Introduction Of Infection Control Measures Research Articles

Early response to the Great East Japan Earthquake and Massive Tsunami at an evacuation shelter in Otsuchi, Iwate Prefecture

Authors served with the Nagasaki University Medical Relief Team providing medical relief and health services at Terano Kyodojo evacuation shelter at Otsuchi, Iwate Prefecture, an area severely affected by the massive tsunamni following the Great East Japan Earthquake. The relief team provided medical consultations at a temporary clinic in March2011, in collaboration with a local general practitioner. The affected area has been characterized by its high level of population aging, which was also reflected in the age composition of the evacuees at the shelter: 38% of evacuees were aged65or older. Many patients presented to the clinic requesting routine medication refills for their chronic medical conditions(e.g. hypertention, diabetes, heart diseases and asthma). However, information on their medications had been lost in many cases, and the identification of medicines was thus a critical task. An increasing trend of symptoms apparently due to stress(e.g. insomnia)was also observed. We supported the introduction of infection control measures to prevent possible outbreak of infectious acute gastroenteritis. While most evacuees had experienced extremely stressful circumstances and profound loss, a functional community had already been developed in the shelter. The evacuees were divided into groups, and the group leaders held meetings to share information and to set the necessary shelter rules. Evacuees shared chores and conducted regular physical exercise together. New infection control measures were also discussed among the group leaders, and implemented only after reaching agreement. We believe collaboration with communities will be critical in planning and implementing future public health and restoration efforts in the affected areas. 〔JJHEP;19(3):256―263〕

Sequential outbreaks of multidrug-resistant Acinetobacter baumannii in intensive care units of a tertiary referral hospital in Italy: combined molecular approach for epidemiological investigation

A laboratory-based surveillance study was conducted from January 2007 to May 2010 in San Martino Tertiary Referral Hospital in Genoa, Italy in which the molecular epidemiology of multidrug-resistant Acinetobacter baumannii was investigated in the five intensive care units (ICUs). A total of 53 A.baumannii strains were isolated from patients admitted to ICUs (69.8%) and to other epidemiologically linked hospital wards (30.2%) and were genotyped by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), multilocus sequence typing (MLST) and adeB sequence typing. REP-PCR fingerprinting analysis, MLST and adeB typing results were well correlated and allowed us to classify strains causing epidemic events into three major epidemic clones: A (REP-I/ST4, adeB-STII genotype) isolated for the first time in May 2007, B (REP-IV/ST95, adeB-STI genotype) from November 2007 to May 2009 and C (REP-VII/ST118, adeB-STII genotype) from July 2008 to May 2010. MLST results demonstrated that epidemic clones A and C were related as they were members of the widespread clonal complex CC92. The genetic determinants of carbapenem resistance were investigated and resistance associated with the presence of the bla(OxA-58-like) gene with ISAba2 and ISAba3 elements flanking it in clone A, and with the bla(OxA-23-like) gene flanked by ISAba1 in clones B and C. Amolecular approach allowed the prompt introduction of infection control measures and the evaluation of data in a global epidemiological context.

First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany

We report the first outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. The presence of KPC was confirmed by polymerase chain reaction (PCR). The KPC-encoding plasmid was analysed by transconjugation experiments, DNA sequencing, Southern blotting and isoelectric focussing. Typing was performed by pulsed-field gel electrophoresis (PFGE). An ertapenem-resistant K. pneumoniae with low minimum inhibitory concentrations (MIC) to other cabapenems (tested by the Vitek system) was isolated from the index patient in January 2008. A KPC-2 was identified after K. pneumoniae with identical susceptibility patterns had been isolated from two more patients. Despite the introduction of infection control measures, transmission occurred in five additional patients and three of the patients died from infections. The source of the outbreak strain remained unclear; however, the Tn4401-containing bla (KPC-2) gene was similar to previously described isolates from Greece. Five months after the end of the outbreak, a KPC-K. pneumoniae was isolated from a patient who had been treated in Greece previously. Retrospectively, this patient was treated in November 2007 on the same unit as the index case. Typing revealed that all patients were colonised by the same strain. KPC-K. pneumoniae has been introduced to Germany possibly from Greece and transmission to other institutions is likely.

Segregation is good for patients with cystic fibrosis.

It is bewildering, in the face of so much evidence for the potential for cross-infection between patients – cross-infection that may have devastating consequences – that we continue to debate the advantages (numerous and important) and disadvantages (few and largely irrelevant) of keeping patients separated. Amazingly, to my mind, there has been no resolution of the conflicting points of view since Professor Geddes and I first argued this issue in a cystic fibrosis (CF) conference in 2001. Some CF centres have a strict patient segregation policy, some centres have no policy at all, and many centres follow management protocols that fall at varied points between these two extremes. In this paper I will provide evidence which I believe supports a strict segregation policy as practised in the Leeds CF centres. An interesting and quizzical starting point might be to ask this question: Why does the international CF community readily accept separation of patients with Burkholderia cepacia complex (Bcc) infection from all other patients but does not universally accept separation of all patients from each other? It is instructive to consider this. We treat patients with Bcc infection separately because we know that Bcc is a potentially virulent pathogen, that it can cause an accelerated or catastrophic clinical deterioration, that it is difficult to treat and almost impossible to eradicate, that it may preclude acceptance onto a lung transplant programme, but most of all because Bcc infection is transmitted from patient to patient. We have known all these facts for some time. In 1987, Tablan et al. reported that patients with Bcc infection and moderate or advanced CF were hospitalized for longer and died sooner than controls with similar levels of disease severity. These early data suggested a possible nosocomial source of Bcc infection, consistent with a report as far back as 1986 that an introduction of infection control measures resulted in a sharp decline in the incidence of Bcc infection. In 1995, Whiteford et al. reported a Bcc outbreak in children with CF and, importantly, a concurrent ‘dramatic decrease in the number of newly colonized patients’ after the introduction of segregation measures. In 1998, Ledson et al. reported cross infection with different Bcc strains between patients with Bcc infection who were already separated from other patients but not from each other, advising that further subsegregation of patients within the Bcc infected group might be necessary. By 1999, the UK CF Trust confidently stated that

