Outbreaks Of Healthcare-associated Infections Research Articles

Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

Rapid Killing and Biofilm Inhibition of Multidrug-Resistant Acinetobacter baumannii Strains and Other Microbes by Iodoindoles.

Multi-drug resistant Acinetobacter baumannii is well-known for its rapid acclimatization in hospital environments. The ability of the bacterium to endure desiccation and starvation on dry surfaces for up to a month results in outbreaks of health care-associated infections. Previously, indole and its derivatives were shown to inhibit other persistent bacteria. We found that among 16 halogenated indoles, 5-iodoindole swiftly inhibited A. baumannii growth, constrained biofilm formation and motility, and killed the bacterium as effectively as commercial antibiotics such as ciprofloxacin, colistin, and gentamicin. 5-Iodoindole treatment was found to induce reactive oxygen species, resulting in loss of plasma membrane integrity and cell shrinkage. In addition, 5-iodoindole rapidly killed three Escherichia coli strains, Staphylococcus aureus, and the fungus Candida albicans, but did not inhibit the growth of Pseudomonas aeruginosa. This study indicates the mechanism responsible for the activities of 5-iodoindole warrants additional study to further characterize its bactericidal effects on antibiotic-resistant A. baumannii and other microbes.

Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections.

BackgroundThe largest health care–associated infection outbreak in the United States occurred during 2012–2013. Following injection of contaminated methylprednisolone, 753 patients developed infection with a dematiaceous mold, Exserohilum rostratum. The long-term outcomes of these infections have not been described.MethodsThis retrospective cohort study of 440 of a total of 753 patients with proven or probable Exserohilum infection evaluated clinical and radiographic findings, antifungal therapy and associated adverse effects, and outcomes at 6 weeks, 3, 6, 9, and 12 months after diagnosis. Patients were grouped into 4 disease categories: meningitis with/without stroke, spinal or paraspinal infections, meningitis/stroke plus spinal/paraspinal infections, and osteoarticular infections.ResultsAmong the 440 patients, 223 (51%) had spinal/paraspinal infection, 82 (19%) meningitis/stroke, 123 (28%) both, and 12 (3%) osteoarticular infection. Of 82 patients with meningitis/stroke, 18 (22%) died; among those surviving, 87% were cured at 12 months. Only 7 (3%) of 223 patients with spinal/paraspinal infection died, but at 12 months, 68% had persistent or worsening pain and only 47% were cured. For the 123 patients with both meningitis/stroke and spinal/paraspinal infection, 10 (8%) died, pain persisted in 72%, and 52% were cured at 12 months. Only 37% of those with osteoarticular infection were cured at 12 months. Adverse events from antifungal therapy were noted at 6 weeks in 71% of patients on voriconazole and 81% on amphotericin B.ConclusionsFungal infections related to contaminated methylprednisolone injections culminated in death in 8% of patients. Persistent pain and disability were seen at 12 months in most patients with spinal/paraspinal infections.

Economic impact of antimicrobial-resistant bacteria outbreaks on Japanese hospitals

Economic evaluation from the perspective of hospitals is important for the optimization of resources for infection control measures. We considered outbreaks that occurred from 2006 to 2016 in Japan. Cost identification analyses were conducted using data from 23 outbreaks by antimicrobial-resistant bacteria. Linear and multivariable regression analyses were conducted to explore the association between potential factors and main outcomes. The potential factors included duration of the outbreaks, duration of bed blocking, timely public announcement, delay of external consultation, and number of patients at the time of external consultation. The largest productivity loss was 4.62 million USD. The maximum total cost for containment was 678,000 USD. After considering the overall interactions, timely public announcement was significantly associated with productivity loss (adjusted estimate of coefficient: 1.24 USD, 95% confidence interval [CI] 179,000 to 2.31 million USD, P= .02), and the number of patients at external consultation was significantly associated with containment costs (3 430 USD, 630 to 6 240 USD, P= .02). The costs of healthcare-associated infection outbreaks of antimicrobial-resistant bacteria can be significant. The productivity loss was much greater than the containment costs. Therefore, hospitals should meet the costs for prevention of these outbreaks.

