods Analyzed the general information,primary disease,fistula' s causes,fistula' s general information,fistula incidence and cure rate of these 26 patients.Results From March 2006 to October 2011,enterocutaneous fistula's incidence rate in our hospital was 0.99％; among these 26 pateints,2 patients died; the cure rate of enterocutaneous fistula was 92.31％; the fatality rate was 7.69％.Conclusions Using therapeutic measures such as fasting and the implementation of good nutritional support treatment,good drainage and infection control,the implementation of somatostatin and growth hormone therapy,timely operation ect.can effectively treat enterocutaneous fistula; the cure rate is high. Key words: Abdominal operation; Intestinal fistula; Treatment

感染対策地域ネットワークに求められる支援内容&lt;br/&gt;&amp;mdash;2012年4月からの感染防止対策加算導入前におけるX県の実態調査より&amp;mdash;

2011年6月の厚生労働省医政局指導課長通知には，「医療機関相互のネットワークを構築し，日常的な相互の協力関係を築くこと」とある．X県における感染対策上の課題を明らかにし，今後どのような協力関係が必要かを明らかにするため，2012年2月に県内の577医療機関に対してアンケート用紙を送付し，288施設から回答を得た．医療機関の規模を問わず平時の対策として，「人材不足」，「職員の教育」，「感染症外来の専用診察室」について不十分である事が分かった．また，アウトブレイク時には，規模を問わず保健所に報告・相談する医療機関が非常に多い事が判明した．一方，規模が小さい医療機関ほど，アウトブレイク時に他施設からの支援が必要な事，また，2012年4月に新設された感染対策に関わる加算は，診療所の86%(167医療機関)が算定を予定しておらず，規模が小さくなるほど算定しにくいことが判明した．逆に，「職員への感染対策の徹底」や「転院時の情報共有」に関しては，規模が大きい医療機関にとって重要な課題であることが判明した．以上より，アウトブレイク時に保健所が相談窓口となり，大病院と連携して中小病院を支援する体制を構築する予定である．また，病院規模の違いによって抱えている課題も異なることから，同じ規模の病院同士の連携も強めたい．最後に，今後は診療所でも算定可能な，新たな加算の設定が望まれる．

Epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Latin America

Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to public health worldwide. Ongoing surveillance is essential to support infection control committees and clinicians in the prevention and treatment of infection. However, in Latin America, resources for monitoring the changing epidemiology of MRSA remain limited. In this article, we review the current situation of MRSA in Latin America in order to highlight the need for a more harmonised effort to improve its management. Literature in the PubMed and SciELO databases as well as the website of the Pan American Health Organization were searched for articles and information about the epidemiology of MRSA in Latin America. MRSA is already the leading cause of nosocomial infection in the Latin American region, and the number of reports of community-acquired MRSA infections is also rising. However, the extent of the problem is not fully understood, especially since data tend to come from large hospitals whereas much of the population is served by small community healthcare centres that do not have extensive facilities for performing microbiological surveillance. In conclusion, wider-reaching and co-ordinated programmes to provide regular MRSA surveillance reports are required across the Latin American region.

Effectiveness of short-term, enhanced, infection control support in improving compliance with infection control guidelines and practice in nursing homes: a cluster randomized trial

In this prospective cluster randomized controlled trial we evaluated the impact of short-term provision of enhanced infection control support on infection control practice in nursing homes in South London. Twelve nursing homes were recruited, six each in intervention (300 residents) and control (265 residents) groups. Baseline observations of hand hygiene facilities, environmental cleanliness and safe disposal of clinical waste showed poor compliance in both groups. Post-intervention observations showed improvement in both groups. There was no statistical difference between the two groups in the compliance for hand hygiene facilities (P=0.69); environmental cleanliness (P=0.43) and safe disposal of clinical waste (P=0.96). In both groups, greatest improvement was in compliance with safe disposal of clinical waste and the least improvement was in hand hygiene facilities. Since infection control practice improved in intervention and control groups, we could not demonstrate that provision of short-term, enhanced, infection control support in nursing homes had a significant impact in infection control practice.

Hospital infectious disease emergency preparedness: A 2007 survey of infection control professionals

Hospital preparedness for infectious disease emergencies is imperative. A 40-item hospital preparedness survey was administered to Association for Professionals in Infection Control and Epidemiology, Inc, members. Kruskal-Wallis tests were used to evaluate the relationship between hospital size and emergency preparedness in relation to various surge capacity measures. Significant findings were followed by Mann-Whitney U post hoc tests. Most hospitals have an infection control professional on their disaster committee, 24/7 infection control support, a health care worker prioritization plan for vaccine or antivirals, and nonhealth care facility surge beds but lack health care worker, laboratory, linen, and negative-pressure room surge capacity. Many hospitals participated in a disaster exercise recently and are stockpiling N95 respirators and medications. Few are stockpiling ventilators, surgical masks, or patient linens; those that are have <or=7 days worth of supplies. Less than one quarter have cross trained their staff, convened their ethics committee to discuss preparedness issues, or developed policies/procedures for altered standards of care during disasters. Approximately half of all hospitals' plans include staff work incentives. The smallest hospitals (<or=99 beds) are less prepared than larger hospitals on a variety of surge capacity indicators. US hospitals lack laboratory, negative-pressure room, health care worker, and medical equipment/supplies surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.