Introduction of Infection Control Measures to Reduce Infection Associated With Implantable Pain Therapy Devices

Implantable pain therapy devices for chronic pain include spinal cord stimulators (SCS) and intrathecal drug delivery systems (IDDS). A number of different complications can occur after implantation of these devices, but among the most serious is infection. Based on Centers for Disease Control and Prevention guidelines for prevention of surgical site infection, published literature on infection risk with implantable pain therapy devices, and recommendations from groups within our own our institution, we introduced infection control measures for all patients receiving either SCS or IDDS. After approval from the Institutional Review Board, we performed a retrospective review of patients undergoing primary implantation of SCS or IDDS before and after introduction at our institution of safety measures designed to reduce device-related infection. We compared infection incidence and compliance to infection precautions before and after introduction of these measures. Thirty-four SCS or IDDS were implanted before implementation of the infection control measures and 58 were placed after. Five device-related infections occurred. Adherence to most infection precautions improved during the study period, but 100% compliance was seen only with venue used for implantation. Infection incidence declined after introduction of the safety measures, but the reduction was not statistically significant. Introduction of infection control measures for implantable pain therapy devices improved adherence to most infection precautions in our practice. Lack of specific documentation could have hindered practice surveillance within our group. A tool to document performance of infection control measures would be useful not only as a marker of compliance but could also serve as a reminder to perform certain safety measures.

Outbreak of adenovirus type 30 in a neonatal intensive care unit

To describe an outbreak of adenovirus, type 30, in a neonatal intensive care unit (NICU). This was a retrospective, observational study. An outbreak of adenovirus infection occurred in an NICU. It lasted 6 months and involved 21 of 333 (6.3%) infants. The introduction of infection control measures controlled the outbreak; however, premature discontinuation of the measures resulted in a second wave of cases. The virus caused pneumonia in 7 infants, conjunctivitis in 7 infants, pneumonia and conjunctivitis in 1 infant, and upper respiratory tract illness in 1 infant. Infection was asymptomatic in 5 infants. Six infants died. Death was associated with the presence of pneumonia ( P = .0001), administration of steroids ( P = .003), and mechanical ventilation ( P = .02). Investigation into the origin of the outbreak suggested that the virus may have been introduced and spread during ophthalmologic procedures. Adenovirus type 30 can cause severe disease among premature infants in an NICU. Infants with severe bronchopulmonary dysplasia requiring mechanical ventilation are more likely to have development of adenovirus pneumonia and die. Standard infection control measures are effective in controlling an outbreak. Ophthalmologic procedures continue to be a potential source of adenovirus outbreaks.

Rapid spread of penicillin-resistant Streptococcus pneumoniae among high-risk hospital inpatients and the role of molecular typing in outbreak confirmation

This study describes an outbreak of penicillin-resistant Streptococcus pneumoniae among patients on an ear, nose and throat (ENT) ward. Over a period of 10 days, S. pneumoniae [penicillin minimum inhibitory concentration (MIC) 0.75] was isolated from a total of seven patients with symptoms and signs of lower respiratory tract infection. Standard source isolation was implemented and the ward was closed to admissions and discharges. Screening of nasopharyngeal secretions was undertaken on all patients and staff contacts. Three patients (of eight possible contacts) and none of the staff (47 screened) were identified as colonized with the same strain. Nasal mupirocin and oral rifampicin were administered to carriers. Confirmation of the outbreak was achieved rapidly using a contemporary molecular typing method (pulsed-field gel electrophoresis) and timely introduction of infection control measures successfully contained the outbreak. Implications for pneumococcal vaccination are discussed.

Significant reduction of methicillin-resistant Staphylococcus aureus bacteremia in geriatric wards after introduction of infection control measures against nosocomial infections.

(1) To investigate the efficacy of infection control measures against methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in geriatric wards. (2) To identify predisposing risk factors for MRSA bacteremia. Cases with nosocomial bacteremias were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods and the period 1, January to December 1991, was applied as the control. We investigated patients with nosocomial bacteremias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. A significant reduction in cases with MRSA-induced nosocomial bacteremia was observed after the introduction of a stringent infection control and prevention program (period 1 vs. periods 2, 3, and 4: p<0.00833, p<0.00167, and p<0.00167, respectively). The major source of bacteremia included urinary tract infections, intravenous catheter-related infections, and infected decubitus ulcers. Improvement of decubitus ulcer was associated with a significant reduction in MRSA bacteremia (period 1 vs. periods 2 and 3: p<0.00017 and p<0.00833). Stringent infection control programs, including prevention and treatment of decubitus ulcers, are necessary in geriatric wards to reduce and prevent MRSA bacteremia.