Faucet aerators as a reservoir for Carbapenem-resistant Acinetobacter baumannii: a healthcare-associated infection outbreak in a neurosurgical intensive care unit

BackgroundOn January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source.MethodsA matched case-control (1:2) study was performed to identify the possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients’ rooms and living area of the staff. CRAB isolates were tested for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE).ResultsEnvironmental sampling showed that a faucet aerator was contaminated with A. baumannii. Molecular typing revealed the only outbreak strain, which was isolated from tracheal aspirate cultures of the first case of community-acquired infection and 3 cases of HAI. In environmental samples, the outbreak strain was found only in the faucet aerator of the dining room. This CRAB outbreak was discovered in time, and further progress of this outbreak was prevented through a pre-set emergency response procedure.ConclusionsThe faucet aerator acted as a reservoir for bacteria in the outbreak, and contamination of the faucet aerator might have occurred from splashes originating from handwashing by the healthcare workers (HCWs). In high-risk areas, such as NSICU, the faucet aerators should not be used during an outbreak or they should be regularly cleaned and disinfected. The start-up criteria for the emergency response played a key role in controlling the CRAB outbreak, and its settings should be discussed more widely.

Qualitative Assessment of a State Partner-Facilitated Health Care-Associated Infection Prevention National Collaborative.

The Centers for Disease Control and Prevention (CDC) funded a 3-year national collaborative focused on facilitating relationships between health care-associated infection (HAI) prevention stakeholders within states and improving HAI prevention activities within hospitals. This program-STRIVE (States Targeting Reduction in Infections via Engagement)-targeted hospitals with elevated rates of common HAIs. To use qualitative methods to better understand STRIVE's effect on state partner relationships and HAI prevention efforts by hospitals. Qualitative case study, by U.S. state. 7 of 22 eligible STRIVE state partnerships. Representatives from state hospital associations, state health departments, and other participating organizations (for example, Quality Innovation Networks-Quality Improvement Organizations), referred to as "state partners." Phone interviews (n = 17) with each organization were conducted, recorded, and transcribed. State partners reported that relationships with each other and with participating hospitals improved through STRIVE participation. The partners saw improvements in hospital-level HAI prevention activities, such as improved auditing and feedback practices and inclusion of environmental services in prevention efforts; however, some noted those improvements may not be reflected in HAI rates. Many partners outlined plans to sustain their partner relationships by working on future state-level initiatives, such as opioid abuse prevention and antimicrobial stewardship. Only 7 participating states were included; direct feedback from participating hospitals was not available. Although there were no substantial changes in aggregate HAI rates, STRIVE achieved its goal of improving state partner relationships and coordination. This improved collaboration may lead to a more streamlined response to future HAI outbreaks and public health emergencies. Centers for Disease Control and Prevention.

Screening asymptomatic households for Streptococcus pyogenes pharyngeal carriage as a part of in-hospital investigation of puerperal sepsis

Invasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care-associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS. We conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations. Identical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases. The concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry.

Infection Control Assessment and Response (ICAR) in Michigan: Past, Present and Future

BACKGROUND The Michigan Department of Health and Human Services (MDHHS) Surveillance for Healthcare Associated and Resistant Pathogens (SHARP) unit secured grant funds in 2015 to improve statewide preparedness and infection control practices and programs across the continuum of care. The program goal was to increase patient safety and expand infection control consultation. The SHARP unit focused on acute care and long-term acute care hospitals, long-term care facilities and outpatient clinics, including dental clinics. METHODS SHARP unit staff used Centers for Disease Control and Prevention?(CDC) provided ICAR tools to conduct infection control needs assessments at the different facility types. This collaborative, non-regulatory, technical assistance focused on quality, process improvement. All sites volunteered. Staff provided recommendations at the time of the visit and provided a report back to the individual facility with key findings. Each report identified strengths and areas for opportunity to improve. RESULTS Results were compiled into aggregate state findings, both as a whole and broken down by facility type. Eighty infection prevention needs assessments were conducted from January 2016-December 2018. 70% were done in person. Strengths included having an identified infection preventionist and a foundation for staff training and education. The main areas of opportunity identified were infection prevention training, providing competency-based training programs both upon hire and annually and creating sustainable audit/feedback programs across the identified disciplines. CONCLUSIONS Now that the 3-year ebola supplemental funding period is done, the ICAR program will continue but will move in a new direction. Moving forward, the ICAR will be offered to facilities that have a healthcare-associated infection outbreak or identification of novel resistance. The ICAR is a tool in the infection preventionist toolbox. No infection prevention program is perfect and there is always room for improvement.

Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014-2017.

Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs). Retrospective observational study. We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible. Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices. Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.

1253. Healthcare-Associated Transmission of Burkholderia cepacia Complex Associated With Extrinsically Contaminated Nasal Spray

Background Burkholderia cepacia complex (Bcc) species can contaminate medical devices and water-based products, resulting in outbreaks of healthcare-associated infections. In March 2018, we investigated a cluster of 20 patients with a sinus culture positive for Bcc seen at two affiliated ENT clinics in Oregon over a 2-month period, based on reporting by a laboratorian in a central laboratory external to the clinics.MethodsWe conducted an epidemiologic investigation to identify potential causes for an apparent outbreak of Bcc, including review of health records and microbiologic reports, site visits, staff interviews, and cultures of common equipment and products.Results20 patients (9 were female; age range 10 to 72 years, median age 54.5 years) had new positive Bcc cultures from the sinus. The absence of cystic fibrosis, immunosuppression or sinonasal polyposis in all patients, scant growth of Bcc in most cases with isolation of another organism in some, and the use of Bcc-directed antibiotics in a minority of patients suggested the presence of a contamination source. All patients had received lidocaine/phenylephrine (L/P) via multidose nasal spray atomizers prior to endoscopically-directed sinus cultures. Site visits revealed improper medication dispensing and storage practices (e.g., no expiration date for L/P stock, storage of L/P-containing atomizers at room temperature), and inadequate instrument reprocessing and environmental cleaning. Cultures of L/P in 2/2 in-use atomizers and 1/1 opened stock bottle, as well as swabs of 3/3 spray mechanisms, grew Bcc. Cultures of L/P from the unopened, refrigerated stock bottle, a flexible endoscope and a rigid endoscope did not yield Bcc. No negative clinical sequelae in these patients were reported.ConclusionContaminated multidose L/P nasal spray with Bcc resulted in nosocomial transmission at these clinics. This investigation highlights the important role of laboratorians in detecting Bcc contamination events that lead to colonization, and suboptimal reporting by clinicians in the outpatient setting. It also raises the question of how often such contamination events go undetected. Injection safety training needs to be broadened to “medication administration safety” training as one and only principles could have prevented this incident.Disclosures All authors: No reported disclosures.

1257. Assessing Risk Factors for an Outbreak of Burkholderia cenocepacia in Non-cystic Fibrosis (CF) Patients

Background Burkholderia spp. have been associated with outbreaks of healthcare-associated infections in non-CF patients, mostly attributable to point sources of contaminated solutions or medications. Fewer non-point source outbreaks have been described.MethodsWe conducted a matched case:control (1:3) study to assess risk factors for B. cenocepacia during an outbreak that occurred in 2017 in a 738-bed university-affiliated hospital involving patients hospitalized on several ICUs and non-ICUs. Clinical isolates identified as B. cepacia complex were speciated using sequencing of the recA allele and genotyped by pulsed field gel electrophoresis (PFGE). Case subjects were patients with a positive culture for the B. cenocepacia outbreak strain (PFGE pattern 17-A, recA 365) from June 1–December 31, 2017. Control subjects had negative respiratory cultures for Burkholderia spp. within 10 days of respective cases’ culture dates and were hospitalized on the same unit at the same time as respective cases. Potential risk factors including procedures, devices, and medications (previously linked to point source outbreaks) were examined. A 5-day exposure window was studied for procedures and devices as this was the shortest interval noted between a case subject’s negative and first positive culture. Exact conditional logistic regression was used to analyze risk factors; Mann–Whitney U and Fisher’s exact tests were used to compare demographic and clinic characteristics of case and control subjects.ResultsSeventeen cases (all with positive respiratory tract cultures) and 41 unit-matched controls were studied. Case and control subjects had similar demographic characteristics, illness severity, and comorbidities. No point source was identified. Only exposure to invasive mechanical ventilation was associated with case status (OR: 10.5, [CI95 1.9, ∞), P = 0.0083). Cases had longer hospital lengths of stay (52 vs. 33 days, P = 0.02) than controls, but similar in-hospital mortality (24% vs.12%, P = 0.43).ConclusionThese findings suggest that suboptimal infection prevention and control practices related to respiratory interventions, including cleaning and disinfection of ventilators, may have contributed to the outbreak. Reinforcement of best practices helped reduce transmission of the outbreak clone.Disclosures All authors: No reported disclosures.