Building a data warehouse for infection control

Recently, the convergence of several themes in health care has stimulated interest in exploiting data collected during clinical encounters to monitor and improve the quality of health care. Infection control departments can be supported by assembling previously collected electronic data into a data warehouse to monitor infections, report communicable diseases, and detect clusters of organisms. I present the rationale for constructing a data warehouse and describe the steps and challenges of developing a data warehouse to support infection control activities.

Norovirus Outbreak Management Applied to Pandemic Influenza Planning

PROJECT: The EOC was activated by the Infection Control Practitioner (ICP) and the Emergency Preparedness Coordinator (EPC) when clusters of ill patients and employees with similar symptoms were reported in multiple patient units and the hospitals nursing home (NH). EOC consisted of the hospital director, ICP, EPC, NH director, managers from Occupational Health (OH), inpatient units, patient and employee food services, housekeepers, police, human resources (HR), and public relations (PR). The EOC met daily to assess new cases and determine additional interventions. An all staff electronic bulletin was posted after each meeting to communicate recommendations. Contact Precautions were used with all suspected patients. A bleach solution was used for cleaning areas with symptomatic patients. The NH closed to new admissions and visitors. Employees called OH if ill or if family members were ill. HR supported 48 hours of paid time off after last symptom for self or family member. PR communicated with local media. An inpatient isolation unit was established to cohort symptomatic patients with designated staff. Outpatients were screened at check in for symptoms to triage ill patients to an isolation room. Group eating was discouraged. The EPC provided Incident Command management expertise during EOC meetings and recorded decisions to analyze post outbreak to determine applicability to influenza planning activities.

NST(栄養サポートチーム)&ICT(感染コントロールチーム)コラボレーションの成果 : 4年間の指標の推移

NST(栄養サポートチーム)&ICT(感染コントロールチーム)コラボレーションの成果 : 4年間の指標の推移

Hospital infectious disease emergency preparedness: A survey of infection control professionals

BackgroundHospital preparedness for infectious disease emergencies is imperative for local, regional, and national response planning.MethodsA secondary data analysis was conducted of a survey administered to Infection Control Professionals (ICPs) in May, 2005.ResultsMost hospitals have ICP representation on their disaster committee, around-the-clock infection control support, a plan to prioritize health care workers to receive vaccine or antivirals, and non-health care facility surge beds. Almost 20% lack a surge capacity plan. Some lack negative pressure rooms for current patient loads or any surge capacity. Less than half have a plan for rapid set-up of negative pressure, and Midwest hospitals are less likely than other areas to have such plans. Smaller hospitals have less negative pressure surge capacity than do larger hospitals. About half have enough health care workers to respond to a surge that involves ≤50 patients; few can handle ≥100 patients. Many do not have sufficient ventilators or can handle ≤10 additional ventilated patients. Most do not have enough National Institute for Occupational Safety and Health–approved respirators, and less than half have sufficient surgical masks to handle a significant surge.ConclusionsUnited States hospitals lack negative pressure, health care worker, and medical equipment/supplies surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.

Updated Review of Blood Culture Contamination

Blood culture contamination represents an ongoing source of frustration for clinicians and microbiologists alike. Ambiguous culture results often lead to diagnostic uncertainty in clinical management and are associated with increased health care costs due to unnecessary treatment and testing. A variety of strategies have been investigated and employed to decrease contamination rates. In addition, numerous approaches to increase our ability to distinguish between clinically significant bacteremia and contamination have been explored. In recent years, there has been an increase in the application of computer-based tools to support infection control activities as well as provide clinical decision support related to the management of infectious diseases. Finally, new approaches for estimating bacteremia risk which have the potential to decrease unnecessary blood culture utilization have been developed and evaluated. In this review, we provide an overview of blood culture contamination and describe the potential utility of a variety of approaches to improve both detection and prevention. While it is clear that progress is being made, fundamental challenges remain.

Nutritional support team and infection control team

Nutritional support team and infection control team

Detection of vancomycin-resistant enterococci colonization in a children’s hospital

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens in many hospitals. The true prevalence of VRE in pediatric hospitals is not known. A surveillance study was performed at a pediatric tertiary care medical center by using vancomycin-containing screening media. Six children (of 112 screened) were found to be colonized with VRE. Colonized patients had a history of receiving broad-spectrum antimicrobial agents. In the absence of VRE infections, surveillance studies can help determine the extent of VRE colonization and support infection control measures.

Infection control—a challenge in a land of contrasts

The general level of health care in any country will dictate to a large extent the amount of attention paid to the control of nosocomial infections. In South Africa the apartheid era, although initially supporting a strong economy, did little to foster a good education system among the mass of the population. With the imposition of sanctions and the decline in the economy, the health services which had been curative in nature and centred around the medical schools of the country and their teaching hospitals, began to suffer the effects of rampant inflation and financial cutbacks. Nevertheless, virtually all the medical schools support infection control programmes of one sort or another. In addition, there are a number of Infection Control Societies in the country. With the present political instability and violence in the country, the health services have not escaped. Staff cutbacks are inevitable and wards may have to close; the academic hospitals are under threat. Privatization is strongly favoured by government. The present population of approximately 30 million could double by the year 2020, putting enormous pressure on limited resources. The squatter problem worsens every month. The spectre of human immunodeficiency virus (HIV) infection increases yearly. Any assessment of priorities must therefore be made against this background. Only proven methods of infection control should be encouraged. In the light of the foregoing, three areas of practical activity are examined: the re-processing of heat-labile equipment, the re-use of disposables and the disposal of clinical waste.(ABSTRACT TRUNCATED AT 250 WORDS)