2140. Healthcare-Associated Infection Outbreak Investigation of an Elevation of Surgical Site Infections at a Critical Access Hospital

BackgroundReported incidence of surgical site infections (SSIs) in the United States commonly ranges from approximately 0.5–20%. An infection preventionist at a critical access hospital (CAH) notified the Nebraska Department of Health Human Services (NDHHS) Healthcare-Associated Infection (HAI) program of a surgeon with a 6-month SSI rate of 29% (N = 7) and requested assistance.MethodsNDHHS HAI program and local health department personnel conducted an investigation. Overall SSI rates were calculated, and seven reported SSI charts were abstracted using the Centers for Disease Control and Prevention’s HAI Outbreak Investigation Form. An additional nine-patient charts with similar characteristics were abstracted and used as the control group. These cases had the same procedures performed at the same facility, by the same surgeon, and during the same period of time but did not develop infections.ResultsIn 2016, of the 452 procedures at this CAH, 17 developed SSIs (rate = 3.8%). SSIs occurred following the most invasive procedures being performed on the sickest patients at this CAH. Of the 17 SSIs, 15 (88.2%) were orthopedic and performed by three surgeons. Surgeon A performed 24 procedures with seven SSIs (rate = 29.2%). Surgeon B performed 171 procedures with five SSIs (rate = 2.9%) and Surgeon C performed 13 procedures with three SSIs (rate = 23.1%). The seven SSIs associated with Surgeon A used different operating room (OR) personnel, rooms, antibiotics, and durations. There were 0 deaths. The seven SSIs and nine controls were evaluated using a stepwise regression model. Using the variables for bone graft, hardware, OR location, and number of people in the OR, the only significant variable was the number of people in the OR. There was an average of 10 people in the OR among cases and seven among controls. Logistic regression yielded an odds ratio of 1.8 (95% CI: 0.99–3.26).ConclusionSSIs occurred primarily after orthopedic procedures, and two of three surgeons were found to have elevated rates. Analysis showed the number of people in the OR was potentially associated with SSIs. After following NDHHS recommendations to limit door openings and OR traffic, there were no additional cases. Additionally, we outlined our methodology in a publically-available response guideline posted to the NDHHS web page.Disclosures All authors: No reported disclosures.

Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) Applications in Bacteriology: brazilian contributions

Among its innumerous applications in Bacteriology, the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) technique is evolving as a powerful tool for bacterial identification and antimicrobial resistance investigation. Publications have evaluated the MALDI-TOF MS performance in the identification of a series of bacterial pathogens, including the most common severe infectious agents, emergent pathogens involved with outbreaks of healthcare-associated infections, rare pathogens, and those whose isolation in culture media is difficult. As compared to conventional methods of bacterial identification, MALDI-TOF MS has proven to be a fast, accurate and cost-effective technique. Currently, MALDI-TOF MS has been used in antimicrobial resistance studies, since it has shown to be an efficient tool in detecting specific resistance mechanisms in bacteria, such as beta-lactamases production, for example. Here, we describe the advances in this growing field of mass spectrometry applied to Bacteriology, including Brazilian contributions.

Tracking Nosocomial Diseases at Individual Level with a Real-Time Indoor Positioning System.

Our research is motivated by the rapidly-evolving outbreaks of rare and fatal infectious diseases, for example, the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome. In many of these outbreaks, main transmission routes were healthcare facility-associated and through person-to-person contact. While a majority of existing work on modelling of the spread of infectious diseases focuses on transmission processes at a community level, we propose a new methodology to model the outbreaks of healthcare-associated infections (HAIs), which must be considered at an individual level. Our work also contributes to a novel aspect of integrating real-time positioning technologies into the tracking and modelling framework for effective HAI outbreak control and prompt responses. Our proposed solution methodology is developed based on three key components – time-varying contact network construction, individual-level transmission tracking and HAI parameter estimation – and aims to identify the hidden health state of each patient and worker within the healthcare facility. We conduct experiments with a four-month human tracking data set collected in a hospital, which bore a big nosocomial outbreak of the 2003 SARS in Hong Kong. The evaluation results demonstrate that our framework outperforms existing epidemic models for characterizing macro-level phenomena such as the number of infected people and epidemic threshold.

Lessons Learned from a Healthcare Associated Infection Tabletop Exercise, June 2017

ObjectiveTo assess healthcare facilities’ level of readiness to respond to an HAI outbreak, the Florida Department of Health in Pinellas County (DOH-Pinellas) conducted an HAI outbreak tabletop exercise (TTX) on June 6, 2017. Other benefits of this TTX were to provide opportunities for collaborative learning, building community partnerships and evaluation of HAI preparedness activities in Pinellas County healthcare facilities.IntroductionOne in twenty-five patients in acute care hospitals develop at least one health care associated infection (HAI); this resulted in approximately 75,000 preventable deaths in 2011. Risk factors associated with developing HAIs include older patients, serviced at a large hospital, central catheter placement, receiving medical ventilation, and placement in a critical care unit. In Pinellas County, individuals 65 years of age and older comprise approximately 24% of the total population.MethodsA line list of contact information for all long-term care facilities in Pinellas County was obtained from the DOH–Pinellas Environmental Health Program. An invitation to the TTX was sent to 234 health care and assisted living facilities. Of those invited, 35 individuals attended the TTX on June 6, 2017. The methods used to facilitate discussion included the four scenarios that addressed different stages of an outbreak investigation and a “force decision-making” framework. Following the course, a twelve-question evaluation was distributed. The first seven questions were based on a five-point Likert scale assessing the course’s impact on knowledge and tabletop learning environment. The other five were open-ended and asked participants to elaborate on what they learned and provide feedback regarding the strengths and areas for improvement of the TTX.ResultsExercise participants included infection control practitioners, safety officers, nursing supervisors, facility managers and epidemiologists from hospitals, assisted living and skilled nursing facilities, hospice, rehabilitation centers and health departments. Of the 35 participants, 30 completed the course evaluation for a completion rate of 86%. For questions addressing HAI knowledge, participants strongly agreed that the tabletop exercise enhanced their understanding of infection control guidelines for HAIs. The question that received the lowest score of 4.3 was the perception that “I was able to develop tools for my agency’s infection control guidelines.” In the open-ended questions, themes regarding HAI knowledge, resources, response and policies were frequently mentioned, in addition to confusion over the health department’s role and available resources during an HAI outbreak.ConclusionsParticipation and feedback during the TTX substantiated the importance of increased collaboration across organizations and opportunities for training on HAI outbreak response. Participants identified a need for an open forum to discuss best practices for HAI control and surveillance methods to help guide preparedness and response efforts. To address this need, DOH-Pinellas will create a HAI coalition which would aim to improve understanding of each facility’s role in responding to an HAI outbreak.

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan.

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints.

A multistate investigation of health care–associated Burkholderia cepacia complex infections related to liquid docusate sodium contamination, January-October 2016

Outbreaks of health care-associated infections (HAIs) caused by Burkholderia cepacia complex (Bcc) have been associated with medical devices and water-based products. Water is the most common raw ingredient in nonsterile liquid drugs, and the significance of organisms recovered from microbiologic testing during manufacturing is assessed using a risk-based approach. This incident demonstrates that lapses in manufacturing practices and quality control of nonsterile liquid drugs can have serious unintended consequences. An epidemiologic and laboratory investigation of clusters of Bcc HAIs that occurred among critically ill, hospitalized, adult and pediatric patients was performed between January 1, 2016, and October 31, 2016. One hundred and eight case patients with Bcc infections at a variety of body sites were identified in 12 states. Two distinct strains of Bcc were obtained from patient clinical cultures. These strains were found to be indistinguishable or closely related to 2 strains of Bcc obtained from cultures of water used in the production of liquid docusate, and product that had been released to the market by manufacturer X. This investigation highlights the ability of bacteria present in nonsterile, liquid drugs to cause infections or colonization among susceptible patients. Prompt reporting and thorough investigation of potentially related infections may assist public health officials in identifying and removing contaminated products from the market when lapses in manufacturing occur.

State and Local Public Health Department Healthcare Outbreak Response Capacity Self-Assessment—United States 2016

Timely and appropriate investigation of potential outbreaks involving medical care is needed to prevent the spread of healthcare-associated infections (HAIs) and antimicrobial-resistant (AR) pathogens. While the ability to detect and respond to outbreaks represents a core public health function, health department (HD) capacities vary and have not been well described. CDC funded 55 HD HAI Programs to complete an interim Outbreak and Response Capacities Self-Assessment Tool as part of the Epidemiology and Laboratory Capacity Infection Control Assessment and Response Ebola Supplement. HAI outbreaks were defined as clusters of infections involving healthcare settings or medical care. Response activities were defined as efforts on the part of public health authorities to assist with investigation of specific HAI risks, including outbreaks, sentinel cases and serious infection control breaches. HDs recorded 6,381 HAI outbreaks and related response activities during 2015 (median = 58 per jurisdiction; Figure 1). HD participation was reported for 71% of these events; HD laboratory support for 44%; and HD on-site visits for 16%. Eighty-four percent of HDs specified clusters or suspected outbreaks and 84% specified a single case of a novel-resistant pathogen were reportable by jurisdictions’ statutes or regulations. Resource limitations to conduct HAI response activities included staff and expertise in infection control (44%), laboratory (40%), and data management/analytics (38%). Areas in need of additional investigation tools and training for HD staff included equipment reprocessing errors (58%), AR pathogens (49%), dialysis centers (47%), and outpatient settings (37%). HDs reported plans to engage HAI advisory committees (76%), state hospital association (51%), APIC chapters (56%), and partners in long-term care (60%), acute care (59%), ambulatory surgery (24%), and dialysis (7%) to improve response capacity. HDs indicated a high background level of HAI response activity. Additional expertise and resources could increase HD capacity to support investigations of HAI/AR outbreaks. Planned partner outreach could further enhance outbreak detection, reporting, and investigation. All authors: No reported disclosures.

CANDIDA AURIS: EMERGENCE AND EPIDEMIOLOGY OF A HIGHLY PATHOGENIC YEAST

Candida auris is a multidrug-resistant emerging yeast, which was responsible for healthcare-associated infection outbreaks, and was cataloged as a new species in 2009, after being isolated from a patient’s ear canal secretion in Japan. Since the notification of this first occurrence, numerous cases have been reported throughout the world, including Brazil. C. auris affects mainly inpatients, patients in intensive care units, exposed to broad-spectrum antifungal medications and who make use of vascular catheters. Currently, this yeast is one of the main responsible for invasive infections in hospitals and has been cause of concern by authorities and organs due to its rapid dissemination and difficult treatment caused by its low susceptibility to antifungal agents traditionally used in clinical practice. As a contributor to the severity of infections associated with C. auris , the transmission mechanism is still unknown, which implies in a lack of control of the microorganism and high mortality rates. Thus, this literature review presents relevant information in order to alert the importance of C. auris as an etiological agent of systemic infections, as well as its epidemiology and the real challenges of the treatment. Keywords : Candida auris ; candidiasis; candidemia; multidrug-resistance; biofilm; epidemiology; diagnosis

Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks.

BackgroundDespite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity.MethodsWe searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance.ResultsThirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries.ConclusionsSystematